Measuring the alveolar bone level in adolescents: A comparison between ultrasound and cone beam computed tomography.

BACKGROUND: Cone beam computed tomography (CBCT) is an imaging modality, which is used routinely in orthodontic diagnosis and treatment planning but delivers much higher radiation than conventional dental radiographs. Ultrasound is a noninvasive imaging method that creates an image without ionizing radiation. AIM: To investigate the reliability of ultrasound and the agreement between ultrasound and CBCT in measuring the alveolar bone level (ABL) on the buccal/labial side of the incisors in adolescent orthodontic patients. DESIGN: One hundred and eighteen incisors from 30 orthodontic adolescent patients were scanned by CBCT with 0.3-mm voxel size and ultrasound at 20 MHz frequency. The ABL, distance from the cementoenamel junction (CEJ) to the alveolar bone crest (ABC), was measured twice to evaluate the agreement between ultrasound and CBCT. In addition, the intra- and inter-rater reliabilities in measuring the ABL by four raters were compared. RESULTS: The mean difference (MD) in the ABL between ultrasound and CBCT was -0.07 mm with 95% limit of agreement (LoA) from -0.47 to 0.32 mm for all teeth. For each jaw, the MDs between the ultrasound and CBCT were -0.18 mm (for mandible with 95% LoA from -0.53 to 0.18 mm) and 0.03 mm (for maxilla with 95% LoA from -0.28 to 0.35 mm). In comparison, ultrasound had higher intra-rater (ICC = 0.83-0.90) and inter-rater reliabilities (ICC = 0.97) in ABL measurement than CBCT (ICC = 0.56-0.78 for intra-rater and ICC = 0.69 for inter-rater reliabilities). CONCLUSION: CBCT parameters used in orthodontic diagnosis and treatment planning in adolescents may not be a reliable tool to assess the ABL for the mandibular incisors. On the contrary, ultrasound imaging, an ionizing radiation-free, inexpensive, and portable diagnostic tool, has potential to be a reliable diagnostic tool in assessing the ABL in adolescent patients.

Morphological analysis of anterior permanent dentition in a Chinese population using cone-beam computed tomography.

PURPOSE: Morphological analysis of permanent anterior dentition is essential for achieving an ideal treatment outcome and avoiding unnecessary failure. This study aimed to analyze the morphologies of anterior teeth in the Chinese population in depth. METHODS: In this retrospective study, 4309 anterior teeth from 401 Chinese patients were investigated using cone-beam computed tomography (CBCT) from 2019-2021. We summarized the morphological characteristics of the anterior teeth in terms of the root length, cementoenamel junction curvature (CEJ-C), root furcation and canal variations. RESULTS: We found that the root lengths of the maxillary anterior incisors were similar (13.3 mm), while the root lengths of the mandibular central (12.2 mm) and lateral incisors (13.4 mm) varied significantly (p < .0001). Both the maxillary (16.6 mm) and mandibular canines (15.5 mm) were found to have greater root lengths than the corresponding incisors (p < .0001). The CEJ-C was significantly greater around incisors (2.5 mm) than around the canines (2.0 mm) in the maxilla (p < .0001), while the curvature remained similar in mandibular anterior teeth (1.8 mm). Root furcation was observed in mandibular canines and lateral incisors. Moreover, all types of Vertucci's classification in anterior dentitions were observed, while two other new types were found. Among them, the maxilla was only observed to exhibit types I, II, III, and ST II, while the mandible was found to exhibit almost all types. However, Type I still accounts for the majority of dentitions. CONCLUSIONS: Morphological analysis of permanent anterior dentition revealed diversity in the tooth length, CEJ-C, furcation proportion, and canal variations. In general, mandibular anterior teeth showed a more complex structure than maxillary teeth.

Assessment of the prevalence and configuration of middle distal canals in the mandibular molars in a Saudi subpopulation using Cone-Beam computed tomography.

PURPOSE: The prevalence of the middle distal (MD) canal in the mandibular molar is significantly low among countries including the USA, Spain, Turkey, and Jordan; however, analysis of its prevalence and configuration has not been performed in Saudi Arabia. Therefore, we aimed to assess the prevalence and configuration of the MD canal in Saudi Arabia. METHODS: A retrospective analysis of 132 cone-beam computed tomography (CBCT) images was performed to evaluate the presence of the MD canal in patients visiting the Radiology Department of The College of Dentistry in King Saud University between July 2018 and July 2019. The canal was examined if it was confluent with the distobuccal (DB) or distolingual (DL) canals, fin, or independent. Moreover, the distances from the MD canal to the DL and DB canals and cementoenamel junction (CEJ) were recorded. RESULTS: One MD canal (0.7%) was observed in 145 teeth. It was confluent with the DL canal. No statistical significance was observed among sex and age. The distances from the MD canal to the DL canal, DB canal, and CEJ were 1.4 mm, 1.9 mm, and 3.1 mm, respectively. CONCLUSIONS: The prevalence of the MD canal was significantly low in a Saudi subpopulation (0.7%). Careful evaluation of CBCT images and the pulpal floor is significantly important to detect the MD canal to ensure a good prognosis.

Design and fabrication of anatomic healing abutment for mandibular first molar implant / 口腔疾病防治

Objective@# To explore the design and manufacture of anatomical healing abutment for mandibular first molar implant in order to provide more choices for clinical healing abutment@*Methods@# The buccal lingual diameter and mesial distal diameter of the tooth neck, as well as the slope data of the four axial surfaces of the natural isolated teeth, were obtained by scanning the isolated mandibular first molar with a shining scanner. After statistical analysis of the data, the anatomical healing abutment of the mandibular first molar was designed and constructed using computer aided design/computer aided manufacturing (CAD/CAM).@*Results@#The mean buccal and lingual diameters of the mesial and distal diameters of the isolated mandibular first molars were (8.54 ± 0.78) mm and (7.87 ± 0.86) mm, and the tooth neck slopes of each axial surface of the isolated mandibular first molars were 17.53 °(buccal), 14.41 °(lingal), 13.40 °(mesial) and 13.43 °(distal), respectively. Three anatomical healing abutments with different peripheral diameters and heights of 5 mm were obtained according to a certain proportion of reduction of the natural teeth of the mandibular first molars@*Conclusion@#The anatomical healing abutment of the mandibular first molar can be quickly obtained by Shining scanning and CAD/CAM technology.

Decision-making process for esthetic treatment of gummy smile: A surgical perspective.

Gummy smile is a quite frequently found esthetic alteration characterized by excessive display of gingiva during smiling. Several causes have been implicated in the literature, but a dearth of clinical decision-making process has been found in the surgical treatment of excessive gingival display. An external bevel gingivectomy with osseous correction was performed in anterior maxillary region in accordance with the proposed decision-making process. The clinical observation at 1 month postoperatively revealed restoration of natural smile with 1-2 mm of facial gingival display. The outcome seems to suggest that this proposed decision-making process can provide valid treatment options for gummy smile cases.

The precision of gingival recession measurements is increased by an automated curvature analysis method.

BACKGROUND: The extent of gingival recession represents one of the most important measures determining outcome of periodontal plastic surgery. The accurate measurements are, thus, critical for optimal treatment planning and outcome evaluation. Present study aimed to introduce automated curvature-based digital gingival recession measurements, evaluate the agreement and reliability of manual measurements, and identify sources of manual variability. METHODS: Measurement of gingival recessions was performed manually by three examiners and automatically using curvature analysis on representative cross-sections (n = 60). Cemento-enamel junction (CEJ) and gingival margin (GM) measurement points selection was the only variable. Agreement and reliability of measurements were analysed using intra- and inter-examiner correlations and Bland-Altman plots. Measurement point selection variability was evaluated with manual point distance deviation from an automatic point. The effect of curvature on manual point selection was evaluated with scatter plots. RESULTS: Bland-Altman plots revealed a high variability of examiner's recession measurements indicated by high 95% limits of agreement range of approximately 1 mm and several outliers beyond the limits of agreement. CEJ point selection was the main source of examiner's variability due to smaller curvature values than GM, i.e., median values of - 0.98 mm- 1 and - 4.39 mm- 1, respectively, indicating straighter profile for CEJ point. Scatter plots revealed inverse relationship between curvature and examiner deviation for CEJ point, indicating a threshold curvature value around 1 mm- 1. CONCLUSIONS: Automated curvature-based approach increases the precision of recession measurements by reproducible measurement point selection. Proposed approach allows evaluation of teeth with indistinguishable CEJ that could be not be included in the previous studies.

Localization of cementoenamel junction in intraoral ultrasonographs with machine learning.

OBJECTIVE: Our goal was to automatically identify the cementoenamel junction (CEJ) location in ultrasound images using deep convolution neural networks (CNNs). METHODS: Three CNNs were evaluated using 1400 images and data augmentation. The training and validation were performed by an experienced nonclinical rater with 1000 and 200 images, respectively. Four clinical raters with different levels of experience with ultrasound tested the networks using the other 200 images. In addition to the comparison of the best approach with each rater, we also employed the simultaneous truth and performance level estimation (STAPLE) algorithm to estimate a ground truth based on all labelings by four clinical raters. The final CEJ location estimate was obtained by taking the first moment of the posterior probability computed using the STAPLE algorithm. The study also computed the machine learning-measured CEJ-alveolar bone crest distance. RESULTS: Quantitative evaluations of the 200 images showed that the comparison of the best approach with the STAPLE-estimate yielded a mean difference (MD) of 0.26 mm, which is close to the comparison with the most experienced nonclinical rater (MD=0.25 mm) but far better than the comparison with clinical raters (MD=0.27-0.33 mm). The machine learning-measured CEJ-alveolar bone crest distances correlated strongly (R = 0.933, p < 0.001) with the manual clinical labeling and the measurements were in good agreement with the 95% Bland-Altman's lines of agreement between -0.68 and 0.57 mm. CONCLUSIONS: The study demonstrated the feasible use of machine learning methodology to localize CEJ in ultrasound images with clinically acceptable accuracy and reliability. Likelihood-weighted ground truth by combining multiple labels by the clinical experts compared favorably with the predictions by the best deep CNN approach. CLINICAL SIGNIFICANCE: Identification of CEJ and its distance from the alveolar bone crest play an important role in the evaluation of periodontal status. Machine learning algorithms can learn from complex features in ultrasound images and have potential to provide a reliable and accurate identification in subsecond. This will greatly assist dental practitioners to provide better point-of-care to patients and enhance the throughput of dental care.

Morphological analysis of cementoenamel junction in premolars of Sri Lankans.

Cementoenamel junction is an anatomical landmark which indicates the meeting point of enamel of the crown and the cementum of the root. It is an important reference point in clinical dentistry as well as in dental radiography. The present study is done to describe the distribution of the mineralized tissue at the cementoenamel junction in relation to various surfaces of the premolars. The study sample consisted of 89 permanent maxillary and mandibular premolars from both males and females extracted for orthodontic reasons. They were stained with carbol fuchsin and observed under a dissecting microscope to identify the following tissue interrelationships at the cementoenamel junction: cementum overlapping the enamel; edge-to-edge relationship between enamel and cementum; gap between the enamel and cementum and enamel overlapping the cementum. The cementum overlapping the enamel interrelationship was predominant in the buccal and lingual surfaces of both first and second maxillary premolars, while the edge-to-edge relationship and the presence of a gap between the enamel and the cementum relationship were abundant in distal and mesial sides. Enamel overlapping the cementum was recorded only in a very small proportion of the sample. A good understanding about the morphological variations at the cementoenamel junction area is very important and this area should be handled carefully during routine dental procedures such as dental bleaching, orthodontic treatment, placement of rubber dam and placement of dental materials.

Morphology of the Cementoenamel Junction in Permanent Teeth of Dogs: A Scanning Electron Microscopic Study.

In human teeth, the cementoenamel junction (CEJ) can have different morphologies, known as Choquet cases or types: in type 1, the cementum overlaps the enamel; in type 2, the enamel overlaps the cementum; in type 3, the relationship between the cementum and enamel is edge-to-edge; and in type 4, there is a gap between the enamel and the cementum, with exposed dentin. Since little is known on the morphology of the CEJ in animals, the aim of this study was to characterize the structure of the CEJ of dog teeth by SEM. We studied 82 permanent teeth extracted from 4 dogs of similar size, aged from 7 months to 2 years. Teeth were grouped according to their size, sectioned and prepared for SEM. The teeth evaluated showed the 4 CEJ types. Type 3 was the most prevalent, being present, either alone or in combination, in 90.79% of the samples, followed by type 4 (present in 31.58% of the samples). Of the samples, 65.13% showed only one type, while 34.87% presented a combination of them. Types 3 and 4 were the only ones present alone (in 55.92% and 9.21% of the samples respectively), whereas the combinations between types 3 and 4 (20.40%) and types 1 and 3 (9.87%) were the most frequent. In all combinations, type 3 was predominant. The CEJ of the dogs evaluated showed a high degree of variability in the different types of teeth, within a same tooth, within the dentition of a single individual, and among individuals.

Morphological Analysis Of Cementoenamel Junction Types In Premolars And Molars Of A Sample Of Pakistani Population.

BACKGROUND: Cementoenamel junction represents the demarcation between enamel covered crown and cementum covered root surface. There is paucity of population specific data of the morphological variability of cementoenamel junctions of permanent and primary teeth. The objective of this study was to investigate the morphological diversity and interrelationship of cementoenamel junction of premolar and molar teeth in permanent dentition of a sample of Pakistani population with potential forensic and anthropological implications. METHODS: This cross-sectional study was conducted at Oral Biology department of Dr Ishrat ul Ebad khan institute of oral health science, Dow University from March till September 2016. Seventy-five maxillary and mandibular permanent premolar and molars from adult patients of both sexes were selected and sectioned. Longitudinal ground sections were prepared to study the morphological interrelationship between Cementum and Enamel in each specimen to be viewed under light microscope. A chi-square test was applied between the categorical variables. RESULTS: Results showed 57.3% of sections had cementum overlapping enamel interrelation, 32% showed edge to edge cementum and enamel relation and 9.3% showed that cementum and enamel failed to meet resulting in exposed dentine, while 1.3% sample showed enamel over cementum relation. No significant correlation was found between gender, type of tooth, maxillary, mandibular arches and the morphological variation of CEJ (p>0.05). CONCLUSIONS: It can be concluded that there are considerable morphological variations in CEJ of premolars and molars with preponderance of cementum overlapping enamel in these teeth. Based on these findings, dentists are advised to be mindful of dental procedures involving the CEJ and that these interventions should be performed meticulously avoiding any detachment of cementum and subsequent exposure of dentin resulting in dentin hypersensitivity.

Stent as an accessory tool in periodontal measurements: An insight.

A better reflection of periodontal destruction can be obtained by the measurement of the clinical attachment level (CAL), i.e., the distance from the probe tip to the level of the cementoenamel junction (CEJ). However, there were several problems in CEJ identification. Due to the time consumption and inherent problems in CEJ identification, CAL measurements without using a stent in surveys or other clinical trials are highly questionable. The use of stent is recommended during clinical trials which will minimize the errors in terms of over and underestimation of CALs. Hence, the stent used for vertical probing (vertical/occlusal stent), horizontal probing (furcation stent), and interdental papilla (IDP) stent for IDP-deficiency measurement is discussed to comprehend its clinical applications.

Analysis of optical mineralogy of cement - enamel junction in deciduous dentition.

BACKGROUND: Optical analysis of mineralized tissues with polarized microscopy is based on the mechanism of light interaction with biological tissues and spatial distribution of light. Understanding the light propagation mechanisms in mineralized tissues has huge clinical relevance in terms of esthetics and restoration. The present study aims to analyze the mineralogy characteristics of the cementoenamel junction (CEJ), which is a vital region involving merger of tissues with varied embryological origins. AIM: To analyze the mineralogy characteristics and CEJ patterns in deciduous teeth. OBJECTIVES: The variations of CEJ pattern in deciduous teeth and mineralogy characteristics such as retardation and birefringence are compared to the adjacent regions of underlying dentin corresponding to the permanent dentition. RESULTS: Mineralogy characteristics showed variation near the CEJ when compared to the adjacent regions of underlying dentin (statistically significant [P < 0.05]). When compared to permanent dentition, they showed a numerical difference, but the values were statistically insignificant. CEJ pattern analysis predominantly showed edge-to-edge interrelation, followed by root cementum overlapping the enamel and gap type. CONCLUSION: Analyzing CEJ in primary dentition is of paramount importance as it is a vulnerable zone in terms of caries progression and restorative margins. Increased edge-to-edge type of CEJ suggests a natural shield-like protection offered by enamel. Variations in mineralogy characteristics in the CEJ of deciduous dentition suggest the increased mineral content than in the adjacent regions of underling dentin. However, further investigations using advanced techniques for mineralogy analyses such as atomic force microscopy can help yield more intricacies of hard tissues of tooth.

The Effectiveness of Micro-osteoperforations during Canine Retraction: A Three-dimensional Randomized Clinical Trial.

AIM: A major challenge in orthodontics is decreasing treatment time without compromising treatment outcome. The purpose of this split-mouth trial was to evaluate micro-osteoperforations (MOPs) in accelerating orthodontic tooth movement. MATERIALS AND METHODS: Eight patients of both genders were selected, age ranging between 15 and 40 years, with Class II Division 1 malocclusion. The participants in this trial with MOPs were randomly allocated to either the right or the left side, distal to the maxillary canine. First maxillary premolars were extracted as part of the treatment plan on both sides and then canine retraction was applied. Miniscrews were used to support anchorage. MOP side received (three small perforations) placed on the buccal bone, distal to the maxillary canine, on randomly selected side using an automated mini-implant driver and the other side was the control side. Blinding was used at the data collection and analysis stages. The primary outcome was the rate of canine retraction measured with a three-dimensional (3D) digital model from the baseline to the first 2 weeks superimposed at the rugae area from the baseline to the first, second, and third months. The following secondary outcomes were examined: anchorage loss, canine tipping, canine rotation, root resorption, plaque index, and gingival index. Pain level, pain interference with the patients' daily life, patients' satisfaction with the procedure and degree of ease, willingness to repeat the procedure, and recommendation to others were also evaluated. RESULTS: No statistically significant difference was observed in the rates of tooth movement between the MOP and the control sides at all-time points (first month: P = 0.77; mean difference, 0.2 mm; 95% CI, -0.13, 0.18 mm; second month: P = 0.50; mean difference, -0.08 mm; 95% CI, -0.33, 0.16 mm; third month: P = 0.76; mean difference, -0.05 mm; 95% CI, -0.40, 0.29 mm). There were also no differences in anchorage loss, rotation, tipping, root resorption, plaque index, periodontal index, and pain perception between the MOP and control sides at any time point (P > 0.05). MOPs had no effect on the patients' daily life except for a feeling of swelling on the first day (P = 0.05). Level of satisfaction and degree of easiness of the procedure were high. CONCLUSION: According to our clinical trial, MOPs cannot help in speeding up a canine retraction.

Frictional coefficient during flossing of teeth.

OBJECTIVE: This in-vitro study aimed to develop a technique to measure the frictional forces and determine the frictional coefficient (µ) associated with the rubbing of dental floss against teeth. Incorrect flossing technique and the etiology of grooves at the cementoenamel junction (CEJ) of proximal area of teeth has long been a controversial topic. We hypothesized that the µ between teeth surfaces and dental floss is affected by contact angulation. MATERIALS AND METHODS: Tests were conducted using two different types of dental floss (waxed and unwaxed nylon) on different surfaces (enamel, dentine, smooth and rough glass rods) under different moisture conditions (dry and wet). The µ generated by performing C-shape flossing was measured, using the Capstan equation, at constant load (100g) over different flossing contact sliding angulations. In addition, the surface characteristics of intact and used nylon flosses were compared using a scanning electron microscope (SEM). RESULTS: The mean µ was highest with a smooth glass rod (0.42±0.11), followed by rough glass rods (0.30±0.07), dry enamel (0.27±0.08), wet enamel (0.23±0.06), then dentine (0.18±0.04). Moreover, higher µ was associated with waxed floss when used against dry enamel, smooth and rough glass rods (P<0.001). At different moisture conditions, waxed floss demonstrated greater µ with dry surfaces (P<0.03). No association was found between µ and dental floss contact angulation. Both floss types showed deterioration after usage; although waxed type exhibited markedly greater deterioration when used on dry surfaces. In conclusion, the magnitude of the µ was found to be influenced by surface roughness, moisture condition, and independent of the contact angulation area during sliding of dental floss. SIGNIFICANCE: It is important to consider the potential side effects of frictional forces on both tooth surface and dental floss during clinical application.

Classification systems for gingival recession and suggestion of a new classification system.

BACKGROUND: Gingival recession is one of the most usual esthetic concerns associated with the periodontal tissues. Classification of such condition is important to diagnose, determine the prognosis, and frame the treatment plan. Various classifications have been put forward since decades to classify gingival recession. Miller's classification is the widely used classification among all classifications, but certain drawbacks have been noted in this classification. Therefore, an effort is made to review most commonly used classification systems for gingival recession, and their drawbacks further come up with a proposal of new classification system for gingival recession.

Comparison of Accuracy of determining the Distance between Alveolar Crest and Cementoenamel Junction in Digital Radiography with Scanora and DentalEye Software Programs.

AIM: To compare the accuracy of determining the distance between alveolar crest and cementoenamel junction (CEJ) in digital radiography with two image processing software programs. MATERIALS AND METHODS: In this in vitro study, 63 sites in a dried human mandible underwent digital periapical radiography. The distance from the alveolar crest to the CEJ was calculated using DentalEye and Scanora software programs and compared with the standard mode (measured on the skull). Statistical analysis was performed with analysis of variance (ANOVA) and paired t-test using Statistical Package for the Social Sciences (SPSS) 23 at α = 0.05. RESULTS: There were significant differences in the distances between CEJ and the alveolar crest at the mesial surfaces as measured by the three techniques in standard mode, using DentalEye and Scanora (p-value ≤ 0.03) softwares; however, there were no significant differences between the results on distal surfaces (p-value = 0.248). CONCLUSION: Under the limitations of the present study, the measurements made to determine the distance from the CEJ to the alveolar crest with DentalEye and Scanora, relative to each other, and relative to the standard mode, were accurate only on distal surfaces of teeth. CLINICAL SIGNIFICANCE: Digital dental software programs are useful assets that can enhance the diagnosing ability and reduce the need of taking extra images.

Cementum as an age determinant: A forensic view.

CONTEXT: Forensic age estimation (FAE) defines an expertise in forensic medicine, which aims to define in the most accurate way to determine the unknown chronological age of the person involved in judicial or legal proceedings. Dental cementum is a vital tissue which demonstrates continuous apposition throughout the life of the tooth. This appositional changes of cementum helps in approximation of age inforensic investigations. AIMS: To correlate age by measuring the overlap or coronal migration of thecementum at thecementoenamel junction (CEJ) and the thickness of the cementum at the apical third of the root. SETTINGS AND DESIGN: A hundred freshly extracted teethfrom patients ranging from ages 17-55were longitudinal buccolingually ground sectioned using a mounted lathe wheel and Arkansas stone. MATERIALS AND METHODS: 100 freshly extracted teeth of age group ranging from 17-55 years were taken. These teeth were longitudinally ground sectioned to a thickness of 8-10µm using a mounted lathe wheel and Arkansas stone. Afterwards the teeth were examined under a light microscope using a micrometer eyepiece for measuring the overlap or coronal migration of the cementum at the CEJ and the thickness of the cementum at the apical one-third of root. STATISTICAL ANALYSIS: Measurements of the overlap or the coronal migration of the cementum at the CEJ and the thickness of the cementum at the apical one-third of the root are correlated with age. RESULTS: Results of the study indicated that the cementum at the CEJ migrated coronally during theaging process in case of the impacted teeth. There is also a significant increase in the thickness of the cementum at the apical onethird of rootin the case of both the impacted and erupted teeth. CONCLUSION: Approximation of age by measuring overlap or coronal migration of the cementum at the CEJ and the thickness of the cementum at the apical one-third of the rootsets new alleys in FAE.

Evaluation of two socket healing procedures with and without mesenchymal stem cells: A comparative study.

AIMS AND OBJECTIVES: Successful preservation of the edentulous ridge after extraction may eliminate or reduce the need for ridge augmentation procedures. It is proved that grafting of fresh extraction sockets with bone grafts promotes ridge preservation. An objective method of maintaining height and width of alveolar ridge using mesenchymal stem cells (MSCs) seeded on collagen membrane was implemented in this study. METHODOLOGY: Ten bilaterally symmetrical extraction sockets scheduled for extraction were selected for this study. Involved teeth were extracted atraumatically and the sockets were curetted. MSCs seeded on collagen membrane were placed in the extracted socket on one side. On the other side, only collagen membrane was placed inside the socket. Both the sockets were closed primarily with nonresorbable sutures. Buccolingual and mesiodistal widths of the ridges at three different levels (2 mm below cementoenamel junction [CEJ], 5 mm below CEJ, and 8 mm below CEJ) were assessed immediately after extraction and postoperatively at 3 and 6 months. RESULTS: There was statistically significant observation in maintaining the alveolar ridge width in the grafted site when compared to the nongrafted site. CONCLUSION: Socket healing procedure using MSCs and collagen membrane was successful in maintaining width of alveolar socket.

Comparison of the clinical applicability of Miller's classification system to Kumar and Masamatti's classification system of gingival recession.

BACKGROUND: The aims of the present study were to (i) Find the percentage of recession cases that could be classified by application of Miller's and/or Kumar and Masamatti's classification of gingival recession, and (ii) compare the percentage of clinical applicability of Miller's criteria and Kumar and Masamatti's criteria to the total recessions present. MATERIALS AND METHODS: A total of 104 patients (1089 recession cases) were included in the study wherein they were classified using both Miller's and Kumar and Masamatti's classification systems of gingival recession. Percentage comparison of the application of both classification systems was done. RESULTS: Data analysis showed that though all the cases of the recession were classified by Kumar and Masamatti's classification, only 34.61% cases were classified by Miller's classification. 19.10% cases were completely (having only labial/buccal recession) classified. In 15.51% (out of 34.61%) cases, only buccal recession was classified according to Miller's criteria and included in this category, although these cases had both buccal and lingual/palatal recessions. Furthermore, 29.75% cases of recession with interdental loss and marginal tissue loss coronal to mucogingival junction (MGJ) remained uncategorized by Miller's classification; categorization of palatal/lingual recession was possible with Kumar and Masamatti's classification. CONCLUSION: The elaborative evaluation of both buccal and palatal/lingual recession by the Kumar and Masamatti's classification system can be used to overcome the limitations of Miller's classification system, especially the cases with interdental loss and having marginal tissue loss coronal to MGJ.