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There are few large surveys of periodontal disease in young age cohorts, and national surveys in Africa do not exist. This study assessed the prevalence and severity of periodontal disease in a national survey of adolescents and young adults in Morocco.A multistage probability sampling design was used to draw a sample of 14,667 students 12-25 years old attending 87 schools. The sample was representative of approximately three million Moroccan students in this age group.A total of 27.9%, 11.9%, and 7.7% of the subjects had ≥1 teeth with ≥4, ≥5, and ≥6 mm probing depth, and the population estimates were ≈ 822,436, 349,961, and 226,297 affected subjects, respectively. For attachment loss, the prevalences were: 11.6%, 9.5%, and 6.9% (or ≈ 341,761, 281,043, and 203,977 affected subjects) for ≥4, ≥5, and ≥6 mm, respectively. The rates of probing depth and attachment loss increased significantly with the increase in age (p 0.01, p 0.001). Sex and urban status did not show significant effects on the prevalence of periodontal disease (p 0.05). Similarly, the relationship between the occupation status and periodontal status was modest and not statistically significant (p 0.05).Children and young adults attending public schools in Morocco have a high prevalence and severity of periodontal disease compared with other populations of similar age. The rate of periodontal disease reported here may be used as baseline population estimates in the surveillance of disease status in this population.

National surveys of periodontal diseases in children are rare. This study describes the first national survey of oral health of adolescents attending public schools in Morocco. We report the prevalence and demographic determinants of periodontal diseases, and generate population estimates for this young population.This study used a multi-stage probability sample comprising 14,667 students in 87 schools and 520 classrooms, representative of students attending grades 6-12 (age 12-18 years) in Morocco. The students were interviewed and then examined clinically to assess their periodontal status, which was classified according to the 2017 World Workshop. In addition, the diagnosis of aggressive periodontitis (AgP) was assessed.Of approximately 3 million students in this age cohort, 12.3% (or approximately 360,894 subjects) had periodontitis and 46.9% (1.4 million) had gingivitis. They comprised 10.8%, 2.9%, and 6.1% subjects with periodontitis stage I, II, and III/IV, respectively; 5.0%, or 148,336 subjects, had AgP. The prevalence rates were not significantly different by gender or urban status. However, the prevalence of AgP was particularly high in certain regions of Morocco.The prevalence of staged periodontitis and AgP in this young population is among the highest reported in national surveys worldwide.

Introduction. The prognosis for a successful treatment of gingival recessions (GRs) is one of the main criteria for deciding whether or not and how to perform root coverage surgery. The defect-related factors are the most important to predict root coverage outcomes. Thus, severe GR could make the root coverage (RC) challenging especially in cases with advanced interdental clinical attachment loss (ICAL). Case Presentation. This case report demonstrates a challenging management of a deep localized Miller Class III GR with root apex exposure associated with ICAL. After initial therapy, the treatment had consisted of a multidisciplinary approach involving endodontic treatment, periodontal plastic surgery including a laterally positioned flap, and orthodontic treatment. The 6-year follow-up showed improvement in clinical outcomes (recession reduction (RR) and keratinized tissue (KT) augmentation) and a higher patient satisfaction. Conclusions. This case report demonstrates the role of the multidisciplinary approach in the management of deep GRs associated with ICAL. A rational choice of the RC technique was critical to achieve good clinical outcomes.

Background To report the prevalence of peri-implant diseases in a North African patient population, and to assess the concurrent associations of patient- and implant-level characteristics with probing depth and bone loss around dental implants METHODS: A total of 642 implants in 145 subjects were followed up for a mean 6.4 years. At the last follow-up visit the subjects were examined clinically and radiographically to assess the status of peri-implant tissues and teeth. Data analysis used the generalized linear mixed models RESULTS: The prevalence of peri-implant mucositis and peri-implantitis were 82.1% and 41.4% at the subject level, and 68.4% and 22.7% at the implant level, respectively. Inadequate plaque control, peri-implant inflammation, history of previous implant failures, and pain/discomfort at the implant site were significantly associated with both outcomes (increased probing depth and bone loss). Diabetes mellitus, inadequate implant restoration, single restorations (versus multi-unit), cement-retained restorations, and presence of occlusal wear facets on teeth were significantly associated with one of the two outcomes. Implants placed in the lower anterior jaw region had the most favorable outcome. Smoking, history of periodontitis, and type of implant surface did not show significant associations with higher frequency of peri-implant diseases in the multivariable analysis. Conclusions Peri-implant diseases are prevalent in this North African patient population. Multiple subject- and implant-level variables were associated with peri-implant diseases. Risk assessment of these effects should consist of a concurrent inclusion of these factors in multivariable analyses that also adjust for the complex variance structure of the oral environment.

To date, there is no general consensus with respect to the amount of soft-tissue volume needed for esthetic and functional purposes on the buccal aspect of dental implants. Numerous studies have investigated the relationship between the width of keratinized mucosa and the health of peri-implant tissues. Our purpose was to discuss about the necessity of keratinized tissue to maintain the peri-implant health and to report clinical efficacy of different techniques used to increase the keratinized tissue around dental implants.

Necrotizing ulcerative gingivitis (NUG) is a typical form of periodontal diseases. It has an acute clinical presentation with the distinctive characteristics of rapid onset of interdental gingival necrosis, gingival pain, bleeding, and halitosis. Systemic symptoms such as lymphadenopathy and malaise could be also found. There are various predisposing factors such as stress, nutritional deficiencies, and immune system dysfunctions, especially, HIV infection that seems to play a major role in the pathogenesis of NUG. The treatment of NUG is organized in successive stages: first, the treatment of the acute phase that should be provided immediately to stop disease progression and to control patient's feeling of discomfort and pain; second, the treatment of the preexisting condition such as chronic gingivitis; then, the surgical correction of the disease sequelae like craters. Moreover, finally, maintenance phase that allows stable outcomes. This case report describes the diagnosis approach and the conservative management with a good outcome of NUG in a 21-year-old male patient with no systemic disease and probable mechanism of pathogenesis of two predisposing factors involved.

Although gingival recessions are usually diagnosed in individuals with good oral hygiene (see Chap. 1), there are limited data to support the impact of plaque control on the healing process and on the maintenance of gingival margin stability after root coverage procedures [1]. Zucchelli and de Sanctis [2] reported in their 5-year longitudinal clinical study that the lack of patient compliance with a supportive oral care regimen was significantly correlated to the recurrence of gingival recession. An optimal plaque control is desirable in order to maintain the clinical outcomes achieved by root coverage surgery.

According to a systematic review conducted by Zweers et al. [1], three gingival biotypes can be clinically distinguished: Normal, thin scalloped, and thick flat according to the differences in the shape, position, and thickness of the marginal periodontal tissues [2]. The authors reported that the dental, gingival, and bony dimensions represent a weak to moderate association. Uniform positive associations were found only between gingival thickness, keratinized tissue, and bone morphotype. Hence, the thin gingival biotype is characterized by a scalloped gingival outline, relatively thin with a narrow band of keratinized tissue. It confirms the finding of the in vivo study by Cook et al. [3] who found that thin gingival biotype was associated with narrow band of keratinized tissue, thin underlying buccal bone, and a big distance from cementoenamel junction to the bone crest (Figs. 2.1 and 2.2).

Root conditioning or root preparation was considered for many years as a fundamental principle and a step in surgical treatment of gingival recession defects [1–3]. This root treatment may be mechanical and/or chemical. The aims of mechanical root instrumentation are removing root caries [4], reducing root convexity [5, 6], reducing the cementum toxins [7], and smoothening the root surface [8] (Table 7.1). It was suggested that this mechanical treatment might enhance a close adaptation of the graft to the surface of the root, which was flattened [5, 6]. This intimate contact could consequently avoid flap shrinkage and graft exposure [14]. However, Saletta et al. [15] demonstrated that root instrumentation did not change root surface convexity, which could be flattened moderately.

Individual surgical skills may be considered as a potential factor that influences case selection and clinical outcomes [1–3]. Cairo et al. [4] reported in their systematic review high heterogeneity in mean root coverage of gingival recessions treated by coronally advanced flap procedures. It may be explained by the possible impact of surgical skills of different operators on the clinical results achieved.

Gingival overgrowth is a major and frequent unwanted effect accompanying the chronic usage of antihypertensive, anticonvulsant, and immunosuppressant drugs. The expression and the severity of this tissue-specific condition are influenced by a variety of factors, mainly drug and periodontal variables. Such increased volume of gingiva may compromise normal oral functions, aesthetics in addition to the patients’ ability to practice optimal oral hygiene. The management of gingival overgrowth includes nonsurgical approach, surgical approach, or both of them for severe cases of gingival overgrowth as well as drug withdrawal. This case report illustrates a successful nonsurgical management of a 21-year-old patient with cyclosporin A-induced gingival overgrowth who experienced a total regression of the gingival enlargement without any surgical procedure or drug substitution. And it highlights therefore the key role of supportive periodontal therapy in maintaining good and stable outcomes over 2 years of follow-up.

In the normal situation, the gingival margin draws a scalloped line located 1 or 2 mm coronally to the cementoenamel junction (CEJ) [1]. Gingival recession is a mucogingival defect referred to the buccal exposure of the root surface of the tooth as a consequence of an apical migration of the gingival margin up to the CEJ [2, 3]. This pathological process involves both gingiva and the underlying bone. Thus, bone dehiscence should be present for gingival recession to occur (intrinsic mechanism) [4]. In some situations, the gingival relapse could slightly expose underling bone. This situation could explain the extrinsic pathological mechanism of gingival recession [5].

Recession classification is a crucial parameter in studies assessing root coverage procedures [1]. Miller [2] has described four classes according to the prognosis of root coverage. The height of the interproximal soft and hard tissues is an important prognostic factor for root coverage. In Class I and II gingival recessions, Miller [2] suggested the possibility of complete root coverage (CRC) with the free gingival graft approach. Only partial root coverage could be predicted in Class III. However, root coverage is not possible in Class IV. Recently, Cairo et al. [1] introduced a new classification based on the amount of the interproximal clinical attachment loss (CAL). The interdental CAL could be considered as a viable parameter to evaluate the interproximal hard tissue resorption. This clinical tool is an important predictor of the clinical outcomes of the different root coverage surgical techniques used. It should be hypothesized that root coverage after surgery could not exceed the coronal level of interproximal CAL. For many years, it has been accepted that CRC couldn’t be achieved in gingival recessions associated with interdental hard tissue resorption (Miller Cl III and IV) [2]. However, recent studies [4, 5] demonstrated that CRC might be predictable also in Class III Miller gingival recessions. Hence, it was demonstrated by Cairo et al. [5] that CRC could be achieved in type 2 gingival recessions (GRT2). CRC could be obtained when interproximal CAL value is ≤3 mm. However, de Sanctis and Clementini [6] suggested in their meta-analysis that available data to support these findings are lacking.

Gingival recession is an oral exposure of the root surface due to an apical displacement of the gingival margin below the cemento-enamel junction. The root coverage is indicated for esthetic reasons, to reduce root hypersensitivity and to create or to augment keratinized tissue. Several surgical techniques have been described, the decision depending on anatomical and technical parameters. The main therapeutic goal is to achieve complete root coverage (CRC) and a satisfactory esthetic result. The purpose of this work was to make an update on the different factors that determine the success of root coverage and to evaluate the efficacy of different surgical techniques reported in literature.

Aim This study assessed the prevalence, clinical characteristics, and demographics of chronic and aggressive periodontitis in a representative sample drawn from a subpopulation in Morocco. Materials & methods Eight hundred and thirty students representative of 12+ years old attending schools in the Province of Benslimane, Morocco were selected by a multi-phased, probability sampling. Their age was 12-25 years (mean: 16.1 years) and comprised of 50% males and 50% females. Chronic and aggressive periodontitis were determined clinically. Results A total of 31% and 10.1% of the subjects had ≥4 mm and ≥6 mm attachment loss, respectively; 4.9% had aggressive periodontitis, and 6.4% had chronic periodontitis. Subjects with chronic periodontitis typically had 4-5 mm attachment loss affecting a few molars or premolars. Subjects with aggressive periodontitis had ≥5 mm attachment loss affecting multiple teeth, and 68% and 73% of these subjects had ≥6 mm attachment loss affecting maxillary and mandibular molars respectively. Attachment loss and periodontitis were significantly more prevalent in the 19-25 years group, than the 12-18 years age group. There were no significant differences in disease prevalence by gender or ethnic groups (Arab versus Berber). Conclusion This young Moroccan population is at high risk of destructive periodontal disease, and further studies are indicated to investigate the biological and environmental factors that may contribute to the increased risk of disease in this population.