Free Gingival Grafts: Graft Shrinkage and Donor-Site Healing in Smokers and Non-Smokers

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Background: This prospective clinical study aims to evaluate the influence of cigarette smoking on free gingival graft (FGG) healing, by assessing FGG dimensional changes and donor-site wound healing. Methods: Twelve non-smokers and 10 smokers treatment planned for FGG to augment keratinized tissue dimensions in the mandibular incisor area completed the study. All subjects received standardized FGG of same dimensions. Probing depth, gingival margin position, clinical attachment level, keratinized tissue (KT) width, gingival thickness, and FGG dimensions (width, length, and area) were assessed and recorded before surgery, and 7, 15, 30, 60, and 90 days postoperatively. The palatal donor area was evaluated for immediate bleeding and complete wound epithelialization. Differences between the two groups (smokers and non-smokers) were statistically analyzed. Results: FGG dimensions changed significantly postoperatively. At 90 days postoperatively, FGG width, length, and area were respectively reduced by 31%, 22%, and 44% in nonsmokers and by 44%, 25%, and 58% in smokers (no significant differences between groups; P>0.05). Significant KT increases were observed in both non-smokers and smokers (5.4 and 4.8 mm, respectively). Donor-site immediate bleeding was significantly more prevalent in non-smokers (75%) compared to smokers (30%) (P=0.04). At 15 days postoperatively, donor-site complete epithelialization was much more prevalent in non-smokers (92%) than in smokers (20%) (P<0.002). Conclusion: Smoking alters FGG donor-site wound healing by reducing immediate bleeding incidence and by delaying epithelialization, although it does not have discernible effects on postoperative FGG dimensional changes. J Periodontol 2010;81:692-701.815692701Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)CAPES [BEX 0573/06-0

Root surface biomodifiction with EDTA for the treatment of gingival recession with a semilunar coronally repositioned flap

Background: The purpose of this randomized clinical trial was to evaluate the outcome of gingival recession therapy using the semilunar coronally repositioned flap (SCRF) with or without EDTA application for root surface biomodification. Methods: Fifteen patients with bilateral Miller Class I buccal gingival recessions (<= 4.0 mm) were selected. Thirty teeth with recessions were assigned randomly to receive the semilunar coronally repositioned flap with (SCRF-E group) or without (SCRF group) the application of an EDTA gel. Recession height (RH), recession width (RW), width (WKT) and thickness of keratinized tissue, probing depth, and clinical attachment level (CAL) were measured at baseline and 6 months post-surgery. Patient perception of root sensitivity and postoperative pain also was evaluated. Results: Both treatments yielded significant improvements in terms of RH and RW decrease and CAL gain compared to baseline values. For SCRF-E and SCRF, the average root coverage was 70.2% and 90.1%, respectively (P= 0.01), and the complete root coverage was 40.0% and 66.7%, respectively. Only the SCRF group had a significant (P < 0.05) increase in WKT. The SCRF group showed a greater reduction (P < 0.05) in RW and RH compared to the SCRF-E group. No patient in either group reported any pain during the postoperative course; however, 6 months later, patients in the SCRF-E group complained more of residual or new root sensitivity compared to patients in the SCRF group. Conclusion: The use of EDTA gel as a root surface biomodifier agent negatively affected the outcome of root coverage with the SCRF.7891695170

A double-blind randomized clinical evaluation of enamel matrix derivative proteins for the treatment of proximal class-II furcation involvements

Objective: The aim of the present randomized, double-blind study was to evaluate the clinical response of proximal furcations treated with enamel matrix derivative proteins (EMD). Material and Methods: Fifteen patients, each with a pair of contralateral class-II proximal furcation involvements, presenting probing depths (PDs) >= 5 mm and bleeding on probing (BOP) were selected. The patients were randomly assigned to: control group (n=15) - open flap debridement (OFD)+24% ethylenediaminetetraacetic acid (EDTA) conditioning; test group (n=15) - OFD+24% EDTA conditioning+EMD application. Plaque index (PI), BOP, PD, gingival margin position (GMP), relative vertical and horizontal clinical attachment level (RVCAL and RHCAL), vertical and horizontal bone level (VBL and HBL) and furcation closure were evaluated immediately before and 2, 4 and 6 months after the surgeries. Results: At 6 months, the RVCAL gains of the control and test group were 0.39 +/- 1.00 and 0.54 +/- 0.95 mm, while the RHCAL gains were 1.21 +/- 2.28 and 1.36 +/- 1.26 mm (p > 0.05). The VBL and HBL gains of the control group were 1.04 +/- 1.12 and 1.00 +/- 1.79 mm, and 0.82 +/- 1.82 and 1.17 +/- 1.38 mm for the test group (p > 0.05). In addition, a statistical difference was observed in the number of the remaining class-II furcations between the test and control groups (p < 0.05) in this period. Conclusion: It may be concluded that the use of EMD in proximal furcations did not promote a superior reduction in PD or a gain in clinical and osseous attachment levels, but resulted in a higher rate of class-II to class-I furcation conversion.35542943

Hydroxyapatite/beta-tricalcium phosphate and enamel matrix derivative for treatment of proximal class II furcation defects: a randomized clinical trial

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Objective To clinically evaluate proximal furcations treated with hydroxyapatite/-tricalcium phosphate (HA/-TCP) isolated or combined with enamel matrix derivative (EMD). Material and Methods Thirty patients, presenting at least one proximal class II furcation defect, probing pocket depth (PPD) 5mm and bleeding on probing, were included. The defects were assigned to the HA/-TCP group (n=15); open-flap debridement (OFD)+HA/-TCP filling, or, HA/-TCP-EMD group (n=15); OFD+HA/-TCP+EMD filling. Plaque (PI) and gingival index (GI), PPD, relative gingival margin position (RGMP), vertical and horizontal attachment level (RVAL and RHAL), vertical and horizontal bone level (RVBL and RHBL), and furcation diagnosis were evaluated at baseline and at 6months. Results Both groups presented improvements after therapies (p0.05). At 6months, the gains in rVCAL in the HA/-TCP and HA/-TCP-EMD groups were 1.47 +/- 0.99 and 2.10 +/- 0.87mm, while the RHCAL gains were 1.47 +/- 1.46 and 1.57 +/- 1.58mm (p>0.05). The RVBL and RHBL gains for the HA/-TCP and HA/-TCP-EMD group were 1.47 +/- 1.13 and 1.70 +/- 1.26mm, and 1.90 +/- 1.11 and 1.70 +/- 1.37mm respectively (p>0.05). The HA/-TCP-EMD group showed seven closed furcations versus four in the HA/-TCP group (p>0.05). Conclusion Both treatments lead to improvements in all clinical variables studied in the present trial. However, the closure of proximal class II furcation defects is still unpredictable.403252259Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [08/56358-2

Radiographic characteristics of furcation involvements win mandibular molars as prognostic indicators of healing after nonsurgical periodontal therapy

Background. The authors conducted a study to evaluate the radiographic characteristics of Class II mandibular furcation involvements as prognostic indicators of healing after nonsurgical periodontal therapy. Methods. Twenty-three patients with chronic periodontitis (Class II furcation involvements in mandibular molars, probing pocket depth [PPD] of 5 millimeters or greater and bleeding on probing [BOP]) were selected to receive nonsurgical periodontal treatment. The authors evaluated visible plaque index, BOP, position of the gingival margin, PPD, relative attachment level (RAL) and relative horizontal attachment level. On radiographs, the authors measured root trunk, bone attachment level in the furcation region, lesion height (Lh), furcation width at alveolar crest level inside furcation (Fw) and 2 nun apical to the fornix (Fw2), and the perpendicular distance from the horizontal line connecting mesial and distal radiographic alveolar crest to furcation fornix. They analyzed all data using linear multiple regression. Results. Six months after treatment, the furcations showed a mean RAL gain of 1.08 mm (+/- 1.25 mm) and a PPD decrease of 2.74 mm (+/- 1.58 mm). The authors found a statistically significant influence between Fw and PPD (P = .0044), Fw2 and PPD (P = .0014), Lh and PPD (P = .0241), and Fw2 and RAL (P = .0037). Conclusions. Within the limitations of this study, the results suggest that Fw, Fw2 and Lh may influence the response of Class II mandibular furcations to nonsurgical periodontal therapy and may serve as prognostic indicators for this therapy. Thus, narrower and shorter root furcations would be expected to have better outcomes.140443444