Periodontal Phenotype Modification of Peri-Implant Soft Tissue Deficiency Using Subepithelial Connective Tissue Grafts and Bone Grafts in the Esthetic Region.

Peri-implant soft tissue deficiency (PSTD) is a significant factor impacting aesthetics, particularly in the anterior zone, where labial bone resorption and thin peri-implant phenotypes are common. The occurrence of a gray color around the implant fixture due to PSTD can be aesthetically concerning in the esthetic zone. In cases involving natural teeth, autogenous soft tissue grafts such as subepithelial connective tissue grafts (SCTGs), free gingival grafts (FGGs), and coronally advanced flaps (CAFs) are commonly utilized. However, there are limited reports of using bone grafts in conjunction with these techniques for modifying the gingival phenotype around both teeth and implants. In the presented cases where PSTD resulted in visible gray coloration of the implant fixture in the esthetic zone, mechanical and chemical decontamination of the exposed implant surface was performed using a titanium brush and tetracycline (Tc) HCl. Subsequently, to enhance peri-implant mucosa thickness and mask the titanium color, simultaneous SCTG and bone grafting procedures were conducted. Within the limitations of these case reports, successful esthetic outcomes were achieved and maintained without recurrence for 3-6 years following the simultaneous subepithelial connective tissue graft and bone graft procedures. These findings suggest the potential efficacy of this combined approach in addressing PSTD and enhancing aesthetic results around dental implants, though further studies are needed to validate these outcomes.

Tunnel technique and subepithelial connective tissue graft, with or without cross-linked hyaluronic acid, in the treatment of multiple gingival recessions: 12-month outcomes of a randomized clinical trial.

BACKGROUND: This study evaluated the influence of the adjunctive application of a cross-linked hyaluronic acid (HA) in the treatment of multiple gingival recessions, using a modified coronally advanced tunnel (MCAT) technique and subepithelial connective tissue graft (SCTG) (MCAT+SCTG±HA). METHODS: A randomized, split-mouth, double-masked comparison of the effects of MCAT+HA+SCTG (test) versus MCAT+SCTG (control) in the treatment of multiple, contralateral gingival recessions with clinical, esthetic, and histological evaluations was carried out. All samples were stained with hematoxylin and eosin, Masson's trichrome, Verhoeff-Van Gieson, and Alcian blue stain for semiquantitative evaluation. The primary outcome variable was 12-month mean root coverage (MRC). RESULTS: Twenty-four patients with 266 gingival recessions received both control and test treatments (133 recessions per group). 12-month MRC of the MCAT+HA+SCTG group was not significantly different from the MCAT+SCTG group with 84.32%±  34.46% and 85.71%±  36.43%, respectively (p = 0.991). Both treatment modes produced favorable esthetic outcomes (root coverage esthetic score [RES] 9.51±  1.01 tests vs. 9.26±  1.10 controls, p = 0.7292). However, the application of HA improved soft tissue texture (p = 0.0091). The remaining end point measures did not differ significantly between groups. Histological evaluation showed a significantly greater number of elastic fibers and a moderate increase in collagen fiber density in biopsy samples taken from the test sides when compared to the control sides (p = 0.0419 and p = 0.300, respectively). CONCLUSIONS: MCAT+SCTG is an effective procedure in the treatment of multiple recession Type 1 (RT1) and RT2 recessions. There were no statistically significant differences in evaluated clinical treatment outcomes in the MCAT+HA+SCTG group compared to the MCAT+SCTG group within a period of 12 months. The application of HA increased collagen and elastic fiber density.

The Effectiveness of Subepithelial Connective Tissue Graft as a Barrier Membrane in Guided Bone Regeneration: A Case Report.

Subepithelial connective tissue graft (SCTG) can be used as a membrane in guided bone regeneration (GBR) to gain more tissue volume. The case presents a 66-year-old female patient with a missing canine and is referred for dental implant placement. The implant was placed; GBR was done using xenograft particulate and a palatal SCTG as a membrane to improve the labial contour and achieve better esthetics. She returned for a routine follow-up after 14 months, and the examination revealed a well-maintained tissue contour following the final crown placement.

Comparative analysis of xenogeneic collagen matrix and autogenous subepithelial connective tissue graft to increase soft tissue volume around dental implants: a systematic review and meta-analysis.

OBJECTIVE: The gold standard for a soft tissue augmentation around implants is a subepithelial connective tissue graft (CTG), but the xenogeneic collagen matrices (XCM) started to be used as an alternative. This systematic review aimed to assess the effectiveness XCM in comparison to CTG for the increasing the thickness of the soft tissue around implants. DATA: All studies included at least two parallel groups comparing the use of CTG and XCM with a minimum follow-up of 3 months. As the primary outcome, the amount of soft tissue thickness gain after soft tissue augmentation with XCM or CTG was assessed. Secondary outcomes were clinical and patient-related outcomes; evaluation of aesthetic outcomes, patient-reported outcomes measures (PROMs) and complications. Eligible studies were selected based on the inclusion criteria. Meta-analysis was applied whenever possible. The quality of the evidence of studies including in meta-analysis was assessed using the GRADE approach. SOURCE: A systematic literature search up to January 2022 was conducted using the following electronic databases: PubMed (MEDLINE), Scopus, Cochrane Library, LILACS, eLIBRARY.RU. Unpublished researches, the gray literature, nonprofit reports, government studies and other materials were reviewed electronically using an EASY search. An additional manual search was carried out in November 2022. STUDY SELECTION: Of the 1376 articles from the initial search, 8 randomized controlled trials (RCTs) (306 patients and 325 implants) were included in this systematic review, and 7 studies were part of the meta-analysis. Meta-analysis revealed that XCM is less effective than the CTG in increasing soft tissue thickness around dental implants. However, XCM also provides soft tissue thickness gain and can be recommended for use in various clinical situations. CLINICAL SIGNIFICANCE: Previous systematic reviews and meta-analyses have shown that autologous grafts are more effective than collagen matrices in increasing soft tissue thickness, however, the latter can be used as an alternative. Studies included in previous systematic reviews varied in design, which could lead to limitations. The present systematic review and meta-analysis includes for the first time only randomized controlled clinical trials with collagen matrix of xenogeneic origin in the test group. Tight eligibility criteria were established, and the main parameter studied was soft tissue thickness. It was found that xenogeneic collagen matrix is effective for increasing soft tissue thickness around dental implants, however, the results obtained using an autogenous connective tissue graft are superior.

Comparison of Root Coverage by the Subepithelial Connective Tissue Graft With and Without Root Biomodification: A Comprehensive Clinical Study.

BACKGROUND: Being an autologous graft, a subepithelial connective tissue (SECT) graft shows more predictable root coverage better than other techniques. Hence, it is most likely to be widely used for recession treatment. During root planing, a smear layer forms on the root surface that cannot be removed by water or saline rinsing. To remove this smear layer, root biomodification agents are widely used. The present study was conducted to assess the efficacy of an SECT graft for root coverage with and without root biomodification. METHODS: This study included 20 patients with no gender predilection, with an age range of 24-36 years and a mean age of 27.6 ± 4.24 years. The chosen range facilitated the acquisition of data in a relatively homogeneous population, minimizing the confounding effects of factors such as aging-related tissue changes or early-onset periodontal issues. All 40 sites were treated with the SECT and coronally advanced flap. Root conditioning in controls was done with distilled saline and tested using 24% ethylenediaminetetraacetic acid (EDTA) gel (Maquira; STM Meditech, Kerala). At baseline and at one, three, and six months postoperatively, pocket depth (PD) and clinical attachment levels (CALs) were assessed at four sites using a UNC-15 probe, and from the gingival margin to the cementoenamel junction (CEJ), the vertical recession was assessed. RESULTS: For the buccal surface, CALs were reduced significantly (p < 0.001). Following root conditioning with 24% EDTA, no difference was seen in the CAL in the control and test group either buccally or interproximally with a p-value of greater than 0.05. For PD, following a SECT graft or root conditioning, no significant change was observed in the buccal or interproximal region (p > 0.05). The vertical recession was significantly reduced with a p-value of less than 0.001 and depth coverage of 97.5%. The difference between the two groups was statistically non-significant (p > 0.05). The root surface coverage decreased significantly from 16.6 ± 2.8 to 0.45 ± 0.4 from baseline to six months, which was statistically significant (p < 0.001). This intergroup difference was non-statistical (p > 0.05). CONCLUSION: The present study concludes that the use of an SECT graft in root coverage can significantly improve the CAL, root surface area, and vertical recession both with and without root biomodification. We conclude that there is a significant decrease in the probing depth following SECT grafting and with root biomodification.

Evaluation of the Effect of Injectable Platelet-rich Fibrin on Palatal Wound Healing: A Two-arm Randomized Controlled Clinical Trial.

AIM: This study aimed to evaluate the effect of injectable platelet-rich fibrin (i-PRF) as a potential catalyst for the acceleration of palatal wound healing after subepithelial connective tissue graft (SCTG) harvesting. MATERIALS AND METHODS: Referred patients to the Department of Periodontology with the complication of the gingival recession were examined. Thirty participants were chosen for root coverage surgeries with SCTGs, and randomly distributed into two groups; the study group (n = 15) with i-PRF was applied, and the control group (n = 15) without i-PRF. The wound healing index was evaluated on the 7th, 14th, and 30th days of the treatment. Palatal tissue thickness was measured before the treatment and at the 1st, 2nd, and 3rd months after the treatment. RESULTS: The study group improved significantly the early healing over the control group on days 7 and 14 (p < 0.01), whereas no difference in the first month (p > 0.05) between the groups. Moreover, the study group showed higher tissue thickness mean in the first and second month (p < 0.01), but in the third month, there were no significant differences (p > 0.05) between both groups. CONCLUSION: The i-PRF has favorable effects on the healing process by enhancing wound healing and increasing the tissue thickness in the palate after SCTG harvesting. CLINICAL SIGNIFICANCE: For clinicians, it is important to know that we can use biological materials to accelerate healing in general, such as i-PRF. In this study, we used it in the palate, which may accelerate the healing so that we can repeatedly use the same area of the patient's palate for more than one occasion faster.

Efficacy of a collagen matrix for soft tissue augmentation after implant placement compared to connective tissue grafts: A multicenter, noninferiority, randomized controlled trial.

OBJECTIVES: To test whether soft tissue volume augmentation using a collagen matrix (VCMX) leads to noninferior results in terms of gain of mucosal thickness at single implant sites, compared to connective tissue grafts (SCTG). METHODS: The study was designed as a multi-center randomized controlled clinical trial. Subjects in need of soft tissue volume augmentation at single tooth implant sites were consecutively recruited at nine centers. The deficient mucosal thickness at the implant sites (one per patient) was augmented by applying either a VCMX or a SCTG. Patients were examined at 120 days (abutment connection = primary endpoint), 180 days (final restoration), and 360 days (1-year after insertion of the final restoration). Outcome measures included: transmucosal probing of the mucosal thickness (crestal = primary outcome), profilometric measurements of the tissue volume, and patient-reported outcome measures (PROMs). RESULTS: Out of the 88 patients, 79 attended the one-year follow-up. The median increase of the crestal mucosal thickness between pre-augmentation and 120 days was 0.3 ± 2.1 mm in the VCMX group and 0.8 ± 1.6 mm in the SCTG group (p = .455). Non-inferiority of the VCMX compared to the SCTG was not observed. The respective numbers at the buccal aspect amounted to 0.9 ± 2.0 mm (VCMX) and 1.1 ± 1.4 mm (SCTG; p = .431). PROMs including pain perception favored the VCMX group. CONCLUSION: It remains inconclusive whether soft tissue augmentation using a VCMX is noninferior to SCTG in terms of crestal mucosal thickening at single implant sites. However, the use of collagen matrices favors PROMs especially pain perception, while achieving similar buccal volume gains along with comparable clinical and aesthetic parameters to SCTG.

Periodontal Phenotype Modification Using Subepithelial Connective Tissue Graft and Bone Graft in the Mandibular Anterior Teeth with Mucogingival Problems Following Orthodontic Treatment.

Among the complications of orthodontic treatment, mucogingival problems with gingival recession in the mandibular anterior teeth are challenging for clinicians. Mucogingival problems can lead to esthetic deficits, thermal hypersensitivity, tooth brushing pain, and complicated plaque control. Herein, we present a case of a 16-year-old female with gingival recession in the left mandibular central incisor after orthodontic treatment. The preoperative clinical findings showed a thin soft tissue biotype with root prominence in the mandibular anterior area. The interdental area was relatively depressed. After reflection of the full-thickness flap, root coverage using a bone graft substitute and subepithelial connective tissue graft obtained from the palatal mucosa was performed. The 6-month and 5-year postoperative clinical findings showed improved soft tissue phenotype. The cross-sectional CBCT scans 5 years after surgery showed a well-maintained labial bone plate in the mandibular incisors. Within the limitations of this case report, for patients with gingival recession in the mandibular incisors after orthodontic treatment, a successful biotype modification can be achieved with a combined procedure using subepithelial connective tissue graft with bone graft substitutes.

Soft tissue contour changes at implant sites with or without soft tissue grafting in the esthetic zone: A retrospective case-control study with a 12-year follow-up.

OBJECTIVES: To evaluate the volumetric changes and peri-implant health at implant sites with and without previous soft tissue grafting over a 12-year observation period. MATERIALS AND METHODS: Eighteen patients received dental implants and simultaneously guided bone regeneration in the esthetic zone (15-25) for dental rehabilitation. Three months following implant placement, 8 patients (test) received an additional subepithelial connective tissue graft, whereas 10 patients (control) did not receive any additional treatment. One week after prothesis delivery and at the 5 and 12 years follow-up examination, impressions were taken. Obtained casts were processed for profilometric and linear analyses. The mean distance (MD) in the mid-buccal area between the two surfaces was considered the primary outcome. Peri-implant health was assessed based on clinical and radiographic data. RESULTS: Nine female and 7 male patients were re-assessed after a median follow-up time of 144.5 months (Min: 114.8; Max: 213.0). The median reduction of MD amounted to -0.81 mm (Min: -1.39; Max: 0.52) in the test group and -0.56 mm (Min: -0.93; Max: 0.11) in the control group, (intergroup comparison p = .607, CI 95%: -0.760/0.530). None of the implants was diagnosed with peri-implantitis. Six tests and two control implants were diagnosed with peri-implant mucositis (p = .103). CONCLUSIONS: Despite the limited number of included patients, similar results in terms of volumetric, linear changes, and peri-implant conditions could be detected at implant sites with or without soft tissue grafting over a period of 12 years.

Tunnel technique with cross-linked hyaluronic acid in addition to subepithelial connective tissue graft, compared with connective tissue graft alone, for the treatment of multiple gingival recessions: 6-month outcomes of a randomized clinical trial.

OBJECTIVES: The aim of this study was to investigate differences in clinical and esthetic outcomes in the treatment of multiple gingival recession types 1 and 2, using the modified coronally advanced tunnel technique (MCAT) combined with subepithelial connective tissue graft (SCTG), with or without cross-linked hyaluronic acid (HA). MATERIALS AND METHODS: A total of 24 patients with 266 multiple gingival recessions (GR) were enrolled in the study (133 recessions per group). MCAT was combined with SCTG and HA on the test side, while MCAT with SCTG was used on the control side. Clinical parameters were measured at baseline and 6 months post-operatively. Visual analogue scales (VAS) and questionnaires were used to assess patient-rated outcomes, and the root coverage esthetic score (RES) was used for professional esthetic evaluation. RESULTS: No significant improvement in root coverage was observed as a result of adding HA. After 6 months, mean root coverage (MRC) was 85% for SCTG + HA group and 83% for SCTG group (p = 0.9819). Complete root coverage (CRC) was observed in 91% (test) and 93% (control) of the cases (p = 0.9001). Professional assessment of soft tissue texture (STT) using RES showed a significant difference (0.94 versus 0.69, p = 0.0219) in favor of the experimental group. CONCLUSIONS: Both treatments were similarly effective in treating multiple GRs and led to comparable improvements in clinical parameters. However, application of HA improved the appearance of soft tissue texture. CLINICAL RELEVANCE: Adjunctive application of HA in the MCAT + SCTG procedure may improve STT results.

In vitro and in vivo evaluation of a modified porcine acellular dermal matrix for soft tissue augmentation.

OBJECTIVES: To evaluate the effects of a modified porcine acellular dermal matrix (P-ADM), subepithelial connective tissue graft (SCTG) and other commercial bovine acellular dermal matrix membrane materials (B-ADM) on gingival soft tissue augmentation in the oral esthetic zone. MATERIAL AND METHODS: The characteristics of P-ADM were observed by scanning electron microscope (SEM), Hematoxylin and eosin (H&E) and Masson's trichrome staining (Masson staining). The biocompatibility of P-ADM was verified by CCK8, phalloidin and living/dead cell staining. Beagle dog models were constructed and the thickness of gingiva was analyzed by the intraoral scanner. The morphology was observed by H&E and Masson staining. RESULTS: Scanning electron microscopy, H&E and Masson staining showed that the P-ADM was mainly composed of collagen fibers, with no component of nuclear. The results of CCK8, phalloidin and living/dead cell staining indicated that the P-ADM had good cytocompatibility and no cytotoxicity. Human gingival fibroblasts were able to adhere and stretch on the surface of the material with pseudopodia. The SCTG group outperformed the B-ADM and P-ADM groups in terms of effectiveness, according to the analysis of digital oral scanning data at various time points following incremental soft tissue surgery. Compared with the B-ADM group, the effect of soft tissue increment was better in the P-ADM group. CONCLUSIONS: P-ADM, as a biocompatible biomaterial, can be used as an alternative biomaterial for oral soft tissue thickening. However, the results of this study need to be verified by more clinical trials.

Comparison of chorion allograft and subepithelial connective tissue autograft in the treatment of gingival recession- A randomized controlled clinical trial.

Background: To compare the clinical outcomes of subepithelial connective tissue graft and chorion membrane along with coronally advanced flap in the treatment of gingival recession. Methods: A total of 12 patients with 24 sites showing isolated bilateral Miller's class I and II gingival recessions were randomly allocated into two treatment sites. One site, connective tissue graft, (n = 12 sites) while on the contra-lateral site, chorion membrane (n = 12 sites) was used with coronally advanced flap. Clinical parameters: probing depth, recession depth, recession width, width of keratinized gingiva, relative attachment level, thickness of keratinized gingiva were recorded at the baseline, 3 months, and 6 months. The amount of root coverage was evaluated after 6 months. Results: Statistically significant differences were observed between test and control sites in terms of recession depth, recession width, width of keratinized gingiva and thickness of keratinized gingiva at 6 months. The test sites presented 66.17 ± 18.85% and the control site showed 87.17 ± 18.33% of root coverage at 6 months. Conclusion: Very limited amount of recession coverage with chorion membrane and did not serve as an alternative to connective tissue graft. Trial registration: CTRI/2017/12/010964.

Interdisciplinary treatment of ankylosed upper central incisors with an anterior vertical ridge defect: A case report.

This case report describes the successful 10-years interdisciplinary treatment of ankylosed upper central incisors with an anterior vertical ridge defect. This treatment was challenging as ankylosis was present before the growth spurt. Orthodontic treatment in association with decoronation, a xenogeneic bone graft, an autogenous sub-epithelial connective tissue graft, and implant placement were performed to correct the vertical ridge defect and to re-establish appropriate function, gingival health, and aesthetics. Decoronation performed during the growth spurt was the key to avoiding alveolar ridge deformity.

Application of soft tissue augmentation in labial contour aesthetics of anterior dental implants / 口腔疾病防治

@#After tooth extraction, labial contour collapses due to inevitable physiologic bone remodeling. To achieve optimal outcomes for pink esthetic treatment at anterior implant sites, bone or soft tissue augmentation has been advocated to maintain or reconstruct the labial tissue contour. When choosing soft tissue augmentation for esthetic restoration, it is necessary to strictly grasp the indications for surgery. Soft tissue augmentation to maintain or reconstruct the labial tissue contour could be considered in patients with healthy soft tissue and no bone defects or only mild horizontal bone defects. In immediate, early and late implant placement, the timing of soft tissue augmentation may vary. In immediate implantation, the labial bone plate is intact, so it is highly recommended to simultaneously manage soft tissue during implant placement. However, patients may have large bone defects with early or late implant placement. The risk of augmenting bone and soft tissue simultaneously is likely too high, and bone augmentation surgery is often performed at the first stage while soft tissue augmentation surgery is performed at the second stage. Therefore, soft tissue surgery is often carried out simultaneously with abutment connection. Currently, soft tissue augmentation is achieved mostly with adjacent autologous soft tissue grafts, such as free gingival grafts, subepithelial connective tissue grafts or pedicle palatal flaps, which are often accompanied by a second surgical area. The replacement of autogenous soft tissue grafting with new biological materials will become an inevitable trend. In this article, we analyze and summarize the indications, timing and different methods of soft tissue augmentation to maintain and reconstruct the labial contour.

Comparison of morbidity at the donor site and clinical efficacy at the recipient site between two different connective tissue graft harvesting techniques from the palate: A randomized clinical trial.

Background: This study was conducted to compare the pain levels in patients and the clinical efficacy of grafts obtained using two techniques, namely de-epithelialized gingival graft (DGG) and subepithelial connective tissue graft (SCTG), in combination with coronally advanced flap (CAF) for the treatment of multiple adjacent gingival recessions. Methods: Twelve patients were treated using DGG+CAF on one side and SCTG+CAF on the other. The patients' pain levels at the surgical site, the number of analgesics taken on days 3 and 7, the mean root coverage (MRC), the percentage of complete root coverage (CRC), color match, and gingival thickness (GT) at the graft recipient site were evaluated 6 months after surgery. Results: The total number of analgesics taken during the 7-day period after surgery and pain levels at the surgical site from day 3 to day 7 were significantly higher in the DGG+CAF group compared to the SCTG+CAF group (P=0.001). In the 6-month follow-up, color match and CRC were significantly higher in the SCTG+CAF group, while GT was significantly higher in the DGG+CAF group. There was no significant difference in MRC between the two groups. Conclusion: The pain and analgesic consumption levels were higher in the DGG+CAF group compared to the SCTG+CAF group, and the recipient site had a weaker color match. However, this technique can lead to a greater increase in the thickness of the grafted area.

Long-Term Clinical Assessment of Two Modifications of Tunnel Technique in Treatment of Cairo Recession Type 1 in Lower Jaw.

AIM: The aim of this study is to compare long-term results after using an MCAT (Modified Coronally Advanced Tunnel) with an SCTG (Subepithelial Connective Tissue Graft) or an MCAT with CM (Collagen Matrices) in the treatment of Cairo recession Type 1 in mandibular single-rooted teeth. MATERIAL AND METHOD: The study encompassed 80 recessions in 18 patients for whom an MCAT was combined with CM on one side of the mandible and with an SCTG on the contralateral one. The following clinical parameters were measured: gingival recession height (GR) and width (RW), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (KT), gingival thickness (GT), and mean (MRC). RESULTS: The MRC on the CM- and SCTG-treated sides was 55.25% and 82.35%, respectively. The SCTG side had a significantly greater improvement in MRC, GR, RW, KT, and GT compared to the CM side. The five-year results were stable relative to one-year observations. CONCLUSIONS: Both methods of treatment enable the achievement of stable long-term clinical results. Application of subepithelial connective tissue grafts is more effective relative to clinical parameters.

Treatment of multiple adjacent RT 1 gingival recessions with the modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: 9-year results of a split-mouth randomized clinical trial.

OBJECTIVES: To evaluate t he long-term outcomes following treatment of RT 1 multiple adjacent gingival recessions (MAGR) using the modified coronally advanced tunnel (MCAT) with either a collagen matrix CM or a connective tissue graft (CTG). MATERIAL AND METHODS: Sixteen of the original 22 subjects included in a randomized, controlled split-mouth clinical trial were available for the 9-year follow-up (114 sites). Recessions were randomly treated by means of MCAT + CM (test) or MCAT + CTG (control). Complete root coverage (CRC), mean root coverage (MRC), gingival recession depth (GRD), probing pocket depth (PD), keratinized tissue width (KTW), and thickness (KGT) were compared with baseline values and with the 12-month results. RESULTS: After 9 years, CRC was observed in 2 patients, one in each group. At 9 years, MRC was 23.0 ± 44.5% in the test and 39.7 ± 35.1% in the control group (p = 0.179). The MRC reduction compared to 12 months was - 50.1 ± 47.0% and - 48.3 ± 37.7%, respectively. The upper jaw obtained 31.92 ± 43.0% of MRC for the test and 51.1 ± 27.8% for the control group (p = 0.111) compared to the lower jaw with 8.3 ± 46.9% and 20.7 ± 40.3%. KTW and KGT increased for both CM and CTG together from 2.0 ± 0.7 to 3.1 ± 1.0 mm (< 0.0001). There were no statistically significant changes in PD. CONCLUSION: The present results indicate that (a) treatment of MAGR using MCAT in conjunction with either CM or CTG is likely to show a relapse over a period of 9 years, and (b) the outcomes obtained in maxillary areas seem to be more stable compared to the mandibular ones. CLINICAL RELEVANCE: The mean root coverage at 12 months could not be fully maintained over 9 years. On a long-term basis, the results seem to be less stable in the mandible as compared to maxillary areas.

Pontic site development for fixed dental prostheses with and without soft tissue grafting: 1-year results of a cohort study.

AIM: To describe and compare the pontic site development for fixed-dental prostheses (FDPs) with and without soft tissue grafting up to one-year post insertion of FDPs. MATERIALS AND METHODS: A convenience sample of 24 patients participating in an ongoing RCT was provided with three-unit tooth-borne FDPs. Six patients received a subepithelial connective tissue graft (SCTG) at the pontic site, whereas 18 patients were treated without any soft tissue graft (CONTROL). Digital impressions were taken prior to tooth preparation, after tooth preparation, after insertion of the final FDP, and at the 1 year of follow-up. The obtained stereolithography files (STL) were superimposed and profilometric as well as linear changes of the soft tissue profile were assessed at the pontic regions. Profilometric outcomes included changes of the ridge contour, the alveolar ridge width, and the crown height of the pontic. Further outcomes assessed included: the papilla index, the pink esthetic score (PES), probing depth (PD), bleeding on probing (BOP), and plaque control record (PCR). Descriptive and nonparametric statistics were applied for all outcome measures. RESULTS: The median profilometric contour between tooth preparation and 1 year after the insertion of the final FDP decreased by - 0.25 mm [Q1, Q3: - 0.36, 0.14] in the CONTROL group and increased by 0.61 mm [Q1, Q3: - 0.18, 1.06] in the SCTG group (intergroup p = 0.038). The alveolar ridge width between prior to tooth preparation and the one-year follow-up amounted to - 0.12 mm [Q1, Q3: - 0.74, 0.70] (= loss) in the CONTROL group and to 2.23 mm [Q1, Q3: 0.62, 3.86] (= gain) in the SCTG group (intergroup p = 0.032). At one year, the median crown height of the pontic tended to decrease by - 1.24 mm [Q1, Q3: - 2.05, - 1.05] in the SCTG group (intragroup p = 0.094) and by - 0.22 mm [Q1, Q3: - 0.58, 0.66] in the CONTROL group (intragroup p = 0.831), with significant differences between the groups (intergroup p = 0.022). The papilla index between prior to tooth preparation and one year of follow-up improved significantly in both groups (p < 0.05). Between FDP delivery and one year of follow-up, the PES values decreased significantly in the CONTROL group (intragroup p = 0.007), while in the SCTG group the change was not significant (intragroup p = 0.875). Clinical parameters (PD, BOP, and PCR) remained stable over time and did not differ between the groups at any time point (intergroup p > 0.05). CONCLUSION: Within the limitations of the present study, soft tissue grafting tends to limit contour changes at pontic sites, thus maintaining the esthetic outcomes over time. The lack of soft tissue grafting results in stable clinical outcomes; however, it may lead to a decrease in aesthetic outcomes over time. CLINICAL RELEVANCE: Autogenous soft tissue grafting seems to be a valid therapeutic option for the development of the pontic site to restore ridge defects prior to the delivery of fixed dental prostheses and to limit dimensional changes over time.

Sequential soft- and hard-tissue augmentation after clear aligner-mediated adjustment of traumatic occlusion: A case report.

BACKGROUND: Oral health and esthetic concerns have increasingly motivated adults with periodontitis to seek orthodontic care. Patients with periodontitis often have other dental complications that can make treatment more challenging or less likely to be successful. The predictability of multidisciplinary regenerative and orthodontic treatment approaches in a patient with periodontitis, thin periodontal phenotype, and anterior crossbite is described. CASE DESCRIPTION: A 35-year-old man was designated as having a high risk of experiencing soft-tissue recession owing to his thin periodontal phenotype. After the initial periodontal therapy, clear aligners were used to eliminate the anterior crossbite that was causing traumatic occlusion. In addition, a subepithelial connective tissue graft was used to alter the thin periodontal phenotype. Three months later, guided bone regeneration with corticotomy was performed to increase bone mass, and orthodontic traction was used at 2 weeks after surgery. Orthodontic treatment was continued until all the spaces had been closed. Clinical and radiographic evaluations conducted at the 6-month follow-up revealed substantial improvements in both the soft- and hard-tissue phenotypes. PRACTICAL IMPLICATIONS: Outcomes in this case indicate that sequential soft- and hard-tissue augmentation, after eliminating traumatic occlusion via using a clear aligner, may be a valuable approach for improving soft- and hard-tissue support in patients with periodontitis.

Surgical management of autogenous bone block graft exposure followed by prosthetic rehabilitation of thin residual ridge.

Autogenous bone block graft is the gold standard technique for alveolar bone augmentation. However, it is technique sensitive and associated with several complications. Exposure of block graft can affect the outcome of surgery and is challenging to manage. A patient diagnosed with Seibert Class III residual alveolar ridge was managed with autogenous bone block graft. Two dental implants were placed after obtaining sufficient ridge augmentation. The patient presented with exposure of bone block graft after implant placement. A full-thickness mucoperiosteal flap was elevated. Exposed bone was shaved and contoured using piezosurgery. A connective tissue graft with epithelial striation from palate was employed to cover the exposed graft and augment the keratinized tissue. Treatment resulted in complete coverage of block graft and gain in keratinized mucosal dimensions. Prosthetic rehabilitation using screw-retained 3 Unit Bridge was delivered. The results are sustained after 2 years, and the patient is being followed up.