bromochloroacetic-acid and Periodontal-Pocket

Previous systematic reviews have reported that the use of a coronally advanced flap (CAF) combined with a connective tissue graft (CTG) or enamel matrix derivative (EMD) is more likely to achieve complete root coverage (CRC) than other modalities. However, the details of periodontal parameters and comparisons among a variety of combinations of CAF with CTG and/or EMD are left to be investigated. This study aimed to analyze the differences in periodontal parameters between these treatment modalities.. A literature search was performed using the Cochrane library and MEDLINE (PubMed) for studies focused on the treatment of gingival recession (Miller Class I, II and III) with CAF alone or combined with CTG, EMD or both up to December 2011. Randomized controlled clinical trials with a follow-up duration ≥ 6 mo were included. The outcome analysis included changes in periodontal probing depth (PPD), clinical attachment level, recession depth (RED) and keratinized tissue width (KTW).. Thirteen randomized controlled clinical trials, including 529 Miller Class I-III defects from 321 patients were included. For an increase in KTW, CAF + CTG significantly improved more than CAF alone. CAF + EMD also gained more KTW than CAF alone. EMD reduced PPD, however, a significant difference was not found. Furthermore, the effects on changes of RED and clinical attachment level were not identified in the study.. When combined with CAF, CTG contributed more in the increase of KTW, while EMD seemed helpful for wound healing by its potential in PPD reduction. However, further research is needed to clarify the effects on changes in RED and clinical attachment level.

Topics: Connective Tissue; Dental Enamel Proteins; Gingiva; Gingival Recession; Humans; Keratins; Periodontal Attachment Loss; Periodontal Pocket; Randomized Controlled Trials as Topic; Surgical Flaps; Tooth Root

The objective of the present review was to analyze the literature with regard to the need for keratinized mucosa around implants to maintain health and tissue stability.. Human and animal studies were identified through electronic and hand searches. Predetermined outcome measures were (i) implant loss, (ii) peri-implant health, (iii) oral hygiene, (iv) soft-tissue recession, (v) change in marginal bone level, and (vi) patient-centered outcomes. With respect to outcome variables, change in "attachment level", soft-tissue recession and change in peri-implant bone level were only retrieved from longitudinal studies. For remaining parameters, cross-sectional studies were also considered.. Nineteen relevant publications were identified (17 human and 2 animal studies). Due to marked heterogeneity in study design and reported data, no statistical analysis of retrieved data was feasible. Twelve human studies reported plaque scores for sites with "adequate" (≥2 mm) and "inadequate" (<2 mm) width of keratinized mucosa, and in five studies, an "inadequate" width was associated with a significant higher plaque score. Half of the studies showed significantly higher bleeding scores at implants with < 2 mm of keratinized mucosa, while the majority of publications (8 of 10) found no differences for probing depths. Two of three longitudinal studies reporting on recessions described no long-term differences with regard to the amount of keratinized mucosa. Evidence on the effect of keratinized mucosa on bone-level changes or implant loss was scarce, and no conclusions could be drawn. No article reporting patient-centered outcomes could be identified.. Collectively, the findings of this review show that evidence in support of the need for keratinized tissues around implants to maintain health and tissue stability is limited.

Topics: Alveolar Bone Loss; Animals; Dental Implants; Dental Plaque Index; Dental Restoration Failure; Gingiva; Gingival Recession; Humans; Keratins; Mouth Mucosa; Oral Hygiene; Periodontal Attachment Loss; Periodontal Pocket; Wound Healing

The aim of the present study was to assess the efficacy of acellular dermal matrix (ADM) and subepithelial connective tissue grafts (sCTG) in the treatment of Miller class I and II gingival recession (GR) defects.. Six patients with eight GR sites were randomly assigned to the test group (GR defects treated with ADM) and control group (GR defects treated with sCTG). Recession height (RH) and width, probing depth, keratinized gingiva, clinical attachment level, and full mouth plaque and bleeding scores were measured at baseline, 3 and 6 months.. The differences in mean changes were insignificant between the two groups in all parameters. In both groups, improvements from baseline to 3 and 6 months were significant for mean RH reduction and clinical attachment gain. A significant increase in the mean keratinized gingiva width was observed in both groups at 3 and 6 months.. ADM and sCTG yield similar outcomes when used in the treatment of GR defects.

Topics: Acellular Dermis; Adult; Asian People; Connective Tissue; Dental Plaque Index; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Malaysia; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Skin Transplantation; Tooth Root; Treatment Outcome; Young Adult

The aim of this split-mouth clinical trial was to compare the effectiveness of Apically Positioned Flap with Fibre Retention Osseous Resective Surgery (FibReORS) or Osseous Resective Surgery (ORS) in the treatment of periodontal pockets associated with intrabony defects ≤ 3 mm at posterior natural teeth.. Twenty-six posterior sextants requiring osseous resective surgery were selected in 13 chronic periodontitis patients: 13 sextants were randomly assigned to ORS and 13 to FibReORS. Clinical evaluation of probing depth (PD), gingival recession and clinical attachment level was performed at baseline, 6 and 12 months postoperatively. Periapical radiographs were taken prior and after surgical treatment, at 6- and 12-month follow-up.. Ostectomy amounted to 1.0 ± 0.3 mm in the ORS group and to 0.4 ± 0.2 mm in the FibReORS group. At 12-month examination PD changes did not significantly differ between the experimental groups. ORS group showed significantly (p < 0.001) greater clinical attachment loss (2.2 ± 1.0 mm versus 1.0 ± 0.6 mm), radiographic bone resorption (0.43 ± 0.08 mm versus 0.13 ± 0.09 mm) and post-operative patient discomfort compared to FibReORS.. FibReORS resulted in similar PD reduction, but less ostectomy, clinical attachment loss and patient morbidity compared to ORS.

Topics: Adult; Alveolar Bone Loss; Alveolectomy; Attitude to Health; Chronic Periodontitis; Dental Plaque Index; Double-Blind Method; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Middle Aged; Pain, Postoperative; Periodontal Attachment Loss; Periodontal Index; Periodontal Ligament; Periodontal Pocket; Prospective Studies; Radiography, Bitewing; Surgical Flaps; Treatment Outcome

The aim of this study was to assess soft-tissue re-growth following Fibre Retention Osseous Resective Surgery (FibReORS) or Osseous Resective Surgery (ORS) over a 12-month healing period.. Thirty patients with chronic periodontitis showing persistent periodontal pockets at posterior natural teeth after cause-related therapy were enroled. Periodontal pockets were associated with infrabony defect ≤3 mm; 15 patients were randomly assigned to FibReORS (test group) and 15 to ORS (control group). Measurements were performed by a blind and calibrated examiner. Soft-tissue rebound after flap suture was monitored by changes in gingival recession at 1-, 3-, 6-, and 12- month follow-up. Multilevel analysis considering patient, site, and time levels was performed.. Greater osseous resection during surgery and higher post surgical gingival recession was observed in the ORS group. The mean amount of soft-tissue rebound following surgery was 2.5 mm for ORS-treated sites and 2.2 mm for FibReORS-treated sites. Approximately 90% of the coronal re-growth was detectable after 6 months for both procedures. The interaction between ORS and time of observation showed a higher soft-tissue rebound after 12 months (p = 0.0233) for ORS-treated sites.. Both procedures showed a similar coronal soft-tissue re-growth with a significant higher recession reduction for ORS-treated sites. Significant clinical stability of the gingival margin is obtained 6 months after surgery for both procedures.

Topics: Adult; Alveolar Bone Loss; Alveolar Process; Alveolectomy; Chronic Periodontitis; Dental Plaque Index; Female; Follow-Up Studies; Gingiva; Gingival Recession; Gingivoplasty; Humans; Keratins; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Single-Blind Method; Surgical Flaps; Tooth Cervix; Tooth Mobility; Treatment Outcome; Wound Healing

The aim of this study was to assess the stability of root coverage outcomes 3 years after Connective Tissue Graft (CTG) plus Coronally Advanced Flap (CAF) or CAF alone at single maxillary gingival recession with minimal inter-dental clinical attachment loss.. Twenty-four of the original 29 patients, 13 treated with CAF + CTG and 11 with CAF, were available for the 3-year follow-up. Measurements were performed by a blind and calibrated examiner. Outcome measures included complete root coverage (CRC), recession reduction (RecRed), Root coverage Esthetic Score (RES) and Keratinized Tissue (KT) Gain. Visual Analogue Scale (VAS) was used to evaluate patient satisfaction.. After 3 years, CAF + CTG resulted in better outcomes in terms of CRC (p = 0.0054) than CAF alone. No difference was detected in terms of RecRed, RES score and VAS values. Furthermore, CAF + CTG was associated with higher KT gain than CAF at the last follow-up (p < 0.0001).. Root coverage outcomes in single gingival recession with inter-dental CAL loss are stable after 3 years. The application of CTG under CAF was associated with increased probability to obtain CRC than CAF alone at the final follow-up.

Topics: Adult; Aged; Alveolar Process; Connective Tissue; Esthetics, Dental; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Maxilla; Middle Aged; Patient Satisfaction; Periodontal Attachment Loss; Periodontal Pocket; Radiography, Bitewing; Single-Blind Method; Surgical Flaps; Tooth Cervix; Tooth Root; Treatment Outcome; Visual Analog Scale

This randomized clinical trial assessed the effect of three different prosthetic abutments (titanium, gold-hue titanium and zirconia) on peri-implant soft tissue 2 years after treatment in partially edentulous subjects.. Baseline data concerning (1) thickness of the buccal peri-implant soft tissue, (2) soft tissue thickness above the bone crest, (3) depth/length of transmucosal pathway, and (4) periodontal biotype at adjacent teeth were collected. The final sample consisted of 47 subjects (21 males, 26 females) with a total of 97 implants. A two-level (patient, implant) statistical model was applied.. At the 2-year clinical observation, recession of the gingival margin was observed only at 13% of implants irrespective of the type of abutment. No significant correlation between periodontal biotype at adjacent teeth and peri-implant biotype was observed. Furthermore, none of the investigated variables at patient level (age, gender, implant type, periodontal biotype) or at implant level (keratinized tissue thickness, probing depth, soft tissue thickness) was identified as a significant predictor of recession. In conclusion, this study pointed out that (1) abutment type was not able to influence peri-implant variables after 2 years, and (2) caution should be used in considering periodontal biotype at patient level as a possible indicator of the future peri-implant biotype.

Topics: Adult; Age Factors; Aged; Alveolar Bone Loss; Dental Abutments; Dental Alloys; Dental Implants; Dental Materials; Dental Prosthesis Design; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Jaw, Edentulous, Partially; Keratins; Male; Middle Aged; Periodontal Pocket; Periodontium; Sex Factors; Titanium; Treatment Outcome; Young Adult; Zirconium

The aim of this study was to compare short- and long-term root coverage and aesthetic outcomes of the coronally advanced flap (CAF) alone or in combination with a connective tissue graft (CTG) for the treatment of multiple gingival recessions.. Fifty patients with multiple (≥2) adjacent gingival recessions (≥2 mm) in the upper jaw were enrolled. Twenty-five patients were randomly assigned to the control group (CAF), and the other 25 patients to the test group (CAF + CTG). Clinical outcomes were evaluated at 6 months, 1 and 5 years. The aesthetic evaluations were made 1 and 5 years after the surgery.. No statistically significant difference was demonstrated between the two groups in terms of Rec Red and complete root coverage (CRC) at 6 months and 1 year. At 5 years, statistically greater recession reduction and probability of CRC, greater increase in buccal KTH and better contour evaluation made by an independent periodontist were observed in the CAF + CTG group. Better post-operative course and better colour match were demonstrated in CAF-treated patients both at 1 and 5 years.. CAF + CTG provided better CRC at 5 years; keloid formation due to graft exposure was responsible for the worse colour match evaluation.

Topics: Adult; Color; Connective Tissue; Double-Blind Method; Esthetics, Dental; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Longitudinal Studies; Male; Operative Time; Pain, Postoperative; Periodontal Attachment Loss; Periodontal Pocket; Surgical Flaps; Tooth Root; Treatment Outcome; Young Adult

In a previously reported split-mouth, randomized controlled trial, Miller Class II gingival recession defects were treated with either a connective tissue graft (CTG) (control) or recombinant human platelet-derived growth factor-BB + β-tricalcium phosphate (test), both in combination with a coronally advanced flap (CAF). At 6 months, multiple outcome measures were examined. The purpose of the current study is to examine the major efficacy parameters at 5 years.. Twenty of the original 30 patients were available for follow-up 5 years after the original surgery. Outcomes examined were recession depth, probing depth, clinical attachment level (CAL), height of keratinized tissue (wKT), and percentage of root coverage. Within- and across-treatment group results at 6 months and 5 years were compared with original baseline values.. At 5 years, all quantitative parameters for both treatment protocols showed statistically significant improvements over baseline. The primary outcome parameter, change in recession depth at 5 years, demonstrated statistically significant improvements in recession over baseline, although intergroup comparisons favored the control group at both 6 months and 5 years. At 5 years, intergroup comparisons also favored the test group for percentage root coverage and change in wKT, whereas no statistically significant intergroup differences were seen for 100% root coverage and changes to CAL.. In the present 5-year investigation, treatment with either test or control treatments for Miller Class II recession defects appear to lead to stable, clinically effective results, although CTG + CAF resulted in greater reductions in recession, greater percentage of root coverage, and increased wKT.

Topics: Adult; Aged; Becaplermin; Biocompatible Materials; Calcium Phosphates; Color; Connective Tissue; Dentin Sensitivity; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Middle Aged; Patient Satisfaction; Periodontal Attachment Loss; Periodontal Pocket; Proto-Oncogene Proteins c-sis; Recombinant Proteins; Surgical Flaps; Tooth Root; Treatment Outcome

Primary aim of this study was to evaluate if patient morbidity was improved by diminishing graft thickness and height; secondary objective was to evaluate if such graft modifications influence root coverage and aesthetic outcomes.. 60 Miller class I and II gingival recessions (GR) (≥ 3 mm in depth) were treated with the coronally advanced flap plus extraoral de-epithelialized free gingival graft (FGG). In 30 randomly selected control GRs ("big graft group"), the FGG thickness was ≥ 2 mm and the height was equal to bone dehiscence (BD); in the other 30 test defects ("small graft group"), the thickness of the FGG was <2 mm and the height was 4 mm. The post-operative patient morbidity was assessed 1 week after the surgery. The clinical and aesthetic evaluations were performed 1 year after the surgery.. Lower analgesic assumption, better post-operative course evaluations, better patient colour match scores and better periodontist aesthetic assessments were reported in the "small graft" group. No statistically significant differences were demonstrated between the two groups in terms of recession reduction, CRC and increase in KTH. Greater GT increase was obtained in the control-treated sites.. Coronally advanced flap plus CTG of reduced thickness and height was associated with less patient morbidity, better aesthetic evaluations with no difference in RC outcomes.

Topics: Alveolar Process; Analgesics, Non-Narcotic; Double-Blind Method; Esthetics, Dental; Follow-Up Studies; Free Tissue Flaps; Gingiva; Gingival Recession; Humans; Ibuprofen; Keratins; Pain, Postoperative; Patient Satisfaction; Periodontal Attachment Loss; Periodontal Pocket; Pilot Projects; Postoperative Complications; Postoperative Hemorrhage; Surgical Flaps; Tooth Root; Treatment Outcome

The aim of this study was to compare the clinical and aesthetic outcomes of two different surgical approaches for the treatment of deep gingival recession affecting the mandibular incisors.. Fifty patients with Miller class I and II gingival recessions (≥ 3 mm) in the lower incisors were enrolled. Twenty-five patients were randomly assigned to the control group and the other 25 patients to the test group. All defects were treated with the coronally advanced flap + connective tissue graft (CAF + CTG) and in the test group the labial submucosal tissue (LST) was removed. Post-operative morbidity was evaluated at 1 week. Clinical and aesthetic evaluations were made at 1 year.. Statistically greater recession reduction, probability of CRC (adjusted OR 7.94 95% CI = 1.88-33.50, p = 0.0024) and greater increase in GT were observed in the test group. Greater graft exposure and increase in KTH were demonstrated in the control group. Better aesthetics outcomes were observed in the test group. No statistically significant between groups differences were demonstrated in patient analgesic assumption and post-operative discomfort and bleeding.. LST removal during CAF + CTG surgery is indicated to provide better root coverage and aesthetic outcomes in the treatment of gingival recessions affecting the lower incisors.

Topics: Alveolar Process; Connective Tissue; Dental Plaque Index; Double-Blind Method; Esthetics, Dental; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Incisor; Keratins; Male; Mandible; Pain, Postoperative; Patient Satisfaction; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Pilot Projects; Postoperative Hemorrhage; Surgical Flaps; Tooth Root; Treatment Outcome

The aim of this randomized controlled clinical study is to investigate whether a modified surgical technique could provide better results for root coverage and greater amounts of keratinized tissue (KT) with the acellular dermal matrix graft (ADMG).. Fifteen bilateral Miller Class I or II gingival recessions (GRs) were selected. The recessions were treated and assigned randomly to the test group (TG), and the contralateral recessions were assigned to the control group (CG). The ADMG was used in both groups with differences in the graft positioning between them. The following clinical parameters were measured before the surgeries and after 12 months: 1) probing depth; 2) relative clinical attachment level; 3) GR; 4) thickness of KT (TKT); and 5) KT width. A new parameter, the GR area (GRA), was measured in standardized photographs using a special device and software.. There was no significant difference between groups in KT width and TKT parameters at the 12-month postoperative period. However, there was a significant difference between the gains in GR (ΔGR) and GRA (ΔGRA), favoring the TG after 12 months. The TG presented ΔGR = 3.04 ± 0.29 mm and ΔGRA= 38,919 ± 9,238 pixel square values (pix(2)), and the CG presented ΔGR= 2.61 ± 0.41 mm and ΔGRA= 22,245 ± 9,334 pix(2) (P <0.05 and <0.001, respectively).. Both techniques were successful. The TG treatment was more effective in reducing GR and GRA. The flap and graft position may be of importance in root coverage procedures outcome.

Topics: Acellular Dermis; Adult; Allografts; Connective Tissue; Female; Follow-Up Studies; Gingiva; Gingival Recession; Gingivoplasty; Humans; Keratins; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Skin Transplantation; Surgical Flaps; Tooth Root; Treatment Outcome; Young Adult

Numerous surgical approaches for the treatment of single gingival recession (GR) defects are documented in the literature. The aim of this 5-year, split mouth-design, randomized clinical trial was to evaluate the effectiveness of coronally advanced flap (CAF) alone versus CAF with connective tissue graft (CAF+CTG) in the treatment of single Miller Class I and II GR defects.. Thirty-seven patients with 114 bilateral, single Miller Class I and II GR defects were treated with CAF on one side of the mouth and CAF+CTG on the other side. Clinical measurements (GR length [REC], keratinized tissue width [KT], complete root coverage [CRC], and percentage of root coverage [PRC]) were evaluated before surgery and after 6, 12, 24, and 60 months.. There was a significant reduction of REC and increase of KT after surgery in both groups. CAF+CTG showed significantly better results for all evaluated clinical parameters in all observed follow-up periods. Miller Class I defects showed better results in terms of REC, CRC, and PRC, whereas Miller Class II showed better results in KT, both in favor of CAF+CTG. Miller Class I defects showed better results than Miller Class II GR defects regardless of the surgical procedure used.. Both surgical procedures were effective in the treatment of single Miller Class I and II GR defects. The CAF+CTG procedure provided better long-term outcomes (60 months postoperatively) than CAF alone. Long-term stability of the gingival margin is less predictable for Miller Class II GR defects compared to those of Class I.

Topics: Adult; Connective Tissue; Dental Plaque Index; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Longitudinal Studies; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Surgical Flaps; Tooth Cervix; Tooth Root; Treatment Outcome; Young Adult

A newly developed collagen matrix (CM) of porcine origin has been shown to represent a potential alternative to palatal connective tissue grafts (CTG) for the treatment of single Miller Class I and II gingival recessions when used in conjunction with a coronally advanced flap (CAF). However, at present it remains unknown to what extent CM may represent a valuable alternative to CTG in the treatment of Miller Class I and II multiple adjacent gingival recessions (MAGR). The aim of this study was to compare the clinical outcomes following treatment of Miller Class I and II MAGR using the modified coronally advanced tunnel technique (MCAT) in conjunction with either CM or CTG.. Twenty-two patients with a total of 156 Miller Class I and II gingival recessions were included in this study. Recessions were randomly treated according to a split-mouth design by means of MCAT + CM (test) or MCAT + CTG (control). The following measurements were recorded at baseline (i.e. prior to surgery) and at 12 months: Gingival Recession Depth (GRD), Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Keratinized Tissue Width (KTW), Gingival Recession Width (GRW) and Gingival Thickness (GT). GT was measured 3-mm apical to the gingival margin. Patient acceptance was recorded using a Visual Analogue Scale (VAS). The primary outcome variable was Complete Root Coverage (CRC), secondary outcomes were Mean Root Coverage (MRC), change in KTW, GT, patient acceptance and duration of surgery.. Healing was uneventful in both groups. No adverse reactions at any of the sites were observed. At 12 months, both treatments resulted in statistically significant improvements of CRC, MRC, KTW and GT compared with baseline (p < 0.05). CRC was found at 42% of test sites and at 85% of control sites respectively (p < 0.05). MRC measured 71 ± 21% mm at test sites versus 90 ± 18% mm at control sites (p < 0.05). Mean KTW measured 2.4 ± 0.7 mm at test sites versus 2.7 ± 0.8 mm at control sites (p > 0.05). At test sites, GT values changed from 0.8 ± 0.2 to 1.0 ± 0.3 mm, and at control sites from 0.8 ± 0.3 to 1.3 ± 0.4 mm (p < 0.05). Duration of surgery and patient morbidity was statistically significantly lower in the test compared with the control group respectively (p < 0.05).. The present findings indicate that the use of CM may represent an alternative to CTG by reducing surgical time and patient morbidity, but yielded lower CRC than CTG in the treatment of Miller Class I and II MAGR when used in conjunction with MCAT.

Topics: Absorbable Implants; Collagen; Connective Tissue; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Operative Time; Patient Satisfaction; Periodontal Attachment Loss; Periodontal Pocket; Prospective Studies; Root Planing; Surgical Flaps; Tooth Root; Treatment Outcome

The purpose of this randomised controlled trial is to compare the efficacy of two techniques for enhancing peri-implant keratinised mucosa: acellular dermal matrix allograft versus free gingival grafts.. Thirty-six patients having implant sites with less than 1.5 mm of keratinised mucosa width were randomly assigned to two groups. Thirty-six implants placed in 18 patients received acellular dermal matrix allografts (ADM group), while 36 implants placed in 18 individuals received free gingival grafts (FGG group). Plaque index (PI), gingival index (GI), probing depth (PD) and the width of attached mucosa (WAM) were measured at baseline and at 1, 3 and 6 months following surgery.. WAM in the FGG group was significantly greater than the ADM group at 3 (P = 0.026) and 6 months (P < 0.001). In the FGG group, final gain of WAM was greater (1.58 mm in ADM group, 2.57 mm in FGG group) (P < 0.001) and postoperative relapse was smaller (2.68 mm in the ADM group, 1.73 mm in the FGG group) (P < 0.001). PI and GI scores were greater in the ADM group at 6 months (P = 0.016 and P = 0.61, respectively). The FGG group demonstrated a greater PD value at 3 months (P < 0.001), however there was no significant difference between the groups at 6 months (P = 0.317).. Although ADM allografts are capable of increasing the width of peri-implant keratinised mucosa, FGGs seem to be more effective. ADM allografts may be the application of choice at implant sites in need of major grafts and in patients where a donor site should be avoided for medical or psychological reasons.

Topics: Acellular Dermis; Dental Implants; Dental Plaque Index; Double-Blind Method; Female; Follow-Up Studies; Gingiva; Gingivoplasty; Humans; Keratins; Male; Middle Aged; Periodontal Index; Periodontal Pocket; Recurrence; Skin Transplantation; Transplantation, Homologous; Treatment Outcome

The aim of this investigation was to evaluate the significance of keratinized mucosa (KM) around dental implants both clinically and biochemically for 12 months.. Fifteen edentulous patients treated with implant-retained overdentures in edentulous mandible (four implants per patient). Based on the presence of keratinized mucosa on the buccal surfaces, implants were divided into two groups: Implants having minimal 2 mm of KM on their buccal surfaces and implants having no KM on their buccal surfaces. Thirty-six implants were included in the evaluations; 19 implants in 15 patients had minimal 2 mm of KM on their buccal surfaces and 17 implants in 15 patients had no KM on their buccal surfaces. Clinical measurements of Plaque Index, Gingival Index, probing depths, and Bleeding on Probing were performed and peri-implant crevicular fluid (PICF) were collected immediately before loading (baseline) and at 6th, 12th months after loading. Interleukin-1 beta (IL-1 β) and tumor necrosis factor-alpha (TNF-α) have been assessed in the crevicular fluid. Results were analyzed by repeated-measures of variance (ANOVA) and Wilcoxon signed rank tests.. After 12 months of evaluation the results of ANOVA showed that implants with KM had lower levels of TNF-α total amounts than implants without KM (P < 0.05). Additionally, TNF-α total amounts were significantly higher at 12(th)  month compared to baseline for implants without KM (P < 0.05). Plaque index and Gingival index values were also found significantly higher for implants without KM (P < 0.05). For IL-1 β and PICF volume levels the differences between the implant groups were non significant, whereas the differences between the periods were significant. (P < 0.05) Additionally, both of the groups had higher levels of PII and BoP scores when compared to baseline (P < 0.05).. The results of this study showed that an adequate band of keratinized mucosa was related with less plaque accumulation and mucosal inflammation as well as pro-inflammatuar mediators, suggesting that it may be critical especially for plaque control and plaque associated mucosal lesions around dental implants.

Topics: Dental Implants; Dental Plaque Index; Dental Prosthesis, Implant-Supported; Denture, Complete, Lower; Denture, Overlay; Female; Follow-Up Studies; Gingiva; Gingival Crevicular Fluid; Gingival Hemorrhage; Humans; Inflammation Mediators; Interleukin-1beta; Jaw, Edentulous; Keratins; Male; Mandible; Middle Aged; Mouth Mucosa; Periodontal Index; Periodontal Pocket; Prospective Studies; Tumor Necrosis Factor-alpha

The aim of this study was to compare the long-term clinical effects produced by subepithelial connective tissue graft (SCTG) and guided tissue regeneration combined with demineralized freeze-dried bone allograft (GTR-DFDBA) in the treatment of gingival recessions in a 30-month follow-up clinical trial.. Twenty-four defects were treated in 12 patients who presented canine or pre-molar Miller class I and/or II bilateral gingival recessions. GTR-DFDBA and SCTG treatments were performed in a randomized selection in a split-mouth design. The clinical measurements included root coverage (RC), gingival recession (GR), probing depth (PD), clinical attachment level (CAL) and keratinized tissue width (KTW). These clinical parameters were evaluated at baseline and after 6, 18 and 30months post-surgery.. The changes in RC, GR, PD and CAL did not show significant differences between groups (p>0.05). Both procedures promoted similar RC (GTR-DFDBA: 87% and SCTG: 95.5%) and similar reduction in GR (GTR-DFDBA: 3.25mm and SCTG: 3.9mm), PD (GTR-DFDBA: 1.6mm and SCTG: 1.2mm) and CAL (GTR-DFDBA: 4.9mm and SCTG: 5.0mm). The increase in KTW was significantly higher (p=0.02) in the SCTG group (3.5mm) than in the GTR-DFDBA group (2.4mm).. Both techniques for treatment of gingival recession (SCTG and GTR-DFDBA) lead to favourable and long-term stable results, but SCTG promoted a more favourable increase in keratinized tissue.

Topics: Absorbable Implants; Adult; Bicuspid; Bone Transplantation; Connective Tissue; Cuspid; Female; Follow-Up Studies; Gingiva; Gingival Recession; Guided Tissue Regeneration, Periodontal; Humans; Keratins; Longitudinal Studies; Male; Membranes, Artificial; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Tooth Root; Treatment Outcome

The aim of this study was to evaluate whether the combination of enamel matrix derivative (EMD) with subepithelial connective tissue graft (SCTG) plus coronally advanced flap (CAF) would improve the treatment outcomes of Miller class I and II gingival recessions when compared with the same technique (SCTG plus CAF) alone.. The study was designed as a randomized, parallel, controlled, double-blinded clinical trial. Forty-two patients were randomly assigned in the test group (SCTG plus EMD) and in the control group (SCTG). Patients had at least one gingival recession ≥ 2 mm. The clinical parameters were evaluated at baseline and at 14 d, 1, 3, 6 and 12 mo follow-up time points.. Forty-two patients, 21 in the test group (SCTG plus EMD) and 21 in the control group (SCTG), aged 21-48 years (mean age 31 ± 8.56) were initially included in the study. Both treatments, STCG plus EMD and SCTG, resulted in a significant final mean root coverage (2.91 ± 0.95mm and 2.91 ± 1.29 mm, respectively) (p < 0.001) and in a high mean percentage of root coverage (82.25 ± 22.20% and 89.75 ± 17.33%, respectively) (p < 0.001), 1 year after surgery. The differences in mean root coverage recorded for the two techniques after 1 year, were not statistically significant (p = 0.19). Complete root coverage was achieved in 56.5% of patients treated with SCTG plus EMD and in 70.6% of patients treated with SCTG (p = 0.275), 1 year after treatment.. The present study failed to demonstrate any additional clinical benefits when EMD was added to SCTG plus CAF.

Topics: Adult; Connective Tissue; Dental Enamel Proteins; Double-Blind Method; Esthetics, Dental; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Middle Aged; Periodontal Pocket; Photography, Dental; Root Planing; Surgical Flaps; Tooth Root; Treatment Outcome; Young Adult

Connective tissue graft (CTG) plus coronally advanced flap (CAF) is the reference therapy for root coverage. The aim of the present study is to evaluate the use of a porcine collagen matrix (PCM) plus CAF as an alternative to CTG+CAF for the treatment of gingival recessions (REC), in a prospective randomized, controlled clinical trial.. Eighteen adult patients participated in this study. The patients presented 22 single Miller's Class I or II REC, randomly assigned to the test (PCM+CAF) or control (CTG+CAF) group. REC, probing depth, clinical attachment level (CAL), and width of keratinized tissue (KG) were evaluated at 12 months. In addition, the gingival thickness (GT) was measured 1mm apical to the bottom of the sulcus.. At 12 months, mean REC was 0.23 mm for test sites and 0.09 mm for control sites (P <0.01), whereas percentage of root coverage was 94.32% and 96.97%, respectively. CAL gain was 2.41 mm in test sites and 2.95 mm in control sites (P <0.01). KG gain was 1.23 mm in the test group and 1.27 mm in the control group (P <0.01). In test sites, GT changed from 0.82 to 1.82 mm, and in control sites, from 0.86 to 2.09 mm (P <0.01).. Within the limits of the study, both treatment procedures resulted in significant reduction in REC at 12 months. No statistically significant differences were found between PCM+CAF and CTG+CAF with regard to any clinical parameter. The collagen matrix represents a possible alternative to CTG.

Topics: Adult; Animals; Collagen; Collagen Type I; Collagen Type III; Connective Tissue; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Membranes, Artificial; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Prospective Studies; Surgical Flaps; Swine; Tooth Root; Young Adult

Minimally invasive techniques have broadened the horizons of periodontal plastic surgery to improve treatment outcomes. Thus, the purpose of this clinical trial was to compare root coverage, postoperative morbidity, and esthetic outcomes of subepithelial connective tissue graft (SCTG) technique with or without the use of a surgical microscope in the treatment of gingival recessions.. In this split-mouth study, twenty-four patients with bilateral Miller's Class I or II buccal gingival recessions ≥2.0 mm in canines or premolars were selected. Gingival recessions were randomly designated to receive treatment with SCTG with or without the assistance of the surgical microscope (test and control groups, respectively). Clinical parameters evaluated included the following: depth (RH) and width (RW) of the gingival defect, width (WKT) and thickness (TKT) of keratinized tissue, probing depth (PD), and clinical attachment level (CAL). Postoperative morbidity was evaluated by means of an analog visual scale and questionnaire. Patient satisfaction was also evaluated with a questionnaire. Descriptive statistics were expressed as mean ± SD. Repeated-measures analysis of variance was used for examination of differences regarding PD, CAL, and TKT. The Wilcoxon test was used to detect differences between groups and the Friedman test to detect differences within group regarding WKT, RH, and RW.. The average percentages of root coverage for test and control treatments, after 12 months, were 98.0% and 88.3%, respectively (P <0.05). Complete root coverage was achieved in 87.5% and 58.3% of teeth treated in test and control groups, respectively. For all parameters except recession height, there was an improvement in the final examination but without difference between treatments. For the RH, a lower value was found in the test group compared to the control group (P <0.05). In the test group, all patients were satisfied with the esthetics obtained, and 19 patients (79.1%) were satisfied in the control group. For postoperative morbidity, 14 patients in each of the two treatment groups did not use analgesics for pain control.. Both approaches were capable of producing root coverage; however, use of the surgical microscope was associated with additional clinical benefits in the treatment of teeth with gingival recessions.

Topics: Adolescent; Adult; Bicuspid; Connective Tissue; Cuspid; Esthetics, Dental; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Microsurgery; Middle Aged; Minimally Invasive Surgical Procedures; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Periodontal Attachment Loss; Periodontal Pocket; Postoperative Complications; Tooth Root; Treatment Outcome; Young Adult

The aim of this multicenter, randomized controlled trial was to compare the clinical outcomes of a connective tissue graft (CTG) alone or in combination with enamel matrix derivative (CTG + EMD) in the treatment of Miller Class I and II gingival recessions. The 56 selected defects were evaluated for probing depth, recession depth, keratinized tissue width, and probing attachment level, and were measured at baseline and 12 months after treatment. The mean recession reduction was 3.9 ± 0.8 mm for EMD-treated sites (test) and 3.6 ± 1.5 mm for the control group (P = .22), corresponding to a mean root coverage of 90% and 80% for test and control groups, respectively (P = .05). Complete root coverage was obtained in 62% of test sites compared to 47% in the control group (P = .27). Both procedures provided good soft tissue coverage. The better results of the test group did not achieve a statistically significant level.

Topics: Adult; Connective Tissue; Dental Enamel Proteins; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Periodontal Attachment Loss; Periodontal Pocket; Surgical Flaps; Tooth Cervix; Tooth Root; Treatment Outcome

This long-term 14-year-randomized split-mouth study aimed at evaluating (1) the outcomes of two different methods of root surface modifications (root surface polishing versus root planing) used in combination with a coronally advanced flap (CAF) and (2) the long-term results of CAF performed for the treatment of single gingival recessions.. Ten patients with similar bilateral recessions ≥2 mm were selected for a split-mouth randomized design study. Exposed root surfaces were assigned to receive polishing (test sites) or root planing (control sites). A multilevel model was used to analyse data at 3 months, 1, 5 and 14 years.. One patient dropped out after 1 year. At 14 years, recession depth (Rec) was 0.9 (1.2) mm for the test sites and 0.9 (0.9) mm for the control sites. The interaction between treatment and keratinized tissue was significant (p=0.0035). Rec increased slightly over time (p=0.0006) in both the groups.. This study shows that during a long-term follow-up, gingival recession recurred in 39% of the treated sites following the CAF procedure.

Topics: Algorithms; Dental Prophylaxis; Dentin Sensitivity; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Longitudinal Studies; Periodontal Attachment Loss; Periodontal Pocket; Recurrence; Root Planing; Surgical Flaps; Tooth Cervix; Tooth Crown; Tooth Root; Treatment Outcome

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.. 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.. FGG dimensions changed significantly postoperatively. At 90 days postoperatively, FGG width, length, and area were respectively reduced by 31%, 22%, and 44% in non-smokers 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).. 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.

Topics: Adult; Dental Plaque Index; Epithelium; Female; Follow-Up Studies; Gingiva; Gingival Hemorrhage; Gingival Recession; Graft Survival; Humans; Keratins; Male; Palate; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Postoperative Hemorrhage; Prospective Studies; Smoking; Surgical Flaps; Tissue and Organ Harvesting; Wound Healing

The primary aim of this randomized, controlled, blinded clinical pilot study was to compare the percentage of recession defect coverage obtained with a coronally positioned tunnel (CPT) plus an acellular dermal matrix allograft (ADM) to that of a CPT plus ADM and platelet-rich plasma (CPT/PRP) 4 months post-surgically.. Eighteen patients with Miller Class I or II recession >or=3 mm at one site were treated and followed for 4 months. Nine patients received a CPT plus ADM and were considered the positive control group. The test group consisted of nine patients treated with a CPT plus ADM and PRP. Patients were randomly selected by a coin toss to receive the test or positive control treatment.. The mean recession at the initial examination for the CPT group was 3.6 +/- 1.0 mm, which was reduced to 1.0 +/- 1.0 mm at the 4-month examination for a gain of 2.6 +/- 1.5 mm or 70% defect coverage (P <0.05). The mean recession at the initial examination for the CPT/PRP group was 3.3 +/- 0.7 mm, which was reduced to 0.4 +/- 0.7 mm at the 4-month examination for a gain of 2.9 +/- 0.5 mm or 90% defect coverage (P <0.05). There were no statistically significant differences between the groups (P >0.05).. The CPT plus ADM and PRP produced defect coverage of 90%, whereas the CPT with ADM produced only 70% defect coverage. This difference was not statistically significant, but it may be clinically significant.

Topics: Adult; Aged; Collagen; Dental Plaque Index; Female; Follow-Up Studies; Gingiva; Gingival Recession; Gingivoplasty; Humans; Keratins; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Pilot Projects; Platelet-Rich Plasma; Single-Blind Method; Skin, Artificial; Surgical Flaps; Tooth Mobility; Tooth Root; Young Adult

Gingival recession refers to the denudation of root surface caused by apical migration of the gingival margin as a result of destruction of the covering gingival tissue of the affected area. It is among the most frequent problems presented by periodontal patients and may have different etiologies and sequels. So far, several techniques have been devised and tested to treat gingival recession. The aim of this study was to assess the effectiveness of using a GTR resorbable collagen membrane in conjunction with coronally advanced flap (CAF) as compared to CAF alone in the treatment of Miller's Class I & II gingival recessions. Seven patients took part in the study, each providing either two or four facial recessions of 3 mm. to 6 mm., totaling 11 pairs of gingival recessions. The two paired sites within each patient were randomly assigned to one of the two treatments mentioned above. Prior to and six months after treatments, the following clinical parameters were measured and recorded: recession depth; probing pocket depth; clinical attachment level; width of keratinized gingiva; and width of recession. After six months, recession depth showed a mean reduction of 67.88% and 57.42% in the "GTR + CAF" and "CAF alone" groups, respectively. The mean difference between the groups was 1+/-0.33 mm (P=0.03). The results of this study indicate that Miller's Class I & II gingival recessions are amenable to treatment using the GTR technique with satisfactory outcome.

Topics: Absorbable Implants; Adult; Aged; Biocompatible Materials; Collagen; Female; Follow-Up Studies; Gingiva; Gingival Recession; Guided Tissue Regeneration, Periodontal; Humans; Keratins; Male; Membranes, Artificial; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Surgical Flaps; Treatment Outcome

The aim of this study was to test a new collagen matrix (CM) aimed to increase keratinized gingiva/mucosa when compared with the free connective tissue graft (CTG).. This randomized longitudinal parallel controlled clinical trial studied 20 patients with at least one location with minimal keratinized tissue (

Topics: Adult; Aged; Analgesics; Biocompatible Materials; Collagen; Connective Tissue; Dental Prosthesis, Implant-Supported; Denture, Partial, Fixed; Esthetics, Dental; Female; Follow-Up Studies; Gingiva; Gingival Recession; Gingivoplasty; Humans; Keratins; Longitudinal Studies; Male; Middle Aged; Mouth Mucosa; Pain, Postoperative; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Prospective Studies; Surgical Flaps; Time Factors; Treatment Outcome

The aim of this retrospective long-term split-mouth study was to compare the periodontal conditions of sites treated with gingival-augmentation procedures to untreated homologous contralateral sites over a long period of time (10 to 27 years).. Fifty-five subjects with 73 sites (test group) lacking attached gingiva associated with recessions were treated by means of submarginal free gingival grafts (SMFGGs) and marginal free gingival grafts (MFGGs). The 73 contralateral homologous sites (control group), with or without recession and with or without attached gingiva, were not treated. Patients were recalled every 4 months during the follow-up period (10 to 27 years). Clinical variables, including recession depth, amount of keratinized tissue (KT), and probing depth (PD), were measured in treated and untreated sites at baseline, at 1 year, and at the end of the follow-up period.. At the end of the follow-up period, recession was reduced in all treated sites (1.5 +/- 1.0 mm for SMFGG and 1.3 +/- 0.9 mm for MFGG), whereas it was increased in the untreated sites (-0.7 +/- 0.7 mm for SMFGG and -1.0 +/- 0.5 mm for MFGG). In the treated sites, the increased KT remained quite stable during the follow-up period. PD remained stable (1 mm) in the treated and untreated sites.. The sites treated with gingival-augmentation surgery showed a tendency for coronal displacement of the gingival margin with a reduction in recession. The contralateral untreated sites showed a tendency for apical displacement of the gingival margin with an increase in the existing recessions.

Topics: Adolescent; Adult; Case-Control Studies; Cohort Studies; Dentin Sensitivity; Disease Progression; Female; Follow-Up Studies; Gingiva; Gingival Pocket; Gingival Recession; Gingivoplasty; Humans; Keratins; Longitudinal Studies; Male; Middle Aged; Periodontal Index; Periodontal Pocket; Retrospective Studies; Tooth Root; Young Adult

This study verifies clinical results of using a polydioxanone (PDS) tent without a guided tissue regeneration (GTR) membrane for root coverage.. Forty-nine gingival recessions (in 16 patients) were treated with a PDS tent inserted under the coronally positioned gingival flap. The recession level (RL), probing depth (PD), and keratinized mucosa width (KMW) were registered. Statistical analysis was performed with the Wilcoxon test.. In 48 cases, there was a significant reduction in the RL (2.55 +/- 1.11 mm on day 0 and 0.34 +/- 0.65 mm on day 120; P = 0.0001). PD showed the same values at the beginning and end of treatment in 47 cases (0.99 +/- 0.71 mm on days 0 and 120; z = 0.000). There was a significant increase of KMW in 46 cases (2.38 +/- 0.76 mm on day 0 and 3.18 +/- 0.90 mm on day 120; P = 0.0001).. The association of the PDS tent without the GTR membrane to a coronal sliding flap for root coverage of Miller Class I and II gingival recessions allows root coverage, gain of attachment level, and an increase of keratinized mucosa. For root coverage, it is not necessary to use the GTR membrane associated to the PDS tent, thereby reducing surgical costs. Future studies should be conducted to assess the sole performance of the PDS as an alternative method to a connective tissue graft and coronal sliding flap, thus decreasing risks and post-surgery discomfort.

Topics: Adult; Biocompatible Materials; Female; Follow-Up Studies; Gingiva; Gingival Recession; Gingivoplasty; Guided Tissue Regeneration, Periodontal; Humans; Keratins; Male; Membranes, Artificial; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Polydioxanone; Surgical Flaps; Tooth Root; Young Adult

The aim of this study was to compare the soft tissue integration of submerged and non-submerged implants by means of periodontal parameter assessments and analysis.. Thirty-one patients, who received 42 non-submerged implants (ITI) and 48 submerged implants (3i), participated in the study. There was no significant difference (P>0.05) between both groups considering gender; educational level; handedness; toothbrushing frequency; the number of auxiliary devices used; and smoking habits. The parameters assessed were gingival index (GI), plaque index (PII), retention index (RI), pocket probing depth (PPD) and keratinized mucosa index.. At evaluation, 66.67% of all sites showed a GI of 0; 72.22% a PI of 0, and 93.33% the absence of calculus. The average PPD was 2.56 mm in the non-submerged and 2.70 mm in the submerged group. With regard to the width of keratinized mucosa, 100% of the ITI implants showed a band of keratinized gingiva around the implant, whereas 14.58% in the 3i group showed a complete absence of keratinized mucosa. The intra-examiner reproducibility was 90.96% for all parameters and the Kendall tau-b analysis showed a powerless correlation between the chosen parameters for both studied groups.. The study material showed no major differences between submerged and non-submerged dental implants regarding GI, PII, RI and PPD, except the width of keratinized mucosa. Regarding the presence of keratinized mucosa, there is a need for further longitudinal studies to elucidate a possible benefit of one implant system over the other.

Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Dental Devices, Home Care; Dental Implantation, Endosseous; Dental Implants; Dental Plaque Index; Dental Prosthesis Design; Dental Prosthesis Retention; Educational Status; Female; Functional Laterality; Gingiva; Humans; Keratins; Male; Middle Aged; Periodontal Index; Periodontal Pocket; Periodontium; Prospective Studies; Smoking; Toothbrushing; Young Adult

Correcting recession defects is one of the goals of periodontal therapy, and the efficacy and predictability of the various techniques are important considerations for both patients and clinicians. Several reports have examined the outcome of gingival recession treatment by means of coronally positioned flaps (CPF) and enamel matrix derivative (EMD). The purpose of this study was to clinically evaluate the use of EMD in association with CPF to cover localized gingival recessions compared to CPF alone.. Twenty-two patients with Miller Class I or II gingival recessions >2 mm were included. One recession from each patient was treated in the study. Two treatments were randomly assigned: coronally positioned flap with EMD (test) and coronally positioned flap alone (control). Clinical parameters measured at baseline and 1, 6, and 12 months included gingival index, plaque index, probing depth, clinical attachment level, vertical and horizontal recession, and width of keratinized gingiva.. At 12 months, both treatment modalities showed significant root coverage, gain in clinical attachment, and gain in width of keratinized gingiva (P <0.05). Vertical recessions were reduced from 2.68 +/- 1.63 mm to 0.36 +/- 0.60 mm in the test group and from 2.31 +/- 1.52 mm to 0.90 +/- 0.95 mm in the control group. Horizontal recessions decreased from 4.27 +/- 2.06 mm to 0.77 +/- 0.87 mm in the test group and from 3.68 +/- 1.91 mm to 1.72 +/- 1.31 mm in the control group. Changes in keratinized gingiva went from 3.81 +/- 1.95 mm to 4.63 +/- 2.15 mm in the test group and from 3.31 +/- 1.81 mm to 3.27 +/- 1.80 mm in the control group. When both treatments were compared at 12 months, there was a significant difference in vertical tooth coverage and gain in keratinized gingiva in favor of the experimental group (P <0.05). The average percentage of root coverage for test and control groups was 88.6% and 62.2%, respectively.. The coronally positioned flap alone or with EMD is an effective procedure to cover localized gingival recessions. The addition of EMD significantly improves the amount of root coverage.

Topics: Adult; Aged; Dental Enamel Proteins; Dental Plaque Index; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Prospective Studies; Surgical Flaps; Tooth Root; Treatment Outcome

Various surgical techniques have been proposed for treating gingival recession. This randomized clinical trial compared the coronally positioned flap (CPF) alone or in conjunction with a subepithelial connective tissue graft (SCTG) in the treatment of gingival recession.. Eleven non-smoking subjects with bilateral and comparable Miller Class I recession defects were selected. The defects, at least 3.0 mm deep, were randomly assigned to the test (CPF + SCTG) or control group (CPF alone). Recession depth (RD), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (KT), and gingival/mucosal thickness (GT) were assessed at baseline and 6 months postoperatively.. Recession depth was significantly reduced 6 months postoperatively (P<0.05) for both groups. Mean root coverage was 75% and 69% in the test and control groups, respectively. There were no significant differences between the two groups in RD, PD, or CAL, either at baseline or at 6 months postoperatively. However, at 6 months postoperatively, the test group showed a statistically significant increase in KT and GT compared to the control group (P<0.05).. The results indicate that both surgical approaches are effective in addressing root coverage. However, when an increase in gingival dimensions (keratinized tissue width, gingival/mucosal thickness) is a desired outcome, then the combined technique (CPF + SCTG) should be used.

Topics: Adolescent; Adult; Connective Tissue; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Surgical Flaps; Tooth Root; Treatment Outcome

The primary aim of this randomized, controlled, blinded clinical investigation was to determine if orientation of an acellular dermal matrix (ADM) allograft, basement membrane side against the tooth or connective tissue side against the tooth, affected the percent root coverage. Additional aims were to: 1) compare results of this study with results obtained from other root coverage studies; 2) determine if multiple additional sites could be successfully covered with the same surgery; 3) determine the effect of the procedure on keratinized tissue; and 4) evaluate the amount of creeping attachment obtained.. Ten patients with 2 Miller Class I or II buccal recession defects > or =3 mm were treated with a coronally positioned flap plus ADM and followed for 12 months. Test sites received ADM with the basement membrane side against the root (AB), while the control sites received the connective tissue side against the root (AC). Multiple additional recession sites were treated with the same flap procedure.. Mean baseline recession for the AB sites was 4.2 mm and for the AC sites, 3.7 mm. Mean root coverage of 95% was obtained for both AB and AC sites. Sixty-eight additional Class I or II AB and AC sites obtained about 93% root coverage. The mean increase in keratinized tissue for both treatments was 0.80 mm. No additional root coverage was gained due to creeping attachment between 2 and 12 months.. Treatment with ADM was an effective and predictable procedure for root coverage. The orientation of the material did not affect the treatment outcome for any of the parameters tested.

Topics: Adult; Aged; Basement Membrane; Connective Tissue; Dental Plaque Index; Female; Follow-Up Studies; Gingiva; Gingival Hemorrhage; Gingival Recession; Gingivoplasty; Humans; Keratins; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Single-Blind Method; Skin Transplantation; Statistics as Topic; Surgical Flaps; Tooth Root; Transplantation, Homologous; Wound Healing

Different techniques have been proposed for the treatment of gingival recessions. This study compared the clinical results of gingival recession treatment using a subepithelial connective tissue graft and an acellular dermal matrix allograft.. Nine patients with bilateral Miller Class I or II gingival recessions were selected. A total of 30 recessions were treated and randomly assigned to the test group and the contralateral recession to the control group. In the control group, the exposed root surfaces were treated by the placement of a connective tissue graft in combination with a coronally positioned flap; in the test group, an acellular dermal matrix allograft was used as a substitute for palatal donor tissue. Probing depth, clinical attachment level, gingival recession, and width of keratinized tissue were measured 2 weeks prior to surgery and 3 and 6 months postsurgery.. There were no statistically significant differences between the test group and the control group in terms of recession reduction, clinical attachment gain, and reduction in probing depth. The control group had a statistically significant increased area of keratinized tissue after 3 months compared to the test group. Both procedures, however, produced an increase in keratinized tissue after 6 months, with no statistically significant difference.. The acellular dermal matrix allograft may be a substitute for palatal donor tissue in root coverage procedures.

Topics: Adult; Connective Tissue; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Reproducibility of Results; Skin Transplantation; Statistics, Nonparametric; Surgical Flaps; Tooth Root; Transplantation, Homologous

Membranes of human placentas have been used in the field of medicine for skin grafts, treatment of burns, and ulcerated skin conditions with great success. The use of placenta allografts in dentistry is a more recent development, with the first commercial product being made available in 2008. The unique inherent biologic properties in placenta allografts enhance wound healing and may propagate regeneration.. Ten healthy adult patients presenting with 21 Miller Class I gingival recession (GR) defects (isolated or adjacent multiple) were surgically treated with a modified coronally advanced flap and chorion membrane for root coverage. Clinical parameters measured at baseline, 3 months, and 6 months were probing depth, clinical attachment level, GR height, width of keratinized gingiva, and assessment of gingival biotype. Statistical analysis was performed to compare the treatment outcomes at the follow-up intervals.. The results showed statistically significant (P <0.001) improvements in all clinical parameters at the 3- and 6-month follow-ups. The mean percentage of root coverage at the end of 6 months was 89.92% ± 15.59%, and 14 of 21 treated GR defects showed 100% root coverage. The gingival biotype also showed a thick biotype in nine sites that had an initial thin biotype.. Fetal membranes possess distinctive properties that can be harnessed to promote periodontal healing. The chorion membrane covered by a modified coronally advanced flap is a new approach that has shown promising results in terms of root coverage, increased width of keratinized tissue, and thickness of the gingival biotype.

Topics: Adult; Allografts; Chorion; Connective Tissue; Female; Follow-Up Studies; Gingiva; Gingival Recession; Gingivoplasty; Humans; Keratins; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Surgical Flaps; Tooth Root; Treatment Outcome; Young Adult

To determine the periodontal status and long-term outcomes of the surgical treatment of severely impacted developing premolars.. Nine impacted and adversely angulated second premolars (four maxillary and five mandibular) were autotransplanted from their initial position to the ideal position within the arches (trans-alveolar autotransplantation). The mean age of patients at the time of the surgery was 13 years and 9 months (from 11 years and 5 months to 17 years) and the mean observation period was 5 years (from 2 to 8 years and 6 months). Naturally erupted, contralateral premolars in the same patients were used for comparison.. The survival and success were 100%. Autotransplanted premolars did not differ statistically from their controls, except for having a wider zone of keratinized gingiva (mean difference 0.625 mm), increased probing depths (from 0.04 to 0.49 mm depending on the probing location), pulp canal obliteration and a slightly higher crown-to-root ratio (C/R = 0.71 for transplanted teeth and C/R = 0.6 for control teeth respectively).. Trans-alveolar transplantation of severely impacted and adversely angulated developing premolars is a viable treatment option and an attractive alternative to other treatment modalities.

Topics: Adolescent; Autografts; Bicuspid; Case-Control Studies; Child; Dental Pulp Cavity; Gingiva; Gingival Recession; Humans; Keratins; Longitudinal Studies; Mandible; Maxilla; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Prospective Studies; Radiography; Survival Rate; Tooth Crown; Tooth Eruption; Tooth Root; Tooth Socket; Tooth, Impacted; Treatment Outcome

The objective was to assess the inter-rater agreement in the diagnosis of mucositis and peri-implantitis.. Adult patients with ≥ 1 dental implant were eligible. Three operators examined the patients. One examiner allocated the patients to three groups of nine as follows: nine implants with peri-implantitis, nine implants with mucositis, and 9 implants with healthy mucosa. Each examiner recorded on all 27 patients (one implant per patient) recessions, probing depth, bleeding on probing, suppuration, keratinized tissue depth and bone loss, leading to a final diagnosis of mucositis, peri-implantitis or healthy mucosa. Examiners were independent and blinded to each other.. Fleiss k-statistic with quadratic weight in the diagnosis of peri-implantitis and mucositis was 0.66 [CI95%: 0.45-0.87]. A complete agreement was obtained only in 14 cases (52%). Fleiss k-statistics in bleeding on probing and bone loss were respectively 0.31 [CI95%: 0.20-0.41] and 0.70 [CI95%: 0.45-0.94]. Intra-class correlation coefficients for recession, probing depth and keratinized tissue depth were respectively 0.69 [CI95%: 0.62-0.75], 0.54 [CI95%: 0.44-0.63] and 0.56 [CI95%: 0.27-0.77].. The inter-rater agreement in the diagnosis of peri-implant disease was qualified as merely good. This could also be due in part to the unclear definition of peri-implantitis and mucositis.

Topics: Adult; Aged; Alveolar Bone Loss; Consensus; Dental Implants; Female; Gingiva; Gingival Recession; Humans; Keratins; Male; Middle Aged; Mucositis; Observer Variation; Peri-Implantitis; Periodontal Index; Periodontal Pocket; Single-Blind Method; Suppuration

To clinically evaluate the treatment of Miller Class I and II multiple adjacent gingival recessions using the modified coronally advanced tunnel technique combined with a newly developed bioresorbable collagen matrix of porcine origin.. Eight healthy patients exhibiting at least three multiple Miller Class I and II multiple adjacent gingival recessions (a total of 42 recessions) were consecutively treated by means of the modified coronally advanced tunnel technique and collagen matrix. The following clinical parameters were assessed at baseline and 12 months postoperatively: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), probing depth (PD), recession depth (RD), recession width (RW), keratinized tissue thickness (KTT), and keratinized tissue width (KTW). The primary outcome variable was complete root coverage.. Neither allergic reactions nor soft tissue irritations or matrix exfoliations occurred. Postoperative pain and discomfort were reported to be low, and patient acceptance was generally high. At 12 months, complete root coverage was obtained in 2 out of the 8 patients and 30 of the 42 recessions (71%).. Within their limits, the present results indicate that treatment of Miller Class I and II multiple adjacent gingival recessions by means of the modified coronally advanced tunnel technique and collagen matrix may result in statistically and clinically significant complete root coverage. Further studies are warranted to evaluate the performance of collagen matrix compared with connective tissue grafts and other soft tissue grafts.

Topics: Absorbable Implants; Adolescent; Adult; Collagen; Dental Plaque Index; Female; Follow-Up Studies; Gingiva; Gingival Recession; Gingivoplasty; Humans; Keratins; Male; Pain, Postoperative; Patient Satisfaction; Periodontal Index; Periodontal Pocket; Pilot Projects; Prospective Studies; Surgical Flaps; Tissue Scaffolds; Tooth Root; Treatment Outcome; Young Adult

Unfavorable conditions at the soft tissues adjacent to a recession defect may preclude performing pedicle flaps (advanced or rotational) both as a root coverage procedure, and as a covering flap for a connective tissue graft. Free gingival grafts may not be recommended because of the low root coverage predictability and the poor esthetic outcome. The goal of the present case report is to suggest modifications of the two-stage surgical technique aimed at improving root coverage and esthetic outcomes, and reducing patient morbidity.. In the first case report, a Miller class II gingival recession, associated with a deep buccal probing depth, affecting a lower central incisor was treated. In the first step of the surgery an epithelized graft with an apical-coronal dimension equal to the keratinized tissue height of the adjacent teeth was sutured apical to the bone dehiscence. Four months later, a coronally advanced flap was performed to cover the root exposure. In the second case report, a Miller class III gingival recession, complicated with a deep buccal probing depth affecting the mesial root of the first lower molar was treated. In the first step of the surgery, a free gingival graft was positioned mesially to the root exposure to create keratinized tissue lateral to the recession defect. This was adequate to perform the laterally moved, coronally advanced flap that was used as a second-step root coverage surgical procedure.. In the first case report complete root coverage, an increase (4 mm) in keratinized tissue height and realignment of the mucogingival line were achieved 1 year after the surgery. The reduced dimension of the graft permitted to minimize patient's discomfort and to obtain good esthetics of mucogingival tissues. These successful outcomes were well maintained for 5 years. In the second case report successful root coverage, increase (3 mm) in keratinized tissue height and good harmony of mucogingival tissues were achieved 1 year after the surgery. These outcomes were well maintained 5 years after the surgery.. The present study suggested that modifications of the two-stage procedure by minimizing the dimension of the graft and by standardizing the surgical techniques allowed successful results to be achieved in the treatment of gingival recessions characterized by local conditions that otherwise preclude the use of one-step root coverage surgical techniques.

Topics: Adult; Alveolar Bone Loss; Anti-Infective Agents, Local; Chlorhexidine; Dental Plaque; Esthetics, Dental; Female; Follow-Up Studies; Gingiva; Gingival Recession; Gingivoplasty; Humans; Incisor; Keratins; Molar; Periodontal Pocket; Surgical Flaps; Suture Techniques; Tooth Root; Treatment Outcome

Aim of the present study was to evaluate the influence of orthognathic surgery on the development of periodontal and microbiological changes.. Fifteen consecutively treated patients with a mean age of 24.9±7.7 years receiving orthognathic surgery were included in the present study. Plaque index (PI) and concentrations of 11 periodonto-pathogenic bacteria were recorded one day prior to surgery (t(0)) and one week (t(1)) and six weeks (t(2)) post-surgery. In addition, a complete periodontal examination including pocket probing depth (PPD), gingival recession (GR), clinical attachment level (CAL), bleeding on probing (BOP) and width of keratinized gingiva (WKG) was conducted at t(0) and t(2). For statistical analysis, general linear model and paired t-test were applied.. A significant increase of PI (t(0)-t(1), p=0.037) was followed by a significant decrease (t(1)-t(2), p=0.017). Apart from Eikenella corrodens (p=0.036), no significant microbiological changes were recorded. PPD significantly increased on oral sites (p=0.045) and GR especially on buccal sites (p=0.001). In the incision area the development of GR was significantly higher on the test (buccal) than on the control sites (oral). Both gingival biotypes were affected by GR.. Orthognathic surgery causes statistically significant changes of periodontal parameters, but these changes do not necessarily impair the aesthetic appearance of the gingival margin.

Topics: Aggregatibacter actinomycetemcomitans; Bacteroides; Campylobacter rectus; Capnocytophaga; Dental Plaque; Dental Plaque Index; Eikenella corrodens; Eubacterium; Female; Follow-Up Studies; Fusobacterium nucleatum; Gingiva; Gingival Hemorrhage; Gingival Recession; Humans; Keratins; Male; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Peptostreptococcus; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Pocket; Periodontium; Porphyromonas gingivalis; Prevotella intermedia; Treponema denticola; Young Adult

Mucogingival conditions are deviations from the normal anatomic relationship between the gingival margin and the mucogingival junction. Mucogingival surgery is plastic surgery designed to correct defects in the gingiva surrounding the teeth. Common mucogingival conditions are recession, absence, or reduction of keratinized tissue, and probing depths extending beyond the mucogingival junction. Surgical techniques used to augment cosmetic mucogingival defects include the free gingival autograft, the subepithelial connective tissue graft, rotational flaps, lateral sliding flaps, coronally repositioned flaps, and the use of acellular dermal matrix grafts.

Topics: Biocompatible Materials; Collagen; Connective Tissue; Esthetics, Dental; Gingiva; Gingival Diseases; Gingival Recession; Gingivoplasty; Humans; Keratins; Periodontal Pocket; Plastic Surgery Procedures; Surgical Flaps; Tissue and Organ Harvesting

Free connective tissue graft techniques are currently considered the most predictable surgical method for root coverage. However, morbidity associated with secondary graft sites has generated interest in other methods. The purpose of this study was to investigate the feasibility of a novel surgical approach to root coverage: the pinhole surgical technique (PST). This retrospective study examined the results of PST used for 43 consecutive patients on 121 recession sites, of which 85 were Class I or II and 36 were Class III. Mean initial recession for all sites was 3.4 ± 1.0 mm. The mean assessment period was 18 ± 6.7 months. No secondary surgical site was necessary, and only bioresorbable membrane or acellular dermal matrix was used as graft material. PST required no releasing incision, sharp dissection, or suturing (when a bioresorbable membrane was used). Only one incision of 2 to 3 mm (for entry) was necessary for the entire procedure. Predictability of PST for Class I and II sites, measured as frequency of complete root coverage, was 81.2%. Effectiveness of PST for Class I and II sites, measured as mean percent defect reduction, was 94.0% ± 14.8%. When data from Class I, II, and III sites were combined, predictability and effectiveness were 69.4% and 88.4% ± 19.8%, respectively. The mean duration per procedure was 22.3 ± 10.1 minutes. The mean level of patient subjective esthetic satisfaction was 95.1% and was realized within a mean 7.34 ± 13.5 days. Postoperative complications were minimal. These results indicate that PST holds promise as a minimally invasive, predictable, effective, and time- and cost-effective method for obtaining optimal patient-based outcomes.

Topics: Absorbable Implants; Acellular Dermis; Adult; Aged; Aged, 80 and over; Esthetics, Dental; Feasibility Studies; Female; Follow-Up Studies; Forecasting; Gingiva; Gingival Recession; Humans; Keratins; Male; Membranes, Artificial; Middle Aged; Operative Time; Patient Satisfaction; Periodontal Attachment Loss; Periodontal Pocket; Postoperative Complications; Retrospective Studies; Surgical Flaps; Tooth Cervix; Tooth Root; Treatment Outcome

To evaluate the hard and the soft tissue parameters around implants supporting fixed prostheses over a period of 5 years and the possible association to the increase in periimplant bone density (IPBD).. A total of 39 dental implants placed in 29 patients were included in the study. Periimplant clinical (gingival index, probing depth, keratinized mucosa, sulcus fluid flow rate) and radiographic variables (bone loss, bone density) were collected, and the data analysis performed.. Periimplant hard and soft tissue parameters remained stable throughout the follow-up period. Of the 39 implants, 20 demonstrated IPBD. The mean distance between first bone-to-implant contact and the microgap for implants with and without IPBD was significantly different at 1-year, 2-year, and 5-year follow-up. The evidence of IPBD demonstrated no influence on the periimplant soft tissue parameters. All mean values of bone density for implants with IPBD were higher than those for implants without IPBD throughout the whole observation period.. All implants were clinically successful over the period of follow-up. IPBD might be more indicative of a stable periimplant bone level.

Topics: Alveolar Bone Loss; Bone Density; Crowns; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Partial, Fixed; Follow-Up Studies; Gingiva; Gingival Crevicular Fluid; Humans; Keratins; Osseointegration; Osteogenesis; Periodontal Index; Periodontal Pocket; Radiography, Dental, Digital; Radiography, Panoramic; Secretory Rate; Treatment Outcome

The treatment of furcation defects is a complex and difficult task that may compromise the success of periodontal therapy. Here we report a new clinical treatment of a Class II furcation defect using an autogenous bone graft associated with a buccal fat pad (BFP) used as a membrane. The surgical treatment was performed following initial periodontal therapy. Post-operative follow-up appointments were performed at 3, 7, and 12 months. Clinically, after 3 and 7 months, a reduction in probing depth without bleeding on probing and an increase in vertical and horizontal clinical attachment level were observed. After 7 post-operative months, an increase in keratinized gingiva was observed. Radiographically, a significant improvement was noted, with the furcation defect almost completely closed. These results could also be observed after 12 postoperative months. It can be concluded that the combined use of autogenous bone graft and a BFP yielded clinically favorable outcome in the treatment of a mandibular Class II furcation defect.

Topics: Adipose Tissue; Alveolar Process; Bone Transplantation; Female; Follow-Up Studies; Furcation Defects; Gingiva; Guided Tissue Regeneration, Periodontal; Humans; Keratins; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Radiography; Surgical Flaps; Transplantation, Autologous; Treatment Outcome

The aim of this study was to explore possible causal relationships among several variables in the coronally advanced flap for root coverage procedure using structural learning of Bayesian networks.. Sixty consecutive patients with maxillary buccal recessions (>or=2 mm) were enrolled. All defects were treated with the coronally advanced flap procedure. Age, gender, smoking habits, recession depth, width of keratinized tissue, probing depth, distance between the incisal margin and the cemento-enamel junction, root sensitivity, and distance between the gingival margin and the cemento-enamel junction were recorded and calculated for all patients at baseline, immediately after surgery, and at 6 months after surgery. A structural learning algorithm of Bayesian networks was used.. The distance between the gingival margin and the cemento-enamel junction immediately after surgery was affected by the baseline recession depth; deeper recessions were associated with a more apical location of the gingival margin after surgery. Moreover, complete root coverage also seemed to be affected by the location of the gingival margin after surgery; a more coronal location of the gingival margin after surgery was associated with a greater probability of complete root coverage.. The use of structural learning of Bayesian networks seemed to facilitate the understanding of the possible relationships among the variables considered. The main result revealed that complete root coverage seemed to be influenced by the post-surgical position of the gingival margin and indirectly by the baseline recession depth.

Topics: Adult; Age Factors; Algorithms; Bayes Theorem; Dentin Sensitivity; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Middle Aged; Periodontal Pocket; Sex Factors; Smoking; Surgical Flaps; Tooth Cervix; Tooth Root; Treatment Outcome; Young Adult

To assess the clinical results obtained with laterally positioned flap (LPF) for the treatment of localized gingival recessions (GR).. 32 systemically healthy, non-smoking patients, with one Miller Class I or II buccal GR of > or = 3 mm, were treated with a LPF. At baseline the following measurements were recorded: (1) recession depth; (2) probing depth; (3) clinical attachment level; and (4) width of keratinized tissue. At 24 months post-surgery, all clinical measurements were repeated.. Mean root coverage obtained with the laterally positioned flaps was 93.8%. Complete root coverage was obtained in 62.5% of the recipient sites. The mean recession depth decreased from 4.71 +/- 1.30 mm to 0.28 +/- 0.42 mm. Statistically significant improvements were found for all clinical parameters from baseline to 24 months (P < 0.05). Patients with maxillary recessions recorded statistically superior gains in the width of keratinized tissue than patients with mandibular recessions. The results of the present study demonstrated that the LPF is an effective procedure to cover localized gingival recession. Moreover, both groups (i.e., patients with maxillary or mandibular recessions) recorded similar significant improvements from baseline to 24-month examination, except for the width of keratinized tissue which was statistically higher for maxillary recessions.

Topics: Adolescent; Adult; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Mandible; Maxilla; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Surgical Flaps; Tooth Root; Treatment Outcome; Young Adult

To investigate the association between keratinized mucosa (KM) width and mucosal thickness (MTh) with clinical and immunological parameters around dental implants.. Sixty-three functioning dental implants (3I osseotite) were examined. Clinical examinations included plaque index (PI), probing depth (PD), bleeding on probing (BOP), KM width, MTh and buccal mucosal recession (MR). Peri-implant crevicular fluid (PICF) samples were collected for PgE2 assay.. KM width ranged from 0 to 7 mm (mean 2.5+/-2), MTh ranged from 0.38 to 2.46 mm (mean 1.11+/-0.4) and the mean MR was 0.62 mm, ranging from 0 to 3 mm. A negative correlation was found between MTh and MR (r=-0.32, P=0.01); Likewise, KM width showed a negative correlation with MR, periodontal attachment level (PAL) and PgE2 levels (r=-0.41, P<0.001; r=-0.26, P=0.04; r=-0.26, P=0.04, respectively). In contrast, a positive correlation was found between KM width and PD (r=0.27, P=0.03). When data were dichotomized by KM width, a wider mucosal band (>1 mm) was associated with less MR compared with narrow (or=1 mm) was associated with lesser recession compared with a thin (<1 mm) mucosa (0.45 and 0.9 mm, respectively, P=0.04).. The KM around dental implants affects both the clinical and the immunological parameters at these sites. These findings are of special importance in the esthetic zone, where thin and narrow KM may lead to a greater MR.

Topics: Dental Implantation, Endosseous; Dental Implants; Dental Plaque Index; Female; Gingival Crevicular Fluid; Gingival Recession; Humans; Keratins; Male; Middle Aged; Mouth Mucosa; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Retrospective Studies; Statistics, Nonparametric

The aim of the present paper was to analyse, on patient and implant basis, factors related to peri-implant lesions.. Two hundred and eighteen patients treated with titanium implants were examined for biological complications at existing implants 9-14 years after initial therapy. The effects of several potentially explanatory variables, both on patient and on implant levels, were analysed.. On the implant level, the presence of keratinized mucosa (p = 0.02) and plaque (p = 0.005) was associated with mucositis (probing depth > or =4 mm + bleeding on probing). The bone level at implants was associated with the presence of keratinized mucosa (p = 0.03) and the presence of pus (p < 0.001). On the patient level, smoking was associated with mucositis, bone level and peri-implantitis (p = 0.02, <0.001 and 0.002, respectively). Peri-implantitis was related to a previous history of periodontitis (p = 0.05).. Individuals with a history of periodontitis and individuals who smoke are more likely to develop peri-implant lesions.

Topics: Aged; Alveolar Bone Loss; Dental Implants; Dental Plaque; Disease; Female; Follow-Up Studies; Humans; Keratins; Male; Middle Aged; Mouth Mucosa; Periodontal Diseases; Periodontal Pocket; Periodontitis; Risk Factors; Smoking; Suppuration; Titanium

Gingival recession is significantly more common among smokers, while the relative outcome of various root coverage procedures in smokers, compared to non-smokers, is debatable. The objective of this study was to evaluate the influence of cigarette smoking on the outcome of coronally positioned flap (CPF) in the treatment of Miller Class I gingival recession defects.. Ten current smokers (> or = 10 cigarettes daily for at least 5 years) and 10 non-smokers (never smokers), each with one 2- to 3-mm Miller Class I recession defect in an upper canine or bicuspid, were treated with CPF. At baseline and 6 months, clinical parameters, probing depth (PD), clinical attachment level (CAL), recession depth (RD), and apico-coronal width of keratinized tissue (KT) were determined.. Intragroup analysis showed that CPF was able to reduce RD and improve CAL in both groups (P <0.05). Intergroup analysis demonstrated that smokers presented greater residual RD at 6 months and lower percentage of root coverage (69.3% versus 91.3%; P <0.05). No smokers obtained complete root coverage compared to 50% of non-smokers (P <0.05).. Within the limits of the present study, it can be concluded that CPF provides benefits for both smokers and non-smokers in terms of root coverage of shallow Miller Class I recession defects. However, cigarette smoking negatively impacts the clinical outcomes, specifically residual recession, percent root coverage, and frequency of complete root coverage.

Topics: Adult; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Smoking; Surgical Flaps; Tooth Cervix; Tooth Root; Treatment Outcome

Coverage of denuded roots has become one of the most challenging procedures in periodontal plastic surgery. The search for the appropriate root coverage technique has taken many different approaches. Various surgical options with predictable outcomes are available. In this clinical study, patients were treated using polyglactin 910 (Vicryl mesh) and a coronally positioned flap. Clinical parameters for 15 patients were recorded immediately prior to surgery and after a minimum of 6 months. Postoperatively, significant root coverage, reductions in probing depths, gains in clinical attachment levels, and highly significant increases in the width of keratinized gingiva were observed. The final esthetics, both color match and tissue contours, were acceptable to both the patients and the clinicians.

Topics: Absorbable Implants; Adult; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Male; Membranes, Artificial; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Pigmentation; Polyglactin 910; Surgical Flaps; Surgical Mesh; Tooth Root

This study reports results of root coverage treatment with a coronally positioned flap and an acellular dermal matrix allograft. The same protocol was followed as in a previous university study to determine if the results could be duplicated in a private practice setting. Complete root coverage was obtained on most defects. Use of an acellular dermal matrix allograft avoided the postoperative morbidity associated with harvesting palatal connective tissue. The unlimited supply of the allograft allowed extended flaps to achieve multiple site root coverage, which proved to be a practical and predictable procedure in these cases.

Topics: Biocompatible Materials; Collagen; Dental Plaque Index; Follow-Up Studies; Gingival Recession; Humans; Keratins; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Surgical Flaps; Suture Techniques; Tooth Root; Treatment Outcome

The aim of this study was to evaluate the predictability of the free connective tissue graft in prosthetically treated patients needing gingival augmentation. The following outcome variables were studied 1) dimensional changes of free connective gingival grafts; 2) color blending with adjacent tissues; and 3) periodontal and marginal health status, when compared to a non-surgical control group.. Two groups of patients without periodontitis were investigated. The test group (group A) consisted of 16 patients. The inclusion criteria for surgical correction were: 1) at least 1 site lacking (<1 mm) keratinized tissue and/or lacking vestibular depth; 2) insufficient plaque control; and 3) the selected site was scheduled to undergo or had already received a fixed prosthetic restoration. The control group (group B) included 14 patients with the same inclusion criteria, but declining to undergo surgery. Group A patients were treated with a free connective tissue graft to augment the keratinized tissue at the selected sites. The size of the graft was recorded at baseline (surgical intervention) and the width of keratinized tissue was measured at 1, 4, 26, and 52 weeks. Gingival inflammation and plaque accumulation were assessed at baseline and 52 weeks in both groups. Probing depth and clinical attachment levels were recorded at baseline and 26 and 52 weeks in both groups. Evaluation of the esthetic results was carried out at the end of the study. All patients in both groups received oral hygiene instructions and supragingival plaque and calculus removal before and at the end of the investigation.. In group A, the results showed a mean amount of keratinized tissue of 5.81 +/- 1.42 mm at 26 weeks and 5.25 +/- 1.34 mm at 52 weeks. Mean shrinkage of the graft was 10.2% (P = 0.001) at 1 week, 28.4% (P = 0.0004) at 4 weeks, 37.2% (P = 0.0004) at 26 weeks, and 43.25% (P = 0.0004) at 52 weeks. All the dimensional changes were statistically significant, when compared to baseline. Evaluation of color blending with the surrounding gingiva demonstrated an "excellent result" at 52 weeks with an 87.5% agreement among the three masked examiners. In the test group, the periodontal indices improved or remained stable; in the control group, there was a minor improvement of the indices, with three patients showing a worse gingival inflammation score and two a worse plaque score.. Although these results are not conclusive, mostly due to a lack of a large enough sample population, the statistically significant results shown in this investigation tend to support the use of gingival augmentation procedures in prosthetic patients with insufficient keratinized gingiva and/or shallow or absent vestibules, when they cannot demonstrate adequate plaque control.

Topics: Adult; Aged; Color; Connective Tissue; Dental Plaque Index; Denture, Partial, Fixed; Esthetics, Dental; Female; Follow-Up Studies; Gingiva; Gingival Recession; Gingivitis; Graft Survival; Humans; Keratins; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Statistics, Nonparametric; Treatment Outcome

Obtaining predictable and esthetic root coverage has become important. Unfortunately, there is only a limited amount of information available on the long-term results of root coverage procedures. The goal of this study was to evaluate the short-term and long-term root coverage results obtained with an acellular dermal matrix and a subepithelial graft.. An a priori power analysis was done to determine that 25 was an adequate sample size for each group in this study. Twenty-five patients treated with either an acellular dermal matrix or a subepithelial graft for root coverage were included in this study. The short-term (mean 12.3 to 13.2 weeks) and long-term (mean 48.1 to 49.2 months) results were compared. Additionally, various factors were evaluated to determine whether they could affect the results. This study was a retrospective study of patients in a fee-for-service private periodontal practice. The patients were not randomly assigned to treatment groups.. The mean root coverages for the short-term acellular dermal matrix (93.4%), short-term subepithelial graft (96.6%), and long-term subepithelial graft (97.0%) were statistically similar. All three were statistically greater than the long-term acellular dermal matrix mean root coverage (65.8%). Similar results were noted in the change in recession. There were smaller probing reductions and less of an increase in keratinized tissue with the acellular dermal matrix than the subepithelial graft. None of the factors evaluated resulted in the acellular dermal graft having a statistically significant better result than the subepithelial graft. However, in long-term cases where multiple defects were treated with an acellular dermal matrix, the mean root coverage (70.8%) was greater than the mean root coverage in long-term cases where a single defect was treated with an acellular dermal matrix (50.0%).. The mean results with the subepithelial graft held up with time better than the mean results with an acellular dermal matrix. However, the results were not universal. In 32.0% of the cases treated with an acellular dermal matrix, the results improved or remained stable with time.

Topics: Adult; Aged; Analysis of Variance; Biocompatible Materials; Collagen; Connective Tissue; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Keratins; Longitudinal Studies; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Photography, Dental; Retrospective Studies; Tooth Root

The pathological lining epithelium of destructive periodontitis was studied by analysis of the expression of intermediate filament proteins in biopsies of untreated advanced periodontitis. The cytokeratin (CK) pair 8/18 characteristic of simple epithelia was expressed consistently in a distribution pattern confined to the reactive pocket epithelium. The pattern of CK8/18 expression was complex with two broad presentations evident. In two-thirds of the advanced disease biopsies, the entire pathological lining epithelium was strongly reactive for both CK8 and CK18. In the remainder, the more superficial lining epithelium was mixed with foci of reactive and unreactive cells, with the deeper epithelium uniformly reactive. Only occasional highly localised reactivity for the simple keratins (CK8/18) was found in the lining epithelia of biopsies from minimally inflamed periodontal tissues. The pathological lining epithelium of advanced periodontitis was further characterised by the co-expression in basal layers of CK14, and of CK13 but not CK4, which are characteristic of suprabasal layers of stratified squamous epithelia. Cytokeratin 17, a marker of high turnover and migrating epithelial cells was extremely variable with no clear association between expression pattern and location of the epithelium ordisease status. There was no reactivity for CK10/11 typical of cornifying cells nor of vimentin, the characteristic intermediate filament of mesenchymal cells. The intermediate filament protein profile of the reactive lining epithelium was indistinguishable from the reactive epithelium present in three of five biopsies of periapical granulomas containing hyperplastic epithelium from activation of the developmental remnants of Hertwig's sheath, known as the cell rests of Malassez. The data reported are compatible with a contribution by remnants of developmental epithelium, including the reduced enamel epithelium and the cell rests of Malassez, to the reactive lining epithelium of the subgingival pocket in the pathogenesis of chronic periodontitis.

Topics: Adult; Aged; Chronic Disease; Enamel Organ; Epithelial Attachment; Epithelial Cells; Female; Humans; Immunoenzyme Techniques; Keratins; Male; Middle Aged; Periodontal Ligament; Periodontal Pocket; Periodontitis; Tooth Root

The importance of gingival augmentation to increase the amount of keratinized tissue is a controversial subject. In this case report, an acellular dermal matrix was used to obtain an increase in the amount of keratinized tissue around four implants. In this case, the acellular dermal matrix was placed on bone. The surgical procedure resulted in an increase in the amount of keratinized tissue. Therefore, it met the clinical goals of the surgical procedure. However, the clinical findings and patient pain levels during the healing seemed to resemble a denudation procedure. Additionally, the histologic evaluation of the tissue that formed around the implants showed that the acellular dermal matrix was not incorporated into the result. Based on this case, the use of an acellular dermal matrix placed on bone does not seem to be a good technique to increase the amount of keratinized tissue.

Topics: Aged; Biopsy; Coloring Agents; Dental Implants; Dermis; Female; Follow-Up Studies; Gingiva; Gingivoplasty; Humans; Keratins; Mandible; Pain, Postoperative; Periodontal Pocket; Periosteum; Surgical Wound Dehiscence; Treatment Outcome; Wound Healing

Hemidesmosomal attachment of the junctional epithelial cells to the tooth and the ability of the attached cells to divide are essential features of the healthy dentogingival junction. Short chain fatty acids are bacterial metabolites associated with gingival inflammation and periodontal pockets. In vitro, short chain fatty acids have been shown to inhibit epithelial cell division and increase the density of their keratin filaments. This study examined these keratin changes by making use of human gingival keratinocyte cultures, gel electrophoresis and Western blot. Short chain fatty acids, butyrate and propionate, increased the relative amount of keratin proteins in the cells, most strikingly keratin K17. The distribution of K17 was further studied in a culture model for human junctional epithelium and in gingival biopsies. In butyrate-treated cultures of junctional epithelium, K17 expression was markedly increased and extended to the basal cells and to the cells mediating the attachment of the explant to the substratum. In clinically healthy gingiva, K17 was expressed predominantly in sulcular epithelium. The dividing basal cells and the cells attached to the tooth were negative. In advanced periodontitis, a strong reaction for K17 was localised to the pocket epithelium. The inhibition of epithelial cell division and the simultaneous upregulation of K17 in vitro, and the strong expression of this protein in detached pocket epithelium suggest a role for the short chain fatty acids in the degenerative process that leads to subgingival advancement of pathogens and, eventually, to periodontal pocket formation.

Topics: Biopsy; Blotting, Western; Butyrates; Cell Adhesion; Cell Count; Cell Division; Cells, Cultured; Coloring Agents; Culture Techniques; Electrophoresis, Polyacrylamide Gel; Epithelial Attachment; Epithelial Cells; Fatty Acids, Volatile; Gingiva; Hemidesmosomes; Humans; Immunoenzyme Techniques; Keratinocytes; Keratins; Periodontal Pocket; Periodontitis; Propionates; Up-Regulation

In order to study inter-individual differences in bacterial adhesion/invasion of periodontal tissues, an in vitro model for culturing multi-layered pocket epithelium without feeder layers or stromal equivalents (including the evaluation of their cytokeratin profiles) was developed.. Pocket epithelium was collected and grown until confluent in Falcon flasks using keratinocyte-serum free medium (KSFM), without a feeder layer. In the second passage, oral keratinocytes were re-grown in a 2 compartment system using either a clear polyester (transwell-clear [TCL]) or a collagen (transwell-col [TCO]) membrane as culture surface. After the first week, the calcium concentration was raised to 1.2 mM and in half the wells, the KSFM was supplemented with 10% fetal calf serum (FCS). Histology and immunohistochemistry were performed after 1, 2, and 3 weeks of additional growth.. In general, all conditions resulted in a structured epithelium consisting of 3 to 5 layers, but important differences were observed between the membrane types and between the media. CK4 was rarely and only lightly expressed while CK18 and 19 (characteristic of junctional epithelium) were very strongly expressed in the older (2 and 3 weeks) cultures. CK13 and 14 (characteristic of any stratifiable epithelial cell) also tended to increase over time; CK13 seemed to be stronger in KSFM with FCS while the contrary was true for CK14. The multi-layer created by the combination TCL/KSFM + 10% FCS resembled a junctional epithelium most, while that grown on TCO without FCS mimicked the sulcular epithelium.. It seems possible to create a histiotypic culture resembling either periodontal pocket or junctional epithelium without the use of stromal equivalents or feeder layers which make this approach more cumbersome. This multi-layered culture offers a model to investigate the permeability of pocket epithelium and the adhesion and penetration of bacteria under well-defined environmental conditions.

Topics: Animals; Cattle; Cell Culture Techniques; Diffusion Chambers, Culture; Epithelial Attachment; Epithelial Cells; Humans; Immunohistochemistry; Keratins; Microscopy; Microscopy, Electron; Models, Biological; Periodontal Pocket

The 160, 190 and 270 kDa outer sheath proteases of Treponema denticola ATCC 35404 were found to be multiple forms of the major 91 kDa phenylalanine protease (PAP) by immunoblotting using anti-91 kDa specific antibodies. Multiple forms of the phenylalanine protease were also found in 2 other T. denticola strains studied, ATCC 33520 and the clinical isolate GM-1. Protein, proteolytic and Western blot analyses using antibodies against the PAP and the major outer sheath protein (MSP) indicated that the 190 and 270 kDa proteases were protein complexes formed by the MSP and the PAP. These complexes dissociated by storage in 0.3% or higher SDS concentrations. The purified PAP was found to completely degrade keratin, but was unable to degrade native actin either in its monomeric or polymerized form. The association of the MSP adhesin with a protease capable of degrading host native proteins may benefit the obtention of protein-based nutrients necessary to support the growth of these treponemes. These complexes may also play a role in the structural organization of T. denticola outer sheath.

Topics: Actins; Bacterial Proteins; Blotting, Western; Chymotrypsin; Electrophoresis, Polyacrylamide Gel; Humans; Keratins; Peptide Hydrolases; Periodontal Pocket; Phenylalanine; Treponema

This case report describes possible etiology, treatment, and 2-year outcome of a complicated case of gingival recession in the mandibular anterior dentition. Deep, cleftlike Miller Class I and II recessions at both mandibular canines and all incisors were treated using subperiosteal connective tissue grafts and coronally repositioned flaps. During surgery it was noted that the facial aspects of the roots had lost bone near the apex. After surgery profound alterations of gingival dimension occurred. Mean gingival thickness increased from 0.87 +/- 0.20 mm to 258 +/- 0.65 mm, and width of keratinized tissue increased from 1.34 +/- 0.79 mm to 4.80 +/- 0.97 mm. Periodontal probing depths increased from 1.06 +/- 0.33 mm to 2.74 +/- 0.81 mm, and depth of the recessions was reduced by 56% +/- 5%. Gingival thickness and periodontal probing depth remained stable over the 2 years of observation. Gingival width decreased and the mucogingival border moved a mean 2.5 mm coronally. Creeping attachment resulted in a 74% +/- 24% coverage of recession after 2 years and a gain in clinical attachment of 1.79 +/- 1.56 mm. The present observations point to long-lasting, continuous alterations in the mucogingival region following periodontal surgery in a case of cleftlike Class II recession.

Topics: Adult; Alveolar Bone Loss; Connective Tissue; Cuspid; Follow-Up Studies; Gingiva; Gingival Recession; Gingivoplasty; Humans; Incisor; Keratins; Male; Mandible; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Surgical Flaps; Treatment Outcome

The increased use of implants in orthodontics has stimulated interest in augmenting bone in patients who have deficient alveolar ridges that preclude ideal implant placement. A nonsurgical technique for increasing the amount of available bone for implant site development and fixture placement is orthodontic extrusion, or forced eruption. The concept of a tooth moving coronally by orthodontic means and the clinical alterations in the soft tissue architecture of the periodontium demonstrated during orthodontic extrusive movement of periodontally compromised teeth have demonstrated a direct relationship of pocket depth reduction, accompanied with an immature appearing tissue, "the red patch." This article will describe the periodontium during eruptive tooth movement.

Topics: Alveolar Bone Loss; Color; Dental Implantation, Endosseous; Dental Implants; Gingiva; Gingival Pocket; Humans; Incisor; Keratins; Maxilla; Periodontal Diseases; Periodontal Pocket; Periodontitis; Periodontium; Radiography; Root Canal Therapy; Tooth Eruption; Tooth Movement Techniques; Wound Healing

The cells of the junctional epithelium (JE) provide and maintain the epithelial attachment, and remain morphologically and phenotypically distinct from oral sulcular (OSE) and external oral epithelia (EOE), from which they may be regenerated de novo. Expression of cytokeratins (CK) in human epithelia has been shown to be highly site-specific, implying a functional role. The aims of this study were to differentiate between the cytokeratin profiles of JE, OSE, EOE and pocket epithelia (PE) in health and disease, in smokers and non-smokers.. The cytokeratin profiles of 40 samples of healthy and clinically inflamed human gingival tissue taken from 15 smokers and 25 non-smokers were studied by immunocytochemistry. Cryostat sections of fresh frozen gingival tissues were stained with a panel of monoclonal antibodies (mAb) and visualised by a biotin-Streptavidin-peroxidase complex technique.. JE and PE expressed an identical range of cytokeratins irrespective of the inflammatory or smoking status, with the exception of CK4 expression, which tended to be increased in smokers. The OSE and EOE expressed non-cornifying and cornifying differentiation cytokeratins respectively, but in the presence of inflammation, both these epithelia showed increased expression of CK19 at a basal level in association with expression of one or more of the simple cytokeratins. JE/PE expressed CK17 in external layers only, approximating the tooth surface. All epithelia expressed CK6, 16 the markers of high cell turnover.. CK 19 was a consistent differentiation marker for JE and PE. Expression of CK8, 18 was enhanced by inflammation. CK4 expression increased in association with smoking. Markers of differentiation were not always co-expressed equally within a pair. Pairs were not always completely mutually exclusive with frequent co-localisation.

Topics: Adolescent; Adult; Biomarkers; Cell Differentiation; Child; Connective Tissue; Epithelial Attachment; Epithelium; Female; Gingiva; Gingivitis; Humans; Immunoenzyme Techniques; Keratins; Male; Middle Aged; Periodontal Pocket; Phenotype; Smoking

Fourteen specimens of periodontal pockets and the associated marginal gingiva were collected and either frozen for examination using antibodies against various defined cytokeratin specificities or processed for 2-dimensional gel electrophoresis. The epithelium forming the pocket lining typically extended into the connective tissue of the pocket wall in the form of a network of finger-like strips. Immunocytological staining indicated that keratins (K) 5, 6, 14 and 19 were expressed by almost all cells of the pocket lining and K13 and K16 by the suprabasal cells. The coronal region of the pocket lining showed some cells staining for K4. Staining for K8 and K18 was seen in the apical region of the pocket lining and in the finger-like extensions of epithelium into the connective tissue. Compared with normal gingiva, the sulcular and the oral gingival epithelia showed a marked increase in staining for K19. Surprisingly, the pattern of keratin expression of the epithelium of the pocket lining was found to be essentially similar to that of normal junctional epithelium and the anatomical position of the boundaries between each epithelial phenotype were not significantly altered. These patterns of keratin expression were confirmed by the 2D electrophoretic analyses of microdissected regions of epithelium. The potential significance of inflammation to the epithelial changes associated with pocket formation is discussed.

Topics: Adult; Antibodies, Monoclonal; Electrophoresis, Gel, Two-Dimensional; Epithelial Attachment; Epithelium; Gingivitis; Humans; Immunoenzyme Techniques; Keratins; Middle Aged; Periodontal Pocket

Gingival crevicular contents provide a potential source of markers of the destruction of periodontal structures and the disease activity. This communication introduces a new device designed for efficient collection of samples from the critical area of initial tissue break-up at the bottom of a sulcus or a periodontal pocket. The instrument is characterized by two injection needles fitted one within the other so that during sampling the thinner "ejection needle" is at the bottom of the pocket and the "collection needle" at the gingival margin. The washing solution is manually ejected into the crevice and immediately drained through the collection needle into a sample tube by continuous suction. The technique developed provides an easy and useful method for studies of qualitative differences in the crevicular cells and in the chemical components of the crevicular fluid in various clinical situations. Furthermore, the use of the technique can be extended for localized lavage of acute periodontal pockets with appropriate therapeutic solutions.

Topics: Adult; Cell Count; Epithelium; Gingiva; Gingival Crevicular Fluid; Humans; Keratins; Leukocyte Count; Leukocytes; Middle Aged; Needles; Peptide Hydrolases; Periodontal Pocket; Proteins; Specimen Handling; Suction; Therapeutic Irrigation

Topics: Gingiva; Gingivitis; Humans; Keratins; Malocclusion; Periodontal Pocket; Periodontics; Wound Healing