Single Miller Class III recession treatment in the anterior maxilla

Introduction: Miller’s Class III gingival recession represents a challenging condition with a low predictability in order to obtain successful outcomes. The purpose of this case report is to document the management of an isolated Class III gingival recession (Rec) with Coronally Advanced Flap in combination with Subepithelial Connective Tissue Graft. Presentation of the case: A 45 years-old female with a 2 mm Rec associated with interproximal attachment loss at the upper left canine requested a dental cosmetic treatment for this area. A bilaminar technique was performed in order to solve the aesthetic impairment. Results at short (1 year) and long term (10 years) are reported. Discussion: At 1-year follow up a complete root coverage with no interproximal attachment loss was observed, with an increased amount of keratinized tissue width and thickness. Optimal aesthetic outcome was accomplished with complete patient satisfaction. However, at 10-year follow-up 1mm Rec on mesio-buccal and buccal sites associated to a non-carious cervical lesion (NCCL) were noticed, associated with a bruxism pattern in combination with a relapse of traumatic brushing technique and vigorous use of interdental brushes. At this time, reinstruction to the appropriate domiciliary oral hygiene procedures and a composite restoration were performed in order to solve the clinical condition. Conclusion: At 1-year follow-up Rec associated to attachment loss and NCCL can be successfully managed by means of bilaminar technique and conservative restorations. However, a careful assessment of prognostic factors must be considered in order to achieve successful treatment outcomes in the long-term

Remote ischemic preconditioning (RIPC) protects against endothelial dysfunction in a human model of systemic inflammation: a randomized clinical trial

Objective: Inflammation, oxidative stress, and endothelial dysfunction are known to contribute to ischemia-reperfusion injury. Remote ischemic preconditioning (RIPC) protects from endothelial dysfunction and the damage induced by ischemia-reperfusion. Using intensive periodontal treatment (IPT), an established human model of acute systemic inflammation, we investigated whether RIPC prevents endothelial dysfunction and modulates systemic levels of inflammation and oxidative stress. Approach and Results: Forty-nine participants with periodontitis were randomly allocated to receive either 3 cycles of ischemia-reperfusion on the upper limb (N=24, RIPC) or a sham procedure (N=25, control) before IPT. Endothelial function assessed by flow-mediated dilatation of the brachial artery, inflammatory cytokines, markers of vascular injury, and oxidative stress were evaluated at baseline, day 1, and day 7 after IPT. Twenty-four hours post-IPT, the RIPC group had lower levels of IL-10 (interleukin-10) and IL-12 (interleukin-12) compared with the control group (P<0.05). RIPC attenuated the IPT-induced increase in IL-1β (interleukin-1β), E-selectin, sICAM-3 (soluble intercellular adhesion molecule 3), and sTM (soluble thrombomodulin) levels between the baseline and day 1 (P for interaction <0.1). Conversely, oxidative stress was differentially increased at day1 in the RIPC group compared with the control group (P for interaction <0.1). This was accompanied by a better flow-mediated dilatation (mean difference 1.75% [95% CI, 0.428–3.07], P=0.011). After 7 days from IPT, most of the inflammatory markers, endothelial-dependent and -independent vasodilation, were similar between groups. Conclusions: RIPC prevented acute endothelial dysfunction by modulation of inflammation and oxidation processes in patients with periodontitis following exposure to an acute inflammatory stimulus

Assessment of information resources for people with hypodontia

Aim: To assess the adequacy of patient information to support understanding and decision-making for people affected by hypodontia. Methods: 1) Questionnaire to understand the provision of patient information by dentists; 2) Systematic search to identify online open-access patient information; 3) Quality assessment of written patient information. Results: Questionnaire response rate was 49% (319/649); 91% examined and/or treated people with hypodontia. Most general dentists referred patients to specialist services without providing written hypodontia information. The majority of dental specialists provide patient leaflets but less than a third used web-resources. Only 19% of respondents felt current resources were fit-for-purpose. Thirty-one patient resources (18 leaflets and 13 online) were assessed against quality criteria. The aim of the resource was seldom explicit, the content was often incomplete and variation in readability scores indicated high levels of literacy were required. Discussion: Access to, and quality of, patient information for hypodontia is inadequate. Current resources are not sufficiently comprehensive to prepare young patients to engage in shared dental care decisions with their parents and/or dental professionals. Conclusion: There is a need for improved access to, and provision of, information about hypodontia if dental professionals want to meet best practice guidance and involve patients in shared decision-making