Long-term predictability of allogenic dermal matrix for root coverage: Three years observation period on 15 consecutive cases

Gingival recession is an apical migration of gingival margin that is a common finding on patients with meticulous oral hygiene and periodontitis patients. Several surgical treatment techniques of gingival recession have been described. The most challenging situation is the presence of multiple adjacent recession defects. 15 patients with total of 53 recession defects have been treated with Acellular Dermal Matrix (ADM). The following clinical parameters were evaluated recession depth (RD), probing depth (PD); and the width of the keratinized tissue (KT). Upon completion of the study; there was statistically significant (P-value = 0.00) reduction in recession depth from baseline, one and three years after the surgery (2.6 mm, 0.32 mm, and 0.17 mm, respectively). There was statistically significant (P-value = 0.00) increase in the width of keratinized tissue from baseline to one year and three years (3.47 mm, 5.02 mm, and 5.40 mm, respectively). Based on this study the use of ADM with the coronally advanced flap resulted in a significant increase in keratinized tissue and percentage of root surface coverage.     

牙龈退缩根面覆盖治疗1例

目的 牙龈退缩常常导致根面敏感、菌斑控制不良和牙龈美学等问题,影响患者的口腔健康和颜面美观。本病例采用根面覆盖术治疗牙龈退缩,以改善患者牙齿敏感问题。诊治经过：手术采用冠向复位瓣联合结缔组织移植瓣双层技术治疗退缩类型（recession type,RT）为1类的牙龈退缩。结果 术后2周,受区龈缘略水肿;术后12个月复诊,龈缘位置趋于稳定,根面覆盖率达100%,角化龈宽度及临床附着水平增加。患者无牙齿敏感、系带牵拉和瘢痕形成等不适症状,牙龈美学效果良好。结论 冠向复位瓣联合结缔组织移植瓣双层技术治疗RT 1类牙龈退缩效果良好,不仅能够获得完全根面覆盖、牙龈美学效果良好,而且增加了术区角化牙龈的宽度和临床附着水平。     

Effect of connective tissue graft orientation on the root coverage outcomes of coronally advanced flap

The aim of the present study was the evaluation of the effect of connective tissue graft orientation on clinical outcome of root coverage procedure when applied in conjunction with coronally advanced flap. Sixteen similar bilateral recession defects--Miller's class I and II--in eight patients were treated using coronally advanced flap and connective tissue graft harvested from the palate. The defects in each patient were randomly allocated to P-teeth or P-flap groups with the periosteum contacting the tooth surface or the flap, respectively. After initial scaling and root planing, acrylic templates of the treatment sites were generated. Recession depth (RD), recession width (RW), gingival sulcular depth, clinical attachment level, length of keratinized tissue, papilla width, and percentage of root coverage were measured at baseline, 1 and 3 months postoperatively. Wilcoxon and Mann-Whitney U tests were used for analyzing the data. The reduction in RD averaged 3.68 mm in P-teeth and 3.25 mm in P-flap. RW decreased 2.68 and 2.6 mm in P-teeth and P-flap, respectively. Keratinized tissue increased an average of 1.25 mm in P-teeth and 1.31 mm in P-flap. Clinical attachment gain equaled 3.87 mm for P-teeth and 3.32 mm for P-flap. All variables exhibited significant improvement compared to baseline (P < 0.0001), but between-group differences were negligible (P > 0.05). It could be concluded that while the application of connective tissue graft with coronally advanced flap is efficient for coverage of Miller's class I and II gingival recession defects, the short-term clinical outcome of this surgical method is not affected by orientation of connective tissue graft.     

A direct technique with a double lateral bridging flap for coverage of denuded root surface and gingiva extension

We are introducing a new surgical technique which enables us to cover gingival recessions and extend the gingiva with a one-step procedure. This method can be described generally as a combination of a coronally repositioned flap and a modified vestibulum plastic. So far this method has been applied to 55 teeth of 19 different patients. The results have been observed for 2 years. After this time, 54.4% (30 teeth) still had complete coverage of the previously denuded root surfaces. The results show that it is possible to cover gingival recessions without increasing the zone of keratinized gingiva.     

Enhancing attachment of human gingival fibroblasts to periodontally compromised teeth: A comparative analysis of hyaluronic acid,EDTA, enamel matrix derivatives

BackgroundGingival recession is a characteristic indicator of periodontitis and one of the factors that contributes to increased tooth clinical crown length. Patients with root exposure frequently undergo periodontal surgical procedures in addition to adjunctive therapy to increase root coverage area and soft tissue stability.PurposeThis study aimed to evaluate fibroblast-root surface adhesion and determine whether periodontitis-damaged root surface microstructure can be restored using ethylenediaminetetraacetic acid (EDTA) and an enamel matrix derivative (EMD), individually or in combination.Material and methodsTeeth extracted from patients with periodontal disease were used to create 60 samples, with each group containing six specimens. The test groups were provided root planing or root condition-specific materials (hyaluronic acid [HA], 24% EDTA, EMD, or EDTA/EMD) for varying treatment time periods. In contrast, the control group did not undergo any surface modifications. The samples and fibroblast cells were incubated for 72 h. The number of living cells on the root surface in each group was calculated using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay (cell viability assessment).ResultsThe control, root planing, and EMD groups showed that the root surfaces treated with EDTA for 4 min had significantly better cell adhesion. Surface EDTA treatment for 2 min significantly promoted cell attachment compared to root planing treatment. The root surfaces modified with EDTA/EMD for 2 and 4 min showed significantly improved cellular migration and adhesion compared to the root surface treated with root planing.ConclusionEDTA and EDTA/EMD substantially affected the root surface, which was related to the length of the treatment process. This effect shifts the surface properties, alters fibroblast interactions with the root surface, and recruits more cells to cover a larger area.     

Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non‐inferiority in root coverage and superiority in oral health‐related quality of life

Aim

To evaluate the non‐inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient‐reported outcomes (PROM).

Material and methods

One hundred and eighty‐seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient‐reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates.

Results

Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six‐month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non‐inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8–8.8).

Conclusion

Replacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.     

下颌尖牙双根双根管1 例

下颌尖牙一般为单根单管,作者碰到1 例双根双根管型下颌尖牙.据观察,该牙颊、舌侧根的大小基本一致.测量其颊、舌侧根的长度,分别为24.5、 23.0 mm.想要成功施行牙髓病治疗,临床医师应意识到下颌尖牙解剖变异的可能.     

Decalcifying effect of 15% EDTA, 15% citric acid, 5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine

Aim To evaluate and compare ex vivo the decalcifying effect of 15% EDTA, 15% citric acid, 5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine. Methodology Two 2‐mm‐thick slices were cut from the coronal third of the root of 10 human incisors. Each slice was sectioned into two equal parts. Specimens were assigned to one of four groups (n = 10) for immersion in 20 mL of either 15% EDTA, or 15% citric acid, 5% phosphoric acid or 2.5% NaOCl, for three time periods (5, 10 and 15 min). The concentration of Ca²⁺ extracted from the dentine was measured by atomic absorption spectrophometry. The amount of calcium extracted was analysed using the Kruskal–Wallis test for global comparisons and the Mann–Whitney U‐test for pairwise comparisons. Results In the three time periods, 15% EDTA and 15% citric acid extracted the largest amount of calcium, with no significant differences between them. The 2.5% NaOCl solution extracted insignificant amounts of calcium, whereas 15% EDTA extracted 86.72% of the calcium in the first 5 min, and 15% citric acid and 5% phosphoric acid had a similar pattern of calcium removal (77.03% and 67.08% in first 5 min, respectively). Conclusions Solutions of 15% EDTA, 15% citric acid and 5% phosphoric acid decalcify root dentine, with most calcium extracted during the first 5 min of action. The efficacy of 15% citric acid and 15% EDTA solutions was significantly greater than that of 5% phosphoric acid solution at each time period (5, 10 and 15 min).     

Effect of root conditioning agents hyaluronic acid,EDTA and chlorhexidine on the attachment of human gingival fibroblasts to healthy root surface

BackgroundThe gold standard treatment of periodontal diseases is scaling and root planing (SRP). Different adjunctive root conditioning agents such as hyaluronic acid (HA), ethylenediaminetetraacetic acid (EDTA), and chlorhexidine (CHX) have been used with SRP to improve the smear layer removal and the healing of periodontal tissues. The aim of this study was to compare the effect of manual scaling with or without HA, EDTA, or CHX root conditioning on the attachment and viability of human gingival fibroblasts (GF).MethodsFifteen healthy single rooted teeth were co llected and divided randomly into a scaled (n = 12) and non-scaled control group (n = 3). The scaled roots were subdivided equally into four groups; the first group did not receive any chemical treatment, while the remaining groups were treated with the conditioning agents HA or 17% EDTA or 0.2% CHX gel. Gingival fibroblasts were seeded on the top of each root and incubated for 48 h to allow attachment to the roots. The viability of fibroblasts attached to the root surface was assessed using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) cell viability assay.ResultsThe cell viability was the highest in the scaled only group (p = 0.0001) while the lowest was in the scaled with EDTA group (p > 0.05). The scaled group was the highest followed by the HA and CHX groups, while the EDTA group showed the lowest mean value.ConclusionSRP remains the superior method for regaining cell attachment to the root surface, leading to better periodontal health, and adjunctive therapies did not enhance the GF attachment to the root surface beyond the effect of SRP. Further studies are needed to investigate the effect of root conditioning agents on periodontally diseased teeth in vitro and compare them in vivo.     

Comparative study of Emdogain and coronally advanced flap technique in the treatment of human gingival recessions. A prospective controlled clinical study

OBJECTIVES: Various surgical techniques have been proposed for coverage of denuded root surfaces. The aim of this study was to evaluate a comparison of coronally repositioned flap procedure with or without the use of enamel matrix proteins in the treatment of recession defects. MATERIAL AND METHODS: This study was an intra-individual longitudinal test of 12 months duration conducted as a blinded, split-mouth, placebo-controlled and randomised design. It was performed in 2 dental schools. 36 patients, aged 22-62 years, with 2 paired buccal recession defects of at least 3 mm participated. Surgical recession coverage was performed as coronally-advanced flap technique at both sites in the same session. One site was additionally treated with commercially-available enamel matrix proteins (Emdogain) and the other site with placebo (propylene glycol alginate) in accordance with the randomisation list. A blinded examiner assessed pre- and post-surgical measurements. Clinical measurements and photographs were taken pre-surgically and after 1 week, 3 weeks, 3 months, 6 months and 12 months, postoperatively. Measurements comprised height and width of the gingival recession, height of keratinized tissue, probing attachment level, probing pocket depth and alveolar bone level by periodontal probe, Florida Probe or caliper to the nearest 0.5 mm. RESULTS: 12 months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. Gingival recession decreased from 3.7 mm to 0.8 mm for the Emdogain treated sites and from 3.9 mm to 1.0 mm for the control sites, corresponding to mean root coverages of 80% and 79%, respectively. This difference was not significant. With the exception of keratinized tissue gain, which was significantly higher (p=0.003) in the Emdogain group, all other clinical variables were not different in the between-group comparison. CONCLUSIONS: As the additional use of Emdogain together with coronally advanced flap technique for recession coverage showed no difference in the overall clinical outcome, there is no clear benefit to combine Emdogain with this surgical technique.     

The clinical effect of acellular dermal matrix on gingival thickness and root coverage compared to coronally positioned flap alone

BACKGROUND: The primary aim of this randomized, controlled, blinded, clinical investigation was to compare the coronally positioned flap (CPF) plus an acellular dermal matrix (ADM) allograft to CPF alone to determine their effect on gingival thickness and percent root coverage. METHODS: Twenty-four subjects with one Miller Class I or II buccal recession defect of > or = 3 mm were treated with a CPF plus ADM or a CPF alone. Multiple additional recession sites were treated with the same flap procedure, and all sites were studied for 6 months. Tissue thickness was measured at the sulcus base and at the mucogingival junction of all teeth, with an SDM ultrasonic gingival thickness meter. RESULTS: For the ADM sites, mean initial recession of 3.46 mm was reduced to 0.04 mm for defect coverage of 3.42 mm or 99% (P < 0.05). For the CPF group, mean initial recession of 3.27 mm was reduced to 1.08 mm for defect coverage of 2.19 mm or 67% (P < 0.05). The difference between ADM and CPF groups was statistically significant (P < 0.05). Marginal soft-tissue thickness was increased by 0.40 mm (P < 0.05) for the ADM group, whereas the CPF group remained essentially unchanged. Keratinized tissue was increased for the ADM group by 0.81 mm (P < 0.05), whereas the CPF group increased by 0.33 mm (P > 0.05). No additional root coverage was gained due to creeping attachment between 2 and 6 months for either group. CONCLUSIONS: Treatment with a CPF plus an ADM allograft significantly increased gingival thickness when compared with a CPF alone. Recession defect coverage was significantly improved with the use of ADM.     

Root coverage stability of the subepithelial connective tissue graft and guided tissue regeneration: A 30-month follow-up clinical trial

Objectives

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.

Methods

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 30 months post-surgery.

Results

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: 3.25 mm and SCTG: 3.9 mm), PD (GTR-DFDBA: 1.6 mm and SCTG: 1.2 mm) and CAL (GTR-DFDBA: 4.9 mm and SCTG: 5.0 mm). The increase in KTW was significantly higher (p = 0.02) in the SCTG group (3.5 mm) than in the GTR-DFDBA group (2.4 mm).

Conclusions

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.     

The effect of Emdogain® and 24% EDTA root conditioning on periodontal healing of replanted dog's teeth

Abstract –  Controversies still exist as for the regenerative role of enamel matrix derivatives and the need for removal of the periodontal ligament in replanted teeth. The purpose of this study was to evaluate the effect of Emdogain^® and 24% ethylenediamine tetraacetic acid (EDTA) root conditioning on periodontal healing of replanted dog's teeth. Teeth were extracted, endodontically treated and preconditioned as follows: group 1, Emdogain^®; group 2, Emdogain^® + EDTA and group 3, EDTA. Teeth were replanted after 30 min extraoral time, splinted for 15 days and animals sacrificed after 8 weeks of observation. Histological evaluation was performed using hematoxylin/eosin and Masson trichrome and results scored based on previously reported criteria for histological evaluation. Replacement root resorption was histologically diagnosed in all groups except in the negative control. A parametric analysis showed no statistically significant differences between experimental groups. Root preconditioning with Emdogain^® alone or in combination with 24% EDTA showed no evidence of regeneration of collagen fibers and consequently did not prevent the development of replacement root resorption on replanted dog's teeth.     

双侧上颌第一前磨牙三根三根管1例

前磨牙是切牙和磨牙之间的一个过渡牙。其根管系统变异较大,大多数上颌第一前磨牙为双根管,三根管较少见,研究表明上颌第一前磨牙三根管发生率为0~5%。然而,双侧上颌第一前磨牙三根管未见报道。该文报告了一个罕见的病例：双侧上颌第一前磨牙三根三根管。