Periodontal dressing after surgical crown lengthening: A randomized clinical trial

Objective. The aim of the present study was to evaluate the effect of periodontal dressing on post-operative pain and swelling after surgical crown lengthening. Materials and methods. A blind, randomized, clinical trial was carried out with 36 patients. Following surgical crown lengthening, the individuals were randomly allocated to the periodontal dressing group (PDG) and control group (CG, non-placement of periodontal dressing). Pain and discomfort were analyzed using a visual analog scale (VAS), verbal scale (VS) and the number of analgesics consumed in 7 days post-operatively. Post-operative infection, stability of the gingival margin and type of healing were also evaluated. Results. The PDG had a significantly higher percentage of responses of ‘strong pain’ on the VS in the first day post-operatively (33.3% vs 5.3%, p = 0.03) and greater pain on the first and second days post-operatively based on the VAS. Moreover, a significant difference between groups was found regarding gingival swelling after 7 days. However, gingival recession was found in 57.8% of the sites in the CG and only 5.5% of sites in the PDG. No change in condition was found among individuals with conjunctive tissue/bone exposure in the CG in the immediate post-operative period and 80% of the patients in the PDG had healing by first intention after 7 days. Conclusion. The use of periodontal dressing seems to be preferable following surgical crown lengthening with connective tissue/bone exposure. However, adequate post-operative analgesic strategies should be employed due to the possibility of intense pain in the first 24 hours.     

Living cellular construct for increasing the width of keratinized gingiva: results from a randomized, within-patient, controlled trial

Background: The standard of care for increasing keratinized gingiva adjacent to teeth that do not require root coverage is the free gingival graft (FGG). A pilot study indicated that the use of a living cellular construct (LCC) could be effective in this clinical scenario. Methods: A pivotal, multicenter, randomized, within‐patient, controlled, open‐label trial was conducted (N = 96 patients). After removing the mucosa and keratinized gingiva from the test site, either an LCC or FGG was applied. The primary efficacy endpoint was the ability of the LCC to regenerate ≥2 mm keratinized gingiva at 6 months. Secondary measures were the same color and texture as the adjacent tissue, a 1‐mm width of keratinized gingiva at 6 months, patient treatment preference, surgical site sensitivity at 1 week, and patient‐reported pain after 3 days. Safety was assessed by reports of adverse events. Results: At 6 months, the LCC regenerated ≥2 mm of keratinized gingiva in 95.3% of patients (81 of 85 patients; P <0.001 versus a 50% predefined standard). As expected, the FGG generated more keratinized gingiva than the LCC (4.57 ± 1.0 mm versus 3.2 ± 1.1 mm, respectively). The gingiva regenerated with the LCC matched the color and texture of the adjacent gingiva. All patients achieved ≥1 mm keratinized gingiva with the LCC treatment by 6 months, and more patients preferred treatment with the LCC than with the FGG. No difference in sensitivity or pain was noted between the treatments. The treatments were well tolerated, and reported adverse events were typical for this type of periodontal surgery. Conclusion: The use of an LCC may provide a safe and effective therapy for augmenting the zone of keratinized gingiva.     

Low‐intensity laser for harvesting palatal graft for the treatment of gingival recession: A systematic review

The aim of the present study was to assess the efficacy of low‐intensity laser therapy (LILT) for harvesting palatal connective tissue graft (PCTG) in the treatment of gingival recession. Databases were searched up to May 2018. The addressed focused question was: Is adjunctive LILT effective in the healing of donor palatine area after harvesting PCTG? Screening of the initially identified studies resulted in four clinical studies. All studies showed that LILT was effective in improving clinical outcomes, such as tissue thickness, postoperative discomfort, remaining wound area, and visual analog score at follow up. Upon comparison with the control group, two studies showed significantly greater improvements in the clinical parameters and patient‐centered outcomes for LILT than control groups at follow up. Due to the low number of included clinical studies, it remains debatable whether LILT improves clinical and patient‐centered outcomes of PCTG procedures. Further randomized controlled trials are needed to evaluate the outcomes of LILT on the healing of donor palatine area after harvesting PCTG     

Effect of topically applied hyaluronic acid on pain and palatal epithelial wound healing: An examiner‐masked,randomized, controlled clinical trial

1 Background

This study aims to evaluate the effects of two different concentrations of topical hyaluronic acid (HA) on postoperative patient discomfort and wound healing of palatal donor sites after free gingival graft (FGG) surgery.

2 Methods

Thirty‐six patients requiring FGG were randomly assigned into three groups in an examiner‐masked, randomized, controlled clinical trial. After harvesting palatal grafts, 0.2% and 0.8% HA gels were used in test groups 1 and 2, respectively. Gels were applied on donor sites and protected with periodontal dressing in the test groups, whereas the wound was covered only with periodontal dressing in the control group. On days 3, 7, 14, and 21, pain and burning sensation were recorded using a visual analog scale (VAS) as well as other parameters such as complete epithelization (CE) and color match on days 3, 7, 14, 21, and 42.

3 Results

Test groups experienced less pain than the control group on days 3 and 7 (P <0.001 and P <0.001, respectively). Mean VAS score for burning sensation was higher in the control group on day 3 compared with test groups 1 and 2 (P = 0.03 and P = 0.02, respectively). CE in all patients was achieved on day 21 in both test groups, whereas it was achieved on day 42 in the control group. The test groups showed higher color match scores than the control group on days 21 (P <0.001 and P <0.001, respectively) and 42 (P = 0.004 and P = 0.002, respectively).

4 Conclusion

Topical application of HA exhibits positive impact on postoperative pain and burning sensation, and accelerates palatal wound healing in terms of epithelization and color match.     

Mucoperiosteal migration after palatal surgery in Beagle dogs: A longitudinal radiographic study

In this study, the effect of palatal surgery on the mucoperiosteum was investigated radiographically. 33 beagle dogs were used, divided into 3 experimental groups, a control group and a sham operated group. At the age of 6, 16 or 25 weeks in the experimental groups, a soft tissue defect was created in the median region of the palate by excising a standardized elliptical mucoperiosteal flap. This defect was closed according to the Von Langenbeck technique. Metallic implants were placed in the mucoperiosteum. Dorso-ventral radiographs were taken until the age of 37 weeks. Increments of distances between these mucoperiosteum markers were calculated. Wound contraction in the denuded areas, recorded as the approaching of the opposite metallic implants followed the same pattern for all experimental groups and was restricted to the first 2 experimental weeks. In all experimental groups, the anterior and posterior overall palatal width diminished during the early wound healing compared to the control group. The largest initial effect was found in the anterior region of the palate. The margins of the mucoperiosteal tissue in the median region of the palate moved towards the denuded areas during the first postoperative week. Palatal surgery as performed did not influence antero-posterior distances on the palatal mucoperiosteum.     

Titanium‐prepared platelet‐rich fibrin provides advantages on periodontal healing: A randomized split‐mouth clinical study

1 Background

The aim of this study to evaluate the contributions of titanium‐prepared platelet‐rich fibrin (T‐PRF) combined with open flap debridement (OFD) on biological markers in gingival crevicular fluid (GCF)and periodontal outcomes.

2 Methods

Twenty‐nine participants with chronic periodontitis were treated either with autologous T‐PRF+OFD or OFD alone. GCF growth factor levels and relative receptor activator nuclear factor kappa‐B/osteoprotegerin (RANKL/OPG) ratio at baseline and 2, 4, and 6 weeks postoperatively were analyzed, and clinical parameters such as probing depth (PD), relative attachment level (RAL) and gingival margin level (GML) at baseline and 9 months after surgery were compared.

3 Results

The mean PD reduction, RAL gain, and GML change were significantly greater in the OFD+T‐PRF sites than in the OFD sites (P = 0.033, P = 0.029, and P = 0.026, respectively). Both groups demonstrated increased growth factor levels at week 2 compared with baseline, followed by reductions at weeks 4 and 6. GCF growth factor levels in the test group were seen at higher concentrations with respect to control group until 6 weeks post‐surgery. During this 6‐week period, relative RANKL/OPG ratio was found significantly lower in the OFD+T‐PRF group compared to the OFD group(P < 0.05).

4 Conclusions

Using T‐PRF membrane combined with OFD provided significantly higher concentrations of growth factors and lower RANKL/OPG ratio in GCF for approximately 4 to 6 weeks, and improved periodontal healing compared to conventional flap sites.     

Effect of chlorhexidine on gingival wound healing in the dog. A histometric study

Abstract Wound healing after gingivectomy was studied in five 1-year-old dogs (Beagles). During a preparatory period of 4 months, the teeth of the dogs were brushed twice a day using a toothbrush and dentifrice. At the end of this period, ail gingival units appeared healthy. All mechanical tooth cleaning procedures were then terminated. Following a period of 2 weeks without oral hygiene, six gingival units, taken bilaterally from the maxillary first molar and posterior premolar areas, were subjected to standardized gingivectomies. Subsequently, the biopsied areas of the left half of the jaws were treated twice a day with a 0.2% aqueous solution of chlorhexidine digluconate for 42 days, while corresponding areas of the right jaws were given saline treatment. Tissue specimens were obtained after healing periods of 42, 28, 14, 7, 4 and 2 days. They were then immediately placed in a Karnovsky fixative, and afterwards decalcified in EDTA. The rate of tissue regeneration and degree of inflammatory cell infiltration were evaluated with histometric methods. It was found that while gingival wounds treated with saline regenerated with extensive inflammatory reactions, corresponding chlorhexidine-treated wounds healed with only minor signs of inflammation.     

Evaluation of gingival blood flow by the use of laser Doppler flowmetry following periodontal surgery. A pilot study

OBJECTIVES: The aim of this pilot study was to evaluate the applicability of laser Doppler flowmetry (LDF) in recording the gingival blood flow following periodontal surgery. MATERIAL AND METHODS: Five patients suffering from advanced chronic generalized periodontitis were included in the study. After completion of basic periodontal therapy, full-mouth plaque score, bleeding on probing, gingival recession and clinical attachment level were recorded. The upper anterior areas with a pocket probing depth of 6 mm or more were treated with an access flap. LDF recordings were performed in both the buccal and palatal aspect of the operated areas with the aid of an individual acrylic stent at the day of the surgery, prior to local anaesthesia, 3 min following anaesthesia, immediately after the operation and at days 1, 2, 3, 4, 7, 15, 30 and 60 following operation. RESULTS: Overall, the blood flow decreased immediately following anaesthesia and remained in lower values compared to baseline immediately following operation. The gingival blood flow presented an overall increase in comparison to baseline values until the 7th day following surgery at the buccal and palatal interdental sites, as well as at the alveolar mucosa sites. By the 15th day, as well as at the following observation periods of 30 and 60 days, the gingival blood flow values at the palatal and alveolar mucosa sites were very similar to baseline. Increased blood flow changes were observed at 30 and 60 days following operation at the buccal interdental sites. CONCLUSION: The results of the present pilot study suggest that the LDF might present clinical applicability in recording changes in gingival blood flow following periodontal surgery.     

Effects of Ozone Therapy on the Early Healing Period of Deepithelialized Gingival Grafts: A Randomized Placebo‐Controlled Clinical Trial

Background: This study evaluates the effects of ozone therapy (OT) on the early healing period of deepithelialized gingival grafts (DGG) placed for non‐root coverage gingival augmentation by laser Doppler flowmetry (LDF). Methods: Thirty‐three patients were assigned to study groups: 1) test: DGG + OT; or 2) control group: DGG alone. Thirty patients completed the study. Ozone was applied on DGGs placed in the recipient bed and donor site immediately after surgery and at days 1 and 3 post‐surgery. Blood perfusion in the recipient site was measured by LDF on the day of surgery and at 1, 2, 3, 6, 8, 10, and 13 days after surgery. Quality of life (assessed by the Oral Health Impact Profile‐14) and pain at donor/recipient sites (assessed by visual analog scale) were also investigated. Results: Increase in blood perfusion units in the test group was significantly higher than control group at 1, 2, 3, 6, and 8 days post‐surgery (P <0.001). Significant differences occurred between test and control groups in terms of visual analog scale values during the first week post‐surgery for both donor and recipient sites (P <0.05). The ozone‐treated group showed significantly higher quality of life than control group on postoperative day 6 (P = 0.002). Conclusions: OT enhanced blood perfusion units in the first postoperative week. This outcome is also consistent with improvement in wound healing, accompanied by an increase in quality of life and decrease in postoperative pain in the test group.