Changes in Keratinized Tissue Width Following Connective Tissue Grafts and Diode Laser- vs Blade-Gingivoplasty.

The objectives of this study were to clinically and histologically assess the capacity of bilaminar subepithelial connective tissue grafts (SCTGs) alone or in combination with gingivoplasty (Gv) to increase the keratinized gingiva width (KGW) in contralateral mandibular sites lacking KG (10 patients, 42 sites). The effects of Gv timing (1 vs 2 months) and technique (blade vs laser) were also evaluated. SCTGs alone resulted in mean KGW increase of 0.1 to 0.7 mm. Laser-Gv significantly increased KGW by an additional 1.9 mm at 4 months postabrasion as opposed to 0.9 mm achieved with blade-Gv. Histologically, laser-treated sites displayed parakeratinization with more pronounced rete pegs than observed in blade-abraded sites.

Microsurgical Instruments in Laterally Moved, Coronally Advanced Flap for Miller Class III Isolated Recession Defects: A Randomized Controlled Clinical Trial.

The aim of this study was to evaluate the laterally moved coronally advanced flap (LMCAF) technique in which magnified vision was used in conjunction with microsurgical instruments (LMCAF-M), and to compare the results with conventional LMCAF technique (LMCAF-C) in Miller Class III isolated recession-type defects. A total of 50 patients with recessions located at incisors and canines were treated with LMCAF-M or LMCAF-C. Outcome parameters (complete root coverage [CRC] and mean root coverage [MRC]) were assessed 6 months postoperatively. Of the 25 defects in each group, 13 in the LMCAF-M (92.0%) and 17 in the LMCAF-C group (68.0%) exhibited CRC (P < .007). MRC scores were 90.48% for the LMCAF-C group and 97.64% for the LMCAF-M group (P < .04). Patient satisfaction with esthetics and postoperative morbidity were better in the LMCAF-M group (P < .032). This study indicates that performing LMCAF with microsurgical instruments offers definite advantages in terms of CRC and MRC, decreased postoperative morbidity, and increased acceptance by patients.

Soft tissue laser in orthodontics.

Today a lot of minor cosmetic surgery operations on the gingiva can easily be carried out directly by the orthodontist with a small quantity of topical anaesthetic and the use of a soft tissue laser. The Diode laser is the most commonly used laser in dentistry for minor surgery to the soft tissues. This kind of laser offers numerous advantages with respect to traditional or electric scalpels. In this article the authors will analyse several typical uses of the diode laser in daily orthodontic practice.

Treatment of multiple gingival recessions using a coronally advanced flap procedure combined with button application.

AIM: The purpose of this randomized controlled clinical trial was to evaluate the effectiveness of a new treatment approach, which consists of coronally advanced flap (CAF) procedure combined with orthodontic button application (CAF+B) for the treatment of multiple recession-type defects in patients with aesthetic demands. MATERIALS AND METHODS: Forty-one healthy subjects presenting at least three adjacent Miller Class I or II multiple gingival recessions were treated with a CAF technique. Twenty-one patients were randomly assigned to the test group, and the other 20 patients were assigned to the control group. On the test group, orthodontic buttons were used for the stabilization of advanced flaps. Clinical and patient centered parameters were measured at baseline, 7 days and 6 months after the surgery. RESULTS: A total of 155 recessions were treated. Complete root coverage from baseline to 6 months post-surgery was 61% for the control group and 84% for the test group. There was no difference on visual analog scale-pain measurements among the treatment groups. Patient satisfaction with aesthetics was very high in CAF+B group when compared with CAF group. CONCLUSION: Six months results showed that the CAF+B approach was effective for the treatment of multiple gingival recessions in patients with aesthetic demands.

A modified tensionless gingival grafting technique using acellular dermal matrix.

Conventional surgical procedures designed for autogenous tissue material may not be appropriate when using acellular dermal matrix (ADM) for the treatment of gingival recessions. This article describes a new surgical technique that addresses the unique and sensitive aspects of ADM specifically to improve esthetic outcomes and gain increased clinical predictability when treating Miller Class I and II gingival recession defects. In this paper, a root coverage case is described and the specific steps and rationale for this new technique are explained. This technique has been predictable clinically, with results comparable to those achieved using autogenous tissue.

The use of a diagnostic wax set-up in aesthetic cases involving crown lengthening--a case report.

UNLABELLED: Crown-lengthening surgery (CLS) consists of recontouring and repositioning the gingival margin as well as the alveolar crest. This technique results in the increase of the clinical crown height of teeth, which can consequently be advantageous in terms of improving retention and resistance, as well as aesthetics.The aim of this article is to demonstrate the uses of the diagnostic wax set-up and the subsequent production of surgical stents and templates to provide the patient with an initial intra-oral diagnostic mock-up for the process of obtaining consent, as well as acting as a useful guide for gingival and osseous recontouring in order to achieve a predictable, healthy and stable dento-gingival complex with pleasing aesthetics. CLINICAL RELEVANCE: The use of a well made diagnostic wax-up can provide valuable information to the dentist, laboratory, and patient which can be otherwise difficult to communicate.

Stage-two implant surgery in the esthetic zone: a new technique.

The esthetic outcome of implant-supported restorations has become increasingly important, especially for single-tooth implants in the esthetic zone. Because of the morphologic alterations that occur following tooth extraction, augmentation procedures are often necessary before, during, or after implantation to achieve an esthetically pleasing result. This article describes a modified technique for augmenting the soft tissue during stage-two implant surgery. The technique uses a modified roll flap, in combination with a tunneling approach to the adjacent teeth and a coronally positioned palatal sliding flap, to achieve sufficient horizontal dimensions and a scarless and harmonious architecture of the peri-implant soft tissue.

Clinical applications of dental lasers.

Dental lasers currently have 24 clinical indications for use that are recognized by the FDA. This article explores the scientific basis for these clinical indications in patient diagnosis and treatment. Multiple examples of relevant clinical applications for these wavelengths are explored in detail and illustrated via clinical photographs.

Improved wound healing by low-level laser irradiation after gingivectomy operations: a controlled clinical pilot study.

AIM: Low-level laser therapy (LLLT) may induce morphological, molecular and cellular processes, which are involved in wound healing. The aim of this split-mouth controlled clinical trial was to assess the effects of LLLT on healing of gingiva after gingivectomy and gingivoplasty. MATERIAL AND METHODS: Twenty patients with inflammatory gingival hyperplasias on their symmetrical teeth were included in this study. After gingivectomy and gingivoplasty, a diode laser (588 nm) was randomly applied to one side of the operation area for 7 days. The surgical areas were disclosed by a solution (Mira-2-tones) to visualize the areas in which the epithelium is absent. Comparison of the surface areas on the LLLT-applied sites and controls were made with an image-analysing software. RESULTS: Despite the prolonged time needed for application, patients have tolerated LLLT well. While there were no statistically significant differences between the stained surface areas of the LLLT applied and the control sites immediately after the surgery, LLLT-applied sites had significantly lower stained areas compared with the controls on the post-operative third, seventh and 15th day (p<0.001 for each). CONCLUSIONS: Within the limitations of this study, the results indicated that LLLT may enhance epithelization and improve wound healing after gingivectomy and gingivoplasty operations.

Microsurgical technique for augmentation of the interdental papilla: three case reports.

The loss of interdental papillae as the result of trauma or inflammatory periodontal disease creates a significant challenge in the esthetic zone. Conventional surgical techniques are unpredictable because of small working spaces and limited blood supply to the area. Vertical releasing incisions can further jeopardize vascular channels and leave unattractive scarring upon healing. The application of microscopes and microsurgical instruments presents a new frontier for predictable esthetic results. This paper describes a predictable microsurgical technique for reconstruction of the interdental papillae.

Use of the 810 nm diode laser: soft tissue management and orthodontic applications of innovative technology.

Innovative technologies such as the diode laser have provided considerable benefit to dental patients and professionals. Facilitating efficient cutting of tissue and subsequent coagulation, the soft tissue laser enhances tissue healing and can reduce postsurgical complications. Due to the conservative nature of treatment accomplished with the laser this technology is very useful in orthodontic procedures. The diode laser is utilized in both esthetic enhancement of the smile, and treatment management of soft tissue issues that impede efficient orthodontic treatment. Its clinical application will be illustrated in a series of orthodontic cases.

Minimally invasive implant and sinus lift surgery with immediate loading.

As 1-stage dental implants continue to gain significantly in popularity, the adaptation of surgical protocols specifically geared to single-stage implants should be considered. Because this type of implant is transgingival at the time of placement, it is now practical to perform implant surgery as well as sinus elevation surgery using minimally invasive techniques without the need for flaps or sutures. The basic concept involves the use of a 5- or 6-mm dermal tissue punch that permits access to the osteotomy site as well as to the sinus, when an elevation procedure is indicated. This technique allows for excellent esthetics in immediate load situations, forming a natural and predictable interdental papilla at the time of surgery.

Anterior esthetic gingival depigmentation and crown lengthening: report of a case.

Excessive gingival display space and gingival hyperpigmentation are major concerns for a large number of patients visiting the dentist. Melanin hyperpigmentation usually does not present a medical problem, but patients usually complain of dark gums as unaesthetic. This problem is aggravated in patients with a "gummy smile" or excessive gingival display while smiling. Esthetic periodontal plastic surgery is especially rewarding in such individuals with compromised esthetics. A case is reported here on the cosmetic correction of "black gums" and "gummy smile." Periodontal plastic surgery combining gingival depigmentation and esthetic crown lengthening was performed in a single appointment using scalpel surgical technique. The outline of steps involved in the surgical procedure is demonstrated and a brief review of the various gingival depigmentation techniques is depicted here.

Microsurgical treatment of gingival recession: a controlled clinical study.

When maximum precision is required in performing surgery to satisfy particular esthetic demands, a surgical microscope that enhances complete visualization of the operative field may represent a useful tool. Twenty-four cases of gingival recession (depth 2 to 5 mm) were treated by different mucogingival surgical techniques in 24 patients: 12 procedures were performed with the aid of a surgical microscope (test group), whereas the other 12 patients were treated without the microscope (control group). Recession depth, probing depth, periodontal attachment loss, and keratinized gingival tissue width were recorded at baseline and 12 months following surgery. Three examiners separately evaluated pictures of the final cases on a scale from 1 to 3, focusing on three esthetic parameters (scarring, gingival margin, and papillae appearance). All parameters significantly improved from baseline to 12 months in both groups, except for probing depth, which did not significantly change. Although the outcomes of the test group always showed a major improvement over the controls, no significant differences could be detected between test and control groups. Mean defect coverage at 12 months was 86% and 78% for test and control groups, respectively; complete coverage was achieved in 58.3% and 33.4% of cases, respectively. Qualitative esthetic evaluation showed: (1) high concurrence among examiners; (2) significantly better scarring and marginal profile in the test group; and (3) no significant difference in papillae appearance. The application of magnification in mucogingival surgery accomplished better results in terms of success and predictability compared to conventional techniques and might help achieve excellent esthetic outcomes.