Search

Background: Along with the popularity of dental implants, implant esthetic complications are also on the rise. Recently a classification was proposed to comprehensively evaluate these conditions, with the definition of peri-implant soft tissue dehiscence/deficiencies (PSTDs). The aim of this article was therefore to test the inter-examiner agreement when utilizing the established rubrics among 25 standardized cases and 34 clinicians of different skill levels., Methods: Twelve periodontal residents, 12 general dentists, and 10 periodontists participated in this study. All examiners were provided with photographs of 25 single PSTDs and asked to rate all cases based on the proposed classification at a single timepoint. Variance components analysis was conducted with multilevel regression fit in a Bayesian framework to obtain uncertainty intervals for fractional variance contributions and interclass correlation values (ICC) to assess the agreement in the rating of all cases, among all examiners, different skill-level practitioners, and to compare their responses relative to the judgment of a gold standard examiner., Results: Overall, the results showed reproducible and consistent responses among the 34 examiners, and in each subgroup of skill-level, comparable to that of the gold examiner. Nevertheless, periodontists and residents were more likely to agree with the response of the gold standard examiner in their assessments of class and subclass of the PSTDs., Conclusions: The proposed PSTD classification showed reproducible assessments among all examiners, and between examiners of the same skill-level. The response of the gold standard examiner was more in line with the assessment of the periodontists and periodontal residents., (© 2022 American Academy of Periodontology.)

The new classification of periodontal diseases recognizes the key role of the interdental clinical attachment for defining the periodontal status and the extent of disease severity. Regenerating interdental clinical attachment not only improves the prognosis of the tooth, but it also lessens the severity of the disease condition. This manuscript provides a state-of-the-art review on surgical reconstructive approaches for treating papillary deficiency associated with soft and hard tissue interproximal defects. Combination therapy of papilla preservation, connective tissue grafting, and coronally advanced flaps may result in regeneration of the intrabony defect coupled with root coverage. Future research highlighted here may have the potential, especially in combination approaches, to repair challenging interproximal soft and hard tissue deficiencies., (© 2020 American Academy of Periodontology.)

The cultivation of human living cells into scaffolding matrices has progressively gained popularity in the field of periodontal wound healing and regeneration. Living cellular constructs based on fibroblasts, keratinocytes alone or in combination have been developed and used as alternatives to autogenous soft tissue grafts in keratinized tissue augmentation and in root coverage procedures. Their promising advantages include reduced patient morbidity, unlimited graft availability, and comparable esthetics. This manuscript reviews soft tissue augmentation and root coverage procedures using bioengineered living cellular therapy and highlights their expected clinical, esthetic, and patient-related outcomes., (© 2019 American Academy of Periodontology.)

This manuscript provides a state-of-the-art review on the efficacy of biologics in root coverage procedures, including enamel matrix derivative, platelet-derived growth factor, platelet concentrates, and fibroblast-growth factor-2. The mechanism of action and the rationale for using biologics in periodontal plastic surgery, as well as their anticipated benefits when compared with conventional approaches are discussed. Although the clinical significance is still under investigation, preclinical data and histologic evidence demonstrate that biologic-based techniques are able to promote periodontal regeneration coupled with the provision of tooth root coverage., (© 2019 American Academy of Periodontology.)

The present article focuses on the properties and indications of scaffold-based extracellular matrix (ECM) technologies as alternatives to autogenous soft tissue grafts for periodontal and peri-implant plastic surgical reconstruction. The different processing methods for the creation of cell-free constructs resulting in preservation of the extracellular matrices influence the characteristics and behavior of scaffolding biomaterials. The aim of this review is to discuss the properties, clinical application, and limitations of ECM-based scaffold technologies in periodontal and peri-implant soft tissue augmentation when used as alternatives to autogenous soft tissue grafts., (© 2019 American Academy of Periodontology.)

This state-of-the-art review presents the latest evidence and the current status of autogenous soft tissue grafting for soft tissue augmentation and recession coverage at teeth and dental implant sites. The indications and predictability of the free gingival graft and connective tissue graft (CTG) techniques are highlighted, together with their expected clinical and esthetic outcomes. CTGs can be harvested from the maxillary tuberosity or from palate with different approaches that can have an impact on graft quality and patient morbidity. The influence of CTGs on soft tissue thickness and keratinized tissue width are also discussed., (© 2019 American Academy of Periodontology.)

Background: Tooth location has been shown to play a significant role on root coverage outcomes. However, whether this has an impact on the outcomes of coronally advanced flap (CAF) for treating multiple adjacent gingival recessions (MAGRs) remains to be determined. The aim of this study was to investigate the impact of tooth location, flap design, and flap extension on the outcomes of MAGRs following CAF with or without a connective tissue graft (CTG)., Methods: A re-analysis of six previously published clinical trials evaluating the outcomes of CAF in the treatment of MAGRs was performed using mixed regression and logistics to assess the influence of potentially influential factors on the treatment outcomes., Results: Six hundred and nine MAGRs in 166 patients were evaluated. The anterior maxilla (second sextant) was associated to the highest mean root coverage (mRC) and complete root coverage (CRC) outcome (P < 0.05). In addition, the maxillary teeth showed significantly greater mRC and CRC than teeth in the mandible (with the lower anterior [fifth sextant] showing the lowest outcomes) (P < 0.05). A higher mRC was observed for the anterior teeth compared with posterior dentition (P < 0.05). While CAF + CTG achieved better results than CAF alone, no differences were found when the flap was performed with or without vertical releasing incisions (P > 0.05). Lastly, teeth in the distal part of the flap showed lower mRC and CRC than teeth in the central or mesial position (P < 0.05)., Conclusions: Tooth location was found to play a key role in determining the amount of root coverage achievable, with maxillary canines and incisors being associated with the highest outcomes compared with other sextants. Maxillary MAGRs showed greater mRC and CRC than mandibular MAGRs., (© 2019 American Academy of Periodontology.)

Background: In the attempt to limit the post-surgery increase in buccal gingival recession (bREC), effect of a connective tissue graft (CTG) when combined with a buccal single flap approach (SFA) in the regenerative treatment of intraosseous defects is evaluated., Methods: Data related to 30 patients with an intraosseous defect treated with a buccal SFA with (SFA+CTG group; n = 15) or without (SFA group; n = 15) placement of a CTG and regenerative treatment were retrospectively derived at three clinical centers. bREC and probing parameters were assessed at presurgery and 6 months post-surgery., Results: In addition to a significant attachment gain and probing depth reduction, adjunctive use of a CTG to a buccal SFA in the regenerative treatment of periodontal intraosseous defects associated with a buccal bone dehiscence resulted in a limited post-surgery bREC, a lower prevalence of defects with a clinically detectable apical displacement of the gingival margin, and an increase in gingival width and thickness., Conclusion: Adjunctive use of a CTG in the regenerative treatment of intraosseous defects associated with buccal bone dehiscence accessed by buccal SFA may support the stability of the gingival profile., (© 2017 American Academy of Periodontology.)

Background: Oscillating-rotating power toothbrushes have been proven to be clinically efficacious. To the best of the authors' knowledge, a clinical evaluation of the safety of these toothbrushes after surgical root coverage procedures has not been published. The aim of this study is to evaluate the gingival margin (GM) stability with the use of an oscillating-rotating toothbrush compared with a manual toothbrush., Methods: Sixty healthy individuals with at least one Miller Class I or II gingival recession underwent a surgical root coverage procedure. Soft-bristle manual and powered toothbrushes were given to participants randomly assigned to control and test groups, respectively. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), and recession depth (RD) were recorded at baseline and 1, 3, and 6 months after completion of the surgical procedure. Data analyses were performed using linear random-intercept models to take into account within-participant correlations over time. Temporal trend differences across treatments by including treatment-time interaction terms were then tested using a global Wald test., Results: Use of a powered toothbrush resulted in a significantly greater reduction of recorded periodontal clinical indices compared with a manual device (FMPS, P = 0.05; FMBS, P = 0.005; RD, P = 0.004). No significant differences were noticed between the two experimental groups both for PD (P = 0.03) and clinical attachment level (P = 0.11). Complete root coverage was significantly higher in participants who used the powered toothbrush compared with the manual toothbrush at 6 months (control, 66.67%; test, 96.67%; P = 0.002)., Conclusion: Use of an oscillating-rotating powered toothbrush with a soft-bristle head resulted in higher GM stability after root coverage procedures compared with the use of a manual soft-bristled toothbrush.

Background: The aim of the present study is to evaluate the association of patient-related and site-specific factors, as well as the adopted treatment modality, with the change in buccal (bREC) and interdental (iREC) gingival recession observed at 6 months after treatment of periodontal intraosseous defects with the single flap approach (SFA)., Methods: Sixty-six patients contributing 74 intraosseous defects accessed with a buccal SFA and treated with different modalities were selected retrospectively. A two-level (patient and site) model was constructed, with the 6-month changes in bREC and iREC as the dependent variables., Results: (1) Significant 6-month increases in bREC (-0.6 ± 0.7 mm) and iREC (-0.9 ± 1.1 mm) were observed. (2) bREC change was significantly predicted by presurgery interproximal probing depth (PD) and depth of osseous dehiscence at the buccal aspect. (3) iREC change was significantly predicted by presurgery interproximal PD and the treatment modality, with defects treated with SFA in combination with a graft material and a bioactive agent being less prone to iREC increase compared to defects treated with SFA alone., Conclusions: After buccal SFA, greater post-surgery increase in bREC must be expected for deep intraosseous defects associated with a buccal dehiscence. The combination of a graft material and a bioactive agent in adjunct to the SFA may limit the postoperative increase in iREC.

Background: Soft tissue grafting for the purposes of increasing the width of keratinized tissue (KT) is an important aspect of periodontal treatment. A systematic review was analyzed, focusing on non-root coverage tissue grafts. The references were updated to reflect the current literature., Methods: To formulate the consensus report, group members submitted any new literature related to the topic that met criteria fitting the systematic review, and this information was reviewed for inclusion in this report. A consensus report was developed to summarize the findings from the systematic review and to guide clinicians in their treatment decision-making process., Results: Forty-six articles met the criteria for inclusion in the final analysis, and two articles were added that were used to formulate this consensus report. A list of eight clinically relevant questions was posed, and consensus statements were developed., Conclusions: The evidence suggests that a minimum amount of KT is not needed to prevent attachment loss (AL) when optimal plaque control is present. However, if plaque control is suboptimal, a minimum of 2 mm of KT is needed. The standard procedure to predictably gain KT is the autogenous gingival graft. There is limited evidence for alternative treatment options. However, additional research may offer promising results in certain clinical scenarios., Clinical Recommendations: Before patient treatment, the clinician should evaluate etiology, including the role of inflammation and various types of trauma that contribute to AL. The best outcome procedure (autograft) and alternative options should be reviewed with the patient during appropriate informed consent. Proper assessment of the outcome should be included during supportive periodontal care.

Background: Limited data exist on the longitudinal crestal bone changes around teeth compared with implants in partially edentulous patients. This study sought to compare the 10-year radiographic crestal bone changes (bone level [BL]) around teeth and implants in periodontally compromised (PCPs) and periodontally healthy (PHPs) patients., Methods: A total of 120 patients were evaluated for the radiographic crestal BL around dental implants and adjacent teeth at time of implant crown insertion and at the 10-year follow-up. Sixty patients had a previous history of periodontitis (PCPs), and the remaining 60 were PHPs. In each category (PCP and PHP), two different implant systems were used. The mean BL change at the implant and at the adjacent tooth at the interproximal area was calculated by subtracting the radiographic crestal BL at the time of crown cementation from the radiographic crestal BL at the 10-year follow-up., Results: At 10 years after therapy, the survival rate ranged from 80% to 95% for subgroups for implants, whereas it was 100% for the adjacent teeth. In all eight different patient categories evaluated, teeth demonstrated a significantly more stable radiographic BL compared with adjacent dental implants (teeth BL, 0.44 ± 0.23 mm; implant BL, 2.28 ± 0.72 mm; P <0.05). Radiographic BL changes around teeth seemed not to be influenced by the presence or absence of advanced bone loss (≥3 mm) at the adjacent implants., Conclusions: Natural teeth yielded better long-term results with respect to survival rate and marginal BL changes compared with dental implants. Moreover, these findings also extend to teeth with an initial reduced periodontal attachment level, provided adequate periodontal treatment and maintenance are performed. As a consequence, the decision of tooth extraction attributable to periodontal reasons in favor of a dental implant should be carefully considered in partially edentulous patients.

Background: The aim of this study is to evaluate the long-term benefits of regenerative therapy and which factors (i.e., smoking, oral hygiene, radiographic angle, tooth, clinical center, and biomaterial) influence results., Methods: A total of 120 infrabony defects were treated with guided tissue regeneration using bioabsorbable and non-resorbable membranes with grafts or enamel matrix derivative (EMD) proteins. At baseline, smoking, x-ray angle, probing depth (PD), recession, and clinical attachment level (CAL) were recorded. CAL was measured 1 year post-surgery and every 2 years for ≤16 years. The participation of patients in oral hygiene protocols was recorded., Results: The mean ± SD baseline CAL was 8.5 ± 2.3 mm, baseline PD was 7.8 ± 2.1 mm, and baseline x-ray angle was 31.8° ± 8.9°. One year post-surgery, CAL gain was 4.1 ± 2.1 mm. EMD was used in 47 defects, bioabsorbable membranes with deproteinized bovine bone were used in 41 cases, non-resorbable membranes were used in seven defects, bioabsorbable membranes and autogenous bone were used in five defects, and a combination was used in 20 defects. A total of 10% of subjects were smokers, and 20% of subjects did not participate in an oral hygiene program. The average follow-up was 9 years. A total of 90% teeth survival was achieved at 13 years, and CAL gain was maintained at 82% for 11 years. Statistical analyses demonstrated that smoking and oral hygiene maintenance influenced long-term outcomes. The x-ray angle, tooth, clinical center, and biomaterials did not influence results., Conclusions: Regenerative therapy provided a high percentage of long-term success. Smoking and non-participation in oral hygiene maintenance negatively influenced the prognosis, whereas other factors did not affect long-term results.

Background: The root coverage esthetic score (RES) system was proposed for evaluating esthetic outcomes of root coverage procedures. The aim of this multicenter study is to assess the interrater agreement of the RES among expert periodontists., Methods: Eleven periodontists were selected in different clinical centers. Each operator had ≥15 years of experience in mucogingival surgery. Each periodontist was trained to use RES before the beginning of the study. Subsequently, baseline and post-treatment (6 months) photographs of 41 Class I and II gingival recessions in 41 patients were separately given to each operator who evaluated the outcomes according to the RES method. A two-way random interclass correlation coefficient and 95% confidence interval (CI) were used to assess the global interrater agreement for RESs., Results: The total interrater agreement for RESs was 0.92 (95% CI: 0.88 to 0.95), which indicated that an almost perfect agreement was achieved., Conclusion: Tested individually by a group of periodontists, the RES seems to be a reliable method for assessing the esthetic outcomes of root coverage procedures.

Background: This prospective multicenter, randomized, controlled clinical trial compared the clinical outcomes of enamel matrix proteins (EMD) versus placement of a bioabsorbable membrane in conjunction with guided tissue regeneration (GTR)., Methods: Seventy-five patients with advanced chronic periodontitis were recruited in seven centers in three countries. All patients had at least one intrabony defect of > or = 3 mm. Heavy smokers (> or = 20 cigarettes/day) were excluded. The surgical procedures included access for root instrumentation using the simplified papilla preservation flap and either the application of EMD or the placement of a GTR membrane. At baseline and 1 year following the interventions, clinical attachment levels (CAL), probing depths (PD), recession (REC), full-mouth plaque scores, and full-mouth bleeding scores were assessed. A total of 67 patients completed the study., Results: At 1 year, the EMD defects gained 3.1 +/- 1.8 mm of CAL, versus 2.5 +/- 1.9 mm for GTR defects. Probing depth reduction was 3.8 +/- 1.5 mm and 3.3 +/- 1.5 mm, respectively. A multivariate analysis indicated that the differences between EMD and GTR treatments were not significant while a center effect and baseline PD significantly influenced CAL gains. No significant differences in terms of frequency distribution of the outcomes were observed. All cases treated with GTR presented at least one surgical complication, mostly membrane exposure, while only 6% of EMD treated sites displayed complications (P < 0.0001)., Conclusions: The results of this trial failed to demonstrate superiority of one treatment modality over the other. GTR outcomes in this trial were lower than anticipated based on previous evidence. This was attributed to the high prevalence of post-surgical complications in the GTR group.

The use of membranes for periodontal regeneration is well established. In clinical use, the exposure of membranes to the oral microflora may result in a pathway for periodontal infections. An important role in this process is played by Porphyromonas gingivalis. The purpose of the present study was to examine the colonization of 6 different bioresorbable and nonresorbable membranes for periodontal regeneration by the strain DSM 20709 of P. gingivalis and to determine the time needed by this microorganism to pass through the membranes. A device consisting of a tube sealed with the membranes and filled with a medium suitable for the growth of P. gingivalis was incubated in a bigger tube containing the same medium to study the process of colonization and the crossing of membranes. The outer tube was inoculated with 10(4) cells of P. gingivalis DSM 20709. The passage of bacteria through the membranes was monitored at 6, 24, and 48 hours by counting the number of cells in the inner tube. The colonized membranes were observed using a scanning electron microscope. Differences in the behavior of the 6 membranes analyzed were demonstrated.