Guided coronally advanced flap to treat gingival recession: Digital workflow and case report.

BACKGROUND: The inherently technique-sensitive nature of periodontal plastic procedures demands a significant level of skill and expertise. The incorporation of three-dimensional (3D) printing technologies emerges as a potential strategy to optimize and simplify surgical procedures. This case report describes the digital workflow and presents the clinical outcomes achieved using a guided coronally advanced flap for the treatment of a single gingival recession (GR). METHODS AND RESULTS: A female patient with a gingival recession type 1 (RT1 B-) defect on the mandibular second left premolar underwent successful treatment using a guided coronally advanced flap (g-CAF) and de-epithelized connective tissue graft (CTG). The digital planning included intraoral scanning of the mandible and hard palate using an intraoral scanner, with resulting polygon format (PLY) files exported for virtual model creation. The CAF guide was meticulously designed to orient horizontal and vertical incisions at the papillae base adjacent to the GR defect. For the donor site, a guide was specifically created, positioning the graft area 2 mm apically to the premolars' gingival margins. The delineation of this area involved two horizontal and vertical incisions, meticulously based on the dimensions of the GR. The digitally designed guides were then 3D-printed using a surgical guide-specific resin, contributing to the precise execution of the innovative surgical approach. Complete root coverage was achieved. CONCLUSION: This case report demonstrates that g-CAF can be a promising approach for the treatment of single GR. HIGHLIGHTS: Why is this case new information? To the best of the authors' knowledge, this is the first manuscript to report a guided procedure for the treatment of gingival recession. This report provides the digital workflow for the fabrication of a guide to perform the coronally advanced flap for single recession defects. What are the keys to successfully manage this case? It is necessary to adequately scan the recession defect area and palate. Properly not only design the guide using specific software but also print it. The guide has to be stable when in position for the surgical procedure. What are the primary limitations of this technique? This guide was designed to help surgeons during the incisions. However, it does not provide aid to split and release the flap and suture.

Resin composite plus connective tissue graft to treat single maxillary gingival recession associated with non-carious cervical lesion: randomized clinical trial.

AIM: To evaluate clinically, the aesthetics and the patient-centred parameters after the treatment of gingival recession associated with non-carious cervical lesion by connective tissue graft alone or combined with a nanofilled resin composite restoration. METHODS: Thirty-six patients presenting one Miller Class I or II gingival recessions and B+ tooth cervical defect were included. The defects were treated by either connective tissue graft (CTG: control group; n = 18) or connective tissue graft plus resin composite restoration (CTG+RC: test group; n = 18). RESULTS: The mean percentage of defect coverage was 82.16 ± 16.1% for CTG and 73.84 ± 19.2% for CTG+RC after 1 year (p > 0.05). Both groups presented statistically significant improvements in two aesthetics evaluations. The professional evaluation (MRES) was 7.44 ± 2.3 for the CTG group and 7.52 ± 2.27 for CTG+RC after 1 year, with no significant difference between the groups. The two groups presented significant reduction of dentin sensitivity (DS), it decreased from 94.4% of the sites to 44.4% in the CTG group and from 88.8% to 5.5% in the CTG+RC group. CONCLUSIONS: CTG or CTG+RC can successfully treat gingival recession associated with B+ non-carious cervical lesion, but less sensitivity may be expected with the combined approach (NCT02423473).

Enamel matrix protein derivative and/or synthetic bone substitute for the treatment of mandibular class II buccal furcation defects. A 12-month randomized clinical trial.

OBJECTIVE: This study aims to clinically evaluate the treatment of mandibular class II furcation defects with enamel matrix derivative (EMD) and/or a bone substitute graft made of ß-tricalcium phosphate/hydroxyapatite (ßTCP/HA). MATERIALS AND METHODS: Forty-one patients, presenting a mandibular class II buccal furcation defect, probing pocket depth (PPD) ≥4 mm and bleeding on probing, were included. They were randomly assigned to the groups: 1-EMD (n = 13); 2-ßTCP/HA (n = 14); 3-EMD + ßTCP/HA (n = 14). Plaque index (PI), gingival index (GI), relative gingival margin position (RGMP), relative vertical and horizontal attachment level (RVCAL and RHCAL), and PPD were evaluated at baseline and 6 and 12 months. The mean horizontal clinical attachment level gain was considered the primary outcome variable. RESULTS: No significant intragroup differences were observed for RGMP, but significant changes were observed for RVCAL, RHCAL, and PPD for all groups (p < 0.05). After 12 months, the mean horizontal clinical attachment level gain was 2.77 ± 0.93 mm for EMD, 2.64 ± 0.93 mm for ßTCP/HA, and 2.93 ± 0.83 mm for EMD + ßTCP/HA, with no significant differences among the groups. At the end of the study, 85.3 % of the sites were partially closed; however, no complete closure was observed. CONCLUSION: EMD + ßTCP/HA does not provide a significant advantage when compared to the isolated approaches. All three tested treatments promote significant improvements and partial closure of class II buccal furcation defects. Based on its potential to induce periodontal regeneration, EMD may be considered an attractive option for this type of defect, but complete closure remains an unrealistic goal. CLINICAL RELEVANCE: The partial closure of buccal furcation defects can be achieved after the three tested approaches. However, the combined treatment does not provide a significant benefit when compared to the isolated approaches.

Derivado da matriz do esmalte e substituto ósseo sintético para bifurcações mandibulares / Enamel matrix protein derivative plus synthetic bone substitute for mandibular class II furcation defects

Lesões de furca representam um desafio para o tratamento periodontal básico, bem como para a abordagem regenerativa. Neste contexto, existem diferentes técnicas regenerativas disponíveis. Dentre as que têm sido amplamente utilizadas, estão: regeneração tecidual guiada, utilização de derivados da matriz do esmalte, substitutos ósseos e técnicas combinadas. Para buscar resultados mais satisfatórios, o uso da terapia regenerativa combinada parece ser promissor. Portanto, o objetivo foi relatar o tratamento de defeitos de furca mandibular de classe II com proteína derivada da matriz do esmalte (EMD), combinada com um substituto ósseo sintético (beta tricálcio fosfato/hidroxiapatita – βTCP/HA).

Enamel matrix protein derivative plus synthetic bone substitute for the treatment of mandibular Class II furcation defects: a case series.

OBJECTIVES: The aim of this study is to report on the treatment of mandibular Class II furcation defects with enamel matrix protein derivative (EMD) combined with a ßTCP/HA (ß-tricalcium phosphate/hydroxyapatite) alloplastic material. METHOD AND MATERIALS: Thirteen patients were selected. All patients were nonsmokers, systemically healthy, and diagnosed with chronic periodontitis; had not taken medications known to interfere with periodontal tissue health and healing; presented one Class II mandibular furcation defect with horizontal probing equal to or greater than 4 mm at buccal site. The clinical parameters evaluated were probing depth (PD), relative gingival margin position (RGMP), relative vertical clinical attachment level (RVCAL), and relative horizontal clinical attachment level (RHCAL). A paired Student t test was used to detect differences between the baseline and 6-month measurements, with the level of significance of .05. RESULTS: After 6 months, the treatment produced a statistically significant reduction in PD and a significant gain in RVCAL and RHCAL, but no observable change in RGMP. RVCAL ranged from 13.77 (± 1.31) at baseline to 12.15 (± 1.29) after 6 months, with a mean change of -1.62 ± 1.00 mm (P < .05). RHCAL ranged from 5.54 (± 0.75) to 2.92 (± 0.92), with a mean change of -2.62 ± 0.63 mm (P < .05). After 6 months, 76.92% of the patients improved their diagnosis to Class I furcation defects while 23.08% remained as Class II. CONCLUSION: The present study has shown that positive clinical results may be expected from the combined treatment of Class II furcation defects with EMD and ßTCP/HA, especially considering the gain of horizontal attachment level. Despite this result, controlled clinical studies are needed to confirm our outcomes.

A utilização do β tricálcio fosfato em associação com a matriz derivada do esmalte em defeito de bifurcação classe II / The use of Beta tricalicium phosphate in association with enamel matrix derivative in class II furcation defects

A presença do biofilme bacteriano é o principal fator etiológico envolvido na iniciação e no desenvolvimento das enfermidades que acometem a cavidade bucal. A remoção mecânica é um método capaz de controlar os patógenos periodontais. No entanto, muitos pacientes apresentam uma deficiência nos métodos de higiene diária habitual. Neste sentido, surgem agentes antimicrobianos capazes de agir de modo a auxiliar na prevenção e no tratamento destas doenças e diversos estudos na literatura têm mostrado a eficácia no emprego de tais substâncias antimicrobianas no controle do biofilme. Este artigo visou apresentar uma revisão da literatura sobre a utilização do agente antimicrobiano triclosan, possibilitando que os cirurgiões-dentistas conheçam melhor suas propriedades, seu mecanismo de ação e sua eficácia.