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

Guided tissue regeneration in gingival recessions

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Periodontal Plastic Surgery to Improve Aesthetics in Patients with Altered Passive Eruption/Gummy Smile: A Case Series Study

Altered passive eruption/gummy smile is a common challenge in patients requiring aesthetic treatment. A specific surgical protocol was designed and tested in patients with altered passive eruption. Standardized preoperative X-rays were used to assess crown length at baseline and to place submarginal incisions. Osseous respective therapy was performed to achieve biological width. Clinical outcomes were recorded 6 months after surgery. Eleven patients with a total of 58 teeth were treated with flap surgery and osseous resective therapy at upper anterior natural teeth. At the last followup, a significant and stable improvement of crown length was obtained when compared to the baseline (P < 0.0001). All patients rated as satisfactory in the final outcomes (final VAS value = 86.6). In conclusion, this study showed that periodontal plastic surgery including osseous resection leads to predictable outcomes in the treatment of altered passive eruption/gummy smile: A careful preoperative planning avoids unpleasant complications and enhances postsurgical stability of the gingival margin

Periodontal pathogens in atheromatous plaques. A controlled clinical and laboratory trial.

OBJECTIVE: A possible relationship between periodontitis and cardiovascular disease has been suggested. The aims of this controlled clinical study were: (i) to ascertain the presence of periodontal bacteria DNA [Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis (formerly Bacteroides forsythus)] in carotid atheromatous plaques and (ii) to assess the concomitant presence of the same periodontal bacteria DNA, if any, in periodontal pockets and in carotid atheroma in the same patient. METHODS: A total of 52 patients scheduled for carotid endarderectomy were enrolled in this study. The test group consisted of 26 dentate patients; the control group included 26 edentulous patients. A complete periodontal examination, including radiographic orthopanoramic and subgingival plaque sample, was performed in the test population. Oral and X-ray examinations were performed in the control group. Atheromatous plaques were harvested during surgical procedure for each dentate and edentulous patient and then sent to the microbiological laboratory. Subgingival plaque samples and carotid specimens were examined using the polymerase chain reaction (PCR) technique by means of specific primers for periodontal bacteria. Amplification of extracted DNA was tested using human beta-globin specific-primers. RESULTS: Out of 52 endarterectomy samples, 12 (seven dentate, five edentulous patients) were excluded as negative to DNA amplification. In subgingival plaque samples of 19 test patients, T. forsythensis (79%), F. nucleatum (63%), P. intermedia (53%), P. gingivalis (37%) and A. actinomycetemcomitans (5%) were found. No periodontal bacteria DNA was detected by PCR in any of the carotid samples in either patient group. CONCLUSION: The presence of periodontal bacteria DNA in atheromatous plaques could not be confirmed by this study and thus no correlation could be established between species associated with periodontal disease and putative bacteria contributing to atheromatous plaques

Clinical and anatomical factors limiting treatment outcomes of gingival recession: a new method to predetermine the line of root coverage.

Complete root coverage is not always achievable, even in gingival recession with no loss of interproximal attachment and bone. The cemento-enamel junction is the most widely used referring parameter to evaluate root coverage results. The aim of the present study was to describe the most frequent diagnostic mistakes that may lead to incomplete root coverage in Miller Class I and II gingival recessions and to suggest a method to predetermine the level/line of root coverage in non-molar teeth. The line of root coverage (i.e., the level/line to which the soft tissue margin will be positioned after the healing process of a root coverage surgical technique) was predetermined by calculating the ideal vertical dimension of the interdental papilla of the tooth with the recession defect. This method was applied to 120 recession-type defects affecting non-molar teeth of 80 young healthy subjects that were treated with root coverage surgical procedures over the last 5 years. All recessions were Miller Class I or II and were associated with at least one of the following characteristics: 1) traumatic loss of the tip of the interdental papilla(e); 2) tooth rotation; 3) tooth extrusion with or without occlusal abrasion; and 4) a cervical abrasion defect with no evidence of the cemento-enamel junction. The line of root coverage may be considered the clinical cemento-enamel junction because it may substitute the anatomic cemento-enamel junction when this is no longer clinically visible on the tooth with recession or when the ideal conditions to obtain complete root coverage are not fully represented