Extracellular matrixâ based scaffolding technologies for periodontal and periâ implant soft tissue regeneration

The present article focuses on the properties and indications of scaffoldâ based extracellular matrix (ECM) technologies as alternatives to autogenous soft tissue grafts for periodontal and periâ implant plastic surgical reconstruction. The different processing methods for the creation of cellâ free constructs resulting in preservation of the extracellular matrices influence the characteristics and behavior of scaffolding biomaterials. The aim of this review is to discuss the properties, clinical application, and limitations of ECMâ based scaffold technologies in periodontal and periâ implant soft tissue augmentation when used as alternatives to autogenous soft tissue grafts.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153617/1/jper10427.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153617/2/jper10427_am.pd

The influence of tooth location on the outcomes of multiple adjacent gingival recessions treated with coronally advanced flap: A multicenter reâ analysis study

BackgroundTooth location has been shown to play a significant role on root coverage outcomes. However, whether this has an impact on the outcomes of coronally advanced flap (CAF) for treating multiple adjacent gingival recessions (MAGRs) remains to be determined. The aim of this study was to investigate the impact of tooth location, flap design, and flap extension on the outcomes of MAGRs following CAF with or without a connective tissue graft (CTG).MethodsA reâ analysis of six previously published clinical trials evaluating the outcomes of CAF in the treatment of MAGRs was performed using mixed regression and logistics to assess the influence of potentially influential factors on the treatment outcomes.ResultsSix hundred and nine MAGRs in 166 patients were evaluated. The anterior maxilla (second sextant) was associated to the highest mean root coverage (mRC) and complete root coverage (CRC) outcome (P  0.05). Lastly, teeth in the distal part of the flap showed lower mRC and CRC than teeth in the central or mesial position (P < 0.05).ConclusionsTooth location was found to play a key role in determining the amount of root coverage achievable, with maxillary canines and incisors being associated with the highest outcomes compared with other sextants. Maxillary MAGRs showed greater mRC and CRC than mandibular MAGRs.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153060/1/jper10366_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153060/2/jper10366.pd

Aesthetic- And patient- related outcomes following root coverage procedures: A systematic review and network meta- analysis

BackgroundAim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self- reported morbidity (post- operative pain/discomfort).Material and MethodsA comprehensive literature search was performed. A mixed- modelling approach to network meta- analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient- reported satisfaction and post- operative pain/discomfort (visual analogue scale (VAS) of 100).ResultsTwenty- six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p = .005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p = .01) and CAF + Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p = .04)) were significantly associated with higher RES than CAF. No significant difference between CAF + CTG and TUN + CTG was detected (0.09 (95% CI [- 0.54, 0.72], p = .77)). Addition of CTG resulted in less natural tissue texture (- 0.21 (95% CI [- 0.34, - 0.08]), p = .003) and gingival colour (- 0.06 (95% CI [- 0.12, - 0.03], p = .03)) than CAF. CTG techniques were associated with increased morbidity.ConclusionsConnective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG- based techniques were also correlated with a greater patient satisfaction and morbidity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163404/2/jcpe13346.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163404/1/jcpe13346_am.pd

Autogenous soft tissue grafting for periodontal and periâ implant plastic surgical reconstruction

This stateâ ofâ theâ art review presents the latest evidence and the current status of autogenous soft tissue grafting for soft tissue augmentation and recession coverage at teeth and dental implant sites. The indications and predictability of the free gingival graft and connective tissue graft (CTG) techniques are highlighted, together with their expected clinical and esthetic outcomes. CTGs can be harvested from the maxillary tuberosity or from palate with different approaches that can have an impact on graft quality and patient morbidity. The influence of CTGs on soft tissue thickness and keratinized tissue width are also discussed.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153773/1/jper10428_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153773/2/jper10428.pd

Living cellâ based regenerative medicine technologies for periodontal soft tissue augmentation

The cultivation of human living cells into scaffolding matrices has progressively gained popularity in the field of periodontal wound healing and regeneration. Living cellular constructs based on fibroblasts, keratinocytes alone or in combination have been developed and used as alternatives to autogenous soft tissue grafts in keratinized tissue augmentation and in root coverage procedures. Their promising advantages include reduced patient morbidity, unlimited graft availability, and comparable esthetics. This manuscript reviews soft tissue augmentation and root coverage procedures using bioengineered living cellular therapy and highlights their expected clinical, esthetic, and patientâ related outcomes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154237/1/jper10429.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154237/2/jper10429_am.pd

Biologicsâ based regenerative technologies for periodontal soft tissue engineering

This manuscript provides a stateâ ofâ theâ art review on the efficacy of biologics in root coverage procedures, including enamel matrix derivative, plateletâ derived growth factor, platelet concentrates, and fibroblastâ growth factorâ 2. The mechanism of action and the rationale for using biologics in periodontal plastic surgery, as well as their anticipated benefits when compared with conventional approaches are discussed. Although the clinical significance is still under investigation, preclinical data and histologic evidence demonstrate that biologicâ based techniques are able to promote periodontal regeneration coupled with the provision of tooth root coverage.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154295/1/jper10426_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154295/2/jper10426.pd

Implant soft tissue Dehiscence coverage Esthetic Score (IDES): A pilot within- and between-rater analysis of consistency in objective and subjective scores

Objectives: To introduce an esthetic index for assessing the outcomes of peri-implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within- and between-reviewer reliability. Materials and methods: Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post-treatment level of the soft tissue margin, peri-implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its four clinical variables. Results: Regression models showed reproducible esthetic evaluation among the examiners (inter-reliability) and negligible intra-reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters' IDES values, and their subjective esthetic response, by the same raters. Conclusion: The IDES showed persistent judgment among the 4 reviewers, and only a slight intra-reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/169153/1/Zucchelli, Barootchi et al. 2021 IDES.pdfSEL

Evaluation of DNA methylation of inflammatory genes following treatment of chronic periodontitis: A pilot case–control study

ObjectiveTo evaluate the influence of periodontal therapy on DNA methylation in patients with chronic periodontitis as compared to healthy individuals.Material and MethodsTwenty patients were enrolled into two groups: (i) 10 diagnosed as clinically healthy; and (ii) 10 diagnosed with chronic periodontitis. Clinical measures were recorded and gingival biopsies were harvested at baseline (both patient groups) and at 2 and 8 weeks post‐baseline for diseased individuals. Molecular DNA methylation analysis was performed by pyrosequencing for the putative inflammation‐associated genes LINE‐1, COX‐2, IFN‐γ and TNF‐α. Random‐intercept linear regression models were applied to evaluate methylation levels across groups at baseline and the methylation changes over time in the diseased and normal tissues.ResultsPeriodontal therapy did not influence gene expression methylation of TNF‐α, IFN‐γ and LINE‐1 levels at normal and periodontitis sites over time. However, it significantly reduced COX‐2 methylation levels comparable to healthy individuals at both 2 and 8 weeks post‐treatment (p < .05).ConclusionsPeriodontal therapy resets the DNA methylation status of inflammatory gene for COX‐2 in patients with periodontal disease. DNA methylation levels of TNF‐α, IFN‐γ and LINE‐1 were sustained in periodontitis sites despite therapy. Future studies should consider an expanded panel of inflammatory genes over time. (ClinicalTrials.gov NCT02835898).Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138219/1/jcpe12783.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138219/2/jcpe12783_am.pd

How efficacious is the combination of substitute bone graft with autogenous bone graft in comparison with substitute bone graft alone in the horizontal bone gain? A systematic review and meta-analysis

A systematic review (SR) was conducted to answer the following focused question based on PICO strategy: In patients who were submitted to horizontal guided bone regeneration, ?how efficacious is the combination of substitute bone graft with autogenous bo