Periodontal Conditions of Sites Treated With Gingival Augmentation Surgery Compared With Untreated Contralateral Homologous Sites: An 18- to 35-Year Long-Term Study

BACKGROUND: The aim of this split-mouth study is to compare long-term (18 to 35 years) periodontal conditions of sites treated with gingival augmentation procedures (GAPs) and untreated homologous contralateral sites. METHODS: Forty-seven patients with 64 sites (test group), with lack of attached gingiva associated with recessions, were treated with marginal or submarginal free gingival grafts. Sixty-four contralateral homologous sites (control group), with or without gingival recession (GR) and with attached gingiva, were left untreated. Patients were recalled every 4 to 6 months during follow-up period. GR depth, keratinized tissue (KT) width, and probing depth were measured at baseline (T0), 1 year after surgery (T1), during follow-up (10 to 27 years, T2), and at the end of the follow-up period (18 to 35 years, T3). Multilevel and regression analyses were conducted. RESULTS: At the end of T3, 83% of the 64 treated sites showed recession reduction (RecRed), whereas 48% of the 64 untreated sites experienced increase in recession. Treated sites ended with gingival margin (GM) 1.7 mm (P = 0.01) more coronal and KT 3.3 mm (P <0.001) wider than untreated sites. In grafted sites, KT at T3 remained stable compared with T1 value (4.1 mm, P <0.001). CONCLUSIONS: Sites treated with GAPs resulted in coronal displacement of GM with RecRed up to complete root coverage, whereas contralateral untreated sites showed a tendency to increase in existing recession or develop new recession during the 18- to 35-year follow-up

State of the science on controversial topics: orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting).

BACKGROUND: Controversy exists in the literature between the role of orthodontic treatment and gingival recession. Whilst movement of teeth outside the alveolar bone has been reported as a risk factor for gingival recession, others have found no such association. FINDINGS: The Angle Society of Europe devoted a study day to explore the evidence surrounding these controversies. The aim of the day was for a panel of experts to evaluate the current evidence base in relation to either the beneficial or detrimental effects of orthodontic treatment on the gingival tissue. CONCLUSIONS: There remains a relatively weak evidence base for the role of orthodontic treatment and gingival recession and thus a need to undertake a risk assessment and appropriate consent prior to the commencement of treatment. In further prospective, well designed trials are needed

Bovine pericardium based non-cross linked collagen matrix for successful root coverage, a clinical study in human

Introduction: The aim of this study was to clinically assess the capacity of a novel bovine pericardium based, non-cross linked collagen matrix in root coverage. Methods: 62 gingival recessions of Miller class I or II were treated. The matrix was adapted underneath a coronal repositioned split thickness flap. Clinical values were assessed at baseline and after six months. Results: The mean recession in each patient was 2.2 mm at baseline. 6 Months after surgery 86.7% of the exposed root surfaces were covered. On average 0,3 mm of recession remained. The clinical attachment level changed from 3.5 ± 1.3 mm to 1,8 ( ± 0,7) mm during the observational time period. No statistically significant difference was found in the difference of probing depth. An increase in the width of gingiva was significant. With a baseline value of 1.5 ± 0.9 mm an improvement of 2.4 ± 0.8 mm after six month could be observed. 40 out of 62 recessions were considered a thin biotype at baseline. After 6 months all 62 sites were assessed thick. Conclusions: The results demonstrate the capacity of the bovine pericardium based non-cross linked collagen matrix for successful root coverage. This material was able to enhance gingival thickness and the width of keratinized gingiva. The percentage of root coverage achieved thereby is comparable to existing techniques. This method might contribute to an increase of patient's comfort and an enhanced aesthetical outcome

Periodontal regeneration of human infrabony defects (V). Effect of oral hygiene on long-term stability.

The aim of this investigation was to assess the role of supportive periodontal care in the maintenance of clinical attachment gained, after surgical treatment according to the principles of GTR, in deep infrabony defects. Following GTR treatment, 40 deep infrabony defects in 23 patients gained 4.1 mm of probing attachment level (PAL) after 1 year of stringent plaque control. In the subsequent 3 years, 15 patients (22 sites, group A) were recalled every 3 months. In this group, the gained attachment level remained stable. Conversely, 8 patients (18 sites, group B), who received only sporadic care, lost at 4 years, 2.8 +/- 2.7 mm of the PAL gained at 1 year. Group A patients had significantly lower full mouth plaque and bleeding scores than group B at 4 years. Furthermore, detection of bleeding on probing, plaque, P. gingivalis and P. intermedia was significantly more frequent in regenerated sites of group B patients. Risk assessment analysis indicated that GTR sites in patients receiving only sporadic care had a 50-fold increase in risk of PAL loss between 1 and 4 years with respect to patients undergoing regular recall. It was concluded that stability of gained clinical attachment was dependent upon stringent oral hygiene.Link_to_subscribed_fulltex

Interproximal free gingival grafts after membrane removal in guided tissue regeneration treatment of intrabony defects. A randomized controlled clinical trial.

The purpose of this controlled clinical trial was to compare the efficacy of two surgical approaches to protect the regenerated tissue following membrane removal in guided tissue regeneration (GTR) treated intrabony defects. Twenty-eight (28) defects, one each in 28 patients were randomly assigned after placement of the membrane to one of two treatment groups by blocking to prognostic variables. The test group received free gingival grafts on the interproximal regenerated tissue. In the control group the surgical flaps were coronally positioned over the regenerated tissue. The two groups were well balanced with respect to all prognostic variables. The results indicated that: 1) similar amounts of regenerated tissue were obtained in the two groups at membrane removal (7.6 +/- 2.8 mm, test; 8.3 +/- 2.3 mm, control); 2) a significantly greater amount of probing attachment level gain was observed in the test group (5.0 +/- 2.1 mm, test; 3.7 +/- 2.1 mm, control). This study indicated that placement of free gingival grafts on the interdental regenerated tissue further improves the clinical outcome of GTR in deep intrabony defects.Link_to_subscribed_fulltex