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The introduction of a new collagen substitute, which will potentially reduce the invasiveness of techniques by avoiding the need for a second surgical site (ie, the donor site), needs to be evaluated in relation to the surgical procedure that could benefit the most by utilizing such a matrix. This study compared the clinical outcomes following treatment of RT1 multiple adjacent gingival recessions (MAGRs) using the modified coronally advanced tunnel (MCAT) technique or the multiple coronally advanced flap (MCAF) in conjunction with a new volume-stable xenogeneic collagen matrix (VXCM). Secondarily, the study evaluated whether patients report a preference between the two surgical techniques in terms of discomfort. A total of 20 patients requiring treatment of MAGRs were randomly assigned to one of the two treatment groups: MCAF+VCMX (Group A) or MCAT+VCMX (Group B). The following measurements were recorded at baseline (before surgery) and at 6 and 12 months: gingival recession depth (REC), probing pocket depth (PD), keratinized tissue width (KTW), and gingival thickness (GT). Postoperative pain and discomfort were recorded using a visual analog scale (VAS) at 1 week. The primary outcome variable was mean root coverage (mRC), and secondary outcomes were complete root coverage (CRC), changes in KTW and GT, patient discomfort and satisfaction, and duration of surgery. Healing was uneventful in both groups. At 12 months, both treatments resulted in statistically significant improvements in REC and GT compared to baseline (P < .05). The mRC was 79.95% ± 29.92% in the MCAF group and 64.74% ± 40.5% in the MCAT group (P = .124). CRC was seen in 65.6% of MCAF-treated sites and 52% of MCAT-treated sites (P = .181). Similar clinical results should be expected when MAGRs are treated with MCAF or MCAT, with the adjunct of VCMX. [ABSTRACT FROM AUTHOR]

The aim of this report is to describe a new sling suturing method with papillary anchorage that is clinically applicable within the available conventional root-coverage tunneling procedures. Although caution is advised to not increase excessive tension on the fragile papilla tips, as they provide coronal and palatal suspension, the tension used with this method ascertains a firm and stable connection for the entire buccogingival graft complex into the horizontal and vertical dimensions of both single and multiple recession defects. This technical note describes the "trapezoidal sling suture" technique, which allows fixation and stabilization for the graft and flap around both natural teeth and implants. [ABSTRACT FROM AUTHOR]

Multiple adjacent gingival recessions (MAGRs) are commonly treated with autogenous grafts. However, several intra- and postsurgical complications have been described following autogenous grafts, leading clinicians to explore the use of different biomaterials to treat these conditions. The aim of the present study was to evaluate the root coverage outcomes of a novel porcine-derived acellular dermal matrix (PADM) in combination with the tunneled coronally advanced flap (TCAF) for the treatment of MAGRs. Ten patients with 33 type 1 recession defects (RT1s) were treated with PADM + TCAF. The outcomes of interest included the mean root coverage (mRC), the frequency of complete root coverage (CRC), changes in keratinized tissue width, volumetric gain at the treated sites (assessed with digital intraoral scanning), and patient-reported outcome measures. All treated sites healed uneventfully, and no complications were noted throughout the study. At 6 months, a statistically significant reduction in recession was noted at the treated sites, exhibiting an overall mRC of 89.14% ± 19.15% and a CRC of 72.7%. The average volume gain after 6 months was 26.28 ± 11.71 mm3, and the mean distance between the surface/mean thickness of the reconstructed volume (DD) was 0.63 ± 0.28 mm. The region-specific volumetric analysis revealed an overall higher linear dimensional gain at the midroot aspect (range: 0.72 to 0.78 mm, assessed 1 to 4 mm apical to the cementoenamel junction) compared to the other regions. The present study presents the clinical and volumetric outcomes of PADM + TCAF for the treatment of MAGRs. A significant amount of volumetric gain was also observed at 6 months as a result of the treatment, along with satisfactory esthetic and patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Gingival recession treatment is one of the major clinical challenges in periodontics, and various surgical techniques have been proposed to correct it. Most of these techniques are suitable for isolated recession sites and involve harvesting an autogenous tissue graft, which increases patient morbidity and might result in inferior esthetics due to incision design. This study assessed the benefit of adding platelet-rich fibrin (PRF) to the vestibular incision subperiosteal tunneling approach (VISTA) in treating multiple gingival recession compared to using VISTA alone. A total of 41 teeth with Miller Class I and II defects were randomized in a split-mouth design. Multiple clinical parameters were tested, including the change in gingival thickness over time, keratinized tissue width, and gingival phenotype (using the transparency of a periodontal probe). Patient-centered outcomes were also assessed via visual analog scale. Multiple Miller Class I and II recessions in the maxilla can be effectively treated with VISTA. However, when used in conjunction with PRF, no significant differences were detected in any parameter. VISTA has been shown to be associated with a low level of postsurgical pain for patients and can be used for patients with high esthetic demands. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the soft tissue response to the placement of additively manufactured subperiosteal jaw implants (AMSJI) in the severely atrophic maxilla and to identify possible risk factors for soft tissue breakdown. Materials and Methods: An international multicenter study was conducted, and 15 men (mean age: 64.62 years; SD: ± 6.75) and 25 women (mean age: 65.24 years; SD: ± 6.77) with advanced maxillary jaw resorption (Cawood and Howell Class V or more) were included in this study. General patient data were collected, and all subjects were clinically examined. Inclusion criteria were patients who underwent bilateral AMSJI placement in the maxilla at least 1 year prior. Exclusion criteria were patients who did not have patient, surgeon, or dentist consent to participate in the study before their inclusion. Results: A total of 40 patients were enrolled, with a mean follow-up period of 917 days (SD: ± 306.89 days). Primary implant stability was achieved postoperatively in all cases, and all implants were loaded with a final prosthesis. At the time of the study, only 1 patient showed mobility (> 1 mm) of the bilateral AMSJI. Due to mucosal recession, exposure of the framework was seen in 26 patients (65%) and was mainly in the left (21.43% of 26) and right (18.57% of 26) midlateral region. A thin biotype and the presence of mucositis were found to be risk factors (P < .05). Although not significant, smokers had a risk of developing a recession that was nearly seven times (odds ratio: 6.88; P = .08) greater than that of nonsmokers. Conclusions: Twenty-six (65%) patients presented with a recession in one (or more) of the seven regions after oral rehabilitation with bilateral AMSJI placement. Several risk drivers were evaluated. The collapse of soft tissues around the AMSJI that led to caudal exposure of the arms was correlated with a thin biotype and the presence of mucositis. [ABSTRACT FROM AUTHOR]

The anterior mandible is the most challenging anatomical site for performing periodontal plastic surgeries. Increased demands for optimal root coverage and esthetic outcomes contribute to the development of pedicle flap-based surgical solutions, in contrast to the predominantly used free gingival graft. The aims of this study were to (1) summarize the current literature to identify the most-used techniques, indications, and their efficacy, and (2) provide a decision table for surgeons to navigate through the selection of appropriate techniques. Four main approaches were identified: free gingival graft, lateral sliding, tunneling, and coronally advanced flap. The flap approaches are mostly combined with a connective tissue graft. The decision table considers the patient's chief complaint, local anatomical factors, and technique sensitivity. The table provides a framework for supporting an evidence-based selection of surgical techniques and for studying novel methods to achieve predictable root coverage in the anterior mandible. [ABSTRACT FROM AUTHOR]

The aim of this study was to present a periodontal plastic surgery approach to treat gingival recessions (GRs) and correct mandibular incisor mucogingival conditions and deformities. Isolated deep GRs (≥ 3 mm) in the mandibular incisors (n = 24 teeth) were treated: 66.6% of sites were recession types 2 or 3, and 58.3% of teeth were malpositioned. Recessions were treated using free mucogingival grafts (FMGs) harvested from the buccal aspect of donor teeth with altered passive eruption or healthy periodontal support, with < 3 mm between the cementoenamel junction and the buccal alveolar crest. Clinical parameters (GR, clinical attachment level, interproximal papilla tip location, keratinized tissue, vestibule depth) and root coverage esthetic score were evaluated at 9 months. FMG significantly reduced GR (P < .001) and increased keratinized tissue (P < .001) without loss of vestibule depth (P > .05). Mean root coverage was 94.37% ± 10.60%, mean residual GR was 0.08 ± 0.65 mm, and the mean root coverage esthetic score was 8.9 ± 1.24. Recession types 2/3 showed significant interproximal clinical attachment gain (P < .05). The interproximal papilla was significantly augmented at sites with papilla loss (P < .001). No clinical attachment loss (P = .346) was detected at donor sites. These results suggest that FMG is a promising root coverage approach for recession types 1, 2, and 3, correcting mucogingival conditions and deformities and reconstructing the interproximal papilla. [ABSTRACT FROM AUTHOR]

Objective: Currently, there is no established treatment protocol to treat interdental papillary loss. This research aimed to evaluate the outcomes of interdental papillary reconstruction using minimally invasive surgery, with injectable hyaluronic acid gel. Method and materials: Seventeen patients were included, each with five sites of class 1 papillary recession (40 sites in the maxilla and 45 sites in the mandible). Subperiosteal tunneling was performed through a horizontal incision made apical to the base of the papilla without penetrating it. The free gingival sulcus was sealed by 000 retraction cord. A total of 0.2 to 0.6 mL hyaluronic acid was injected gradually. The incision was sutured with poly-glycolic sutures. Treated sites underwent clinical and digital evaluation at three follow-up time points (1 month, 3 months, and 6 months). Results: The interdental papillary defect height in the maxillary sites significantly reduced by 60%, 66%, and 42% at 1,3, and 6 months, respectively. In mandibular sites, the reduction was 54%, 55%, and 40% at the same follow-up time points. Regarding interdental papillary defect surface area in the maxilla, the reduction was 65%, 71%, and 45% at 1, 3, and 6 months. In the mandible, a reduction of 60%, 64%, and 48% was noticed at the same time points. Regarding patients' pain level score, during the day of surgery, 16 patients reported pain; the average pain score out of 10 was 3.94, and 11 patients (64.7%) needed to take analgesics. The pain generally subsided in the following days. At the day of treatment, 12 out of the 17 patients (70.6%) reported mild difficulty in speaking and eating. No complication, hypersensitivity, or allergy was noted in any patient. Conclusion: Subperiosteal tunneling with hyaluronic acid injection demonstrates clinical improvements in papilla height and papillary recession surface area reduction after 3 months of follow-up, with reduction in improvement after 6 months. Clinical significance: Adjunctive use of hyaluronic acid injection with minimally invasive surgery in interdental papillary management may improve clinical and esthetic outcomes. [ABSTRACT FROM AUTHOR]

Surgical treatment of infrabony defects may result in gingival recession of the neighboring teeth. The aim of this clinical report is to describe a surgical technique to promote gingival margin stability in the treatment of infrabony defects at sites with a thin or medium gingival phenotype. A coronally advanced entire papilla preservation (CA-EPP) flap with a connective tissue graft (CTG) was executed in two different clinical cases. This technique substantially improved interproximal clinical attachment level and pocket closure, with no gingival recession. A CA-EPP flap using a CTG may promote gingival margin stability and can be recommended in regenerative periodontal procedures. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to describe a novel protocol for a minimally invasive pocket elimination surgery (MI-PES) in the posterior maxilla and mandible, which consists of the combined use of (1) an access flap based on an internally beveled gingivectomy with minimal to no papilla mobilization at the buccal aspect, and (2) a resective procedure with an apically positioned flap on the lingual aspect. The interproximal bone defects were accessed with a single (lingual) flap, and the bone architecture was modified by the adoption of piezoelectric inserts for controlled bone recontouring associated with fiber retention. Mean probing depth (PD) was 5.5 ± 0.8 mm before surgery and 2.7 ± 0.6 mm at the 6-month reevaluation. All treated pockets showed a postsurgical PD < 4 mm. Gingival recession (REC) was 0.3 ± 0.5 mm at baseline and increased to 1.6 ± 0.8 mm at 6 months. When buccal and lingual pockets were analyzed separately, a trend toward a similar PD reduction, less REC increase, and greater clinical attachment level gain was recorded for buccal pockets. These preliminary observations seem to support the use of MI-PES as a valuable option for pocket elimination, at least when residual pockets are associated with a shallow interproximal osseous crater in the posterior maxilla or mandible. [ABSTRACT FROM AUTHOR]