Connective tissue graft and resin glass ionomer for the treatment of gingival recession associated with noncarious cervical lesions: a case series

This article describes the treatment of gingival recession associated with noncarious cervical lesions by a connective tissue graft in combination with a resin-modified glass-ionomer restoration (CTG + R). Eleven patients showing the association of recession and lesions were selected and treated by CTG + R. Bleeding on probing, probing depth, relative gingival recession, clinical attachment level, noncarious cervical lesion height, and dentin sensitivity were measured. The treatment provided statistically significant gains in clinical attachment level and shallow probing depths. The percentage of cervical lesion height covered was 74.0% ± 22.90%. It can be concluded that the presence of resin-modified glass-ionomer filling did not interfere with coverage achieved by the connective tissue graft.     

Connective tissue reactions to glass ionomer cements and resin composites.

This study evaluated the histopathologic reactions of rat connective tissue to two glass-ionomer cements (Fuji Cap II, Fuji Ionomer Type III) and two microfilled light-cured composite resins (Helio-molar Radiopaque and Helioprogress). IRM (zinc oxide-eugenol cement) was used as a control. Discs of the materials, 5 mm in diameter and 2 mm thick, that had set for 15 minutes were implanted under the dorsal skin of 75 Sprague-Dawley rats. There were 15 rats in each group and each animal received two identical implants. Five rats from each group were terminated at 7, 28 and 85 days after implantation. Histologic sections of the implant sites were stained with hematoxylin and eosin. Findings at all study periods indicated that Fuji Ionomer Type III elicited more intense reactions than the other materials. Reactions to Fuji Cap II, Heliomolar Radiopaque and Helioprogress, at all study periods, were comparable to each other and to IRM.     

Treatment of gingival recession in two surgical stages: Free gingival graft and connective tissue grafting

This report describes a clinical case of severe Miller Class II gingival recession treated by two stages of surgery that combined a free gingival graft and connective tissue grafting. First, a free gingival graft (FGG) was performed to obtain an adequate keratinized tissue level. Three months later, a connective tissue graft (CTG) was performed to obtain root coverage. The results indicated that the FGG allows for a gain in the keratinized tissue level and the CTG allows for root coverage with decreased recession level after 16 months. Therefore, for this type of specific gingival recession, the combination of FGG and CTG can be used.     

Connective tissue graft plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesion: a randomized-controlled clinical trial

Background: The aim of this clinical study was to evaluate the treatment of gingival recession, associated with non-carious cervical lesions by a connective tissue graft (CTG) alone, or in combination with a resin-modified glass ionomer restoration (CTG+R).
Materials and Methods: Forty patients presenting Miller Class I buccal gingival recessions, associated with non-carious cervical lesions, were selected. The defects were randomly assigned to receive either CTG or CTG+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL) and cervical lesion height (CLH) coverage were measured at baseline and 45 days, and 2, 3 and 6 months after treatment.
Results: Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant in BOP, PD, RGR and CAL, after 6 months. The percentages of CLH covered were 74.88 ± 8.66% for CTG and 70.76 ± 9.81% for CTG+R ( p >0.05). The estimated root coverage was 91.91 ± 17.76% for CTG and 88.64 ± 11.9% for CTG+R ( p >0.05).
Conclusion: Within the limits of the present study, it can be concluded that both procedures provide comparable soft tissue coverage. The presence of the glass ionomer restoration may not prevent the root coverage achieved by CTG.     

Connective tissue graft plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesions: microbiological and immunological results

Objectives

It was previously reported the clinical results of placing subgingival resin-modified glass ionomer restoration for treatment of gingival recession associated with non-carious cervical lesions. The aim of this study was to evaluate the influence of this treatment on the subgingival biofilm and gingival crevicular fluid (GCF) inflammatory markers.

Materials and methods

Thirty-four patients presenting the combined defect were selected. The defects were treated with either connective tissue graft plus modified glass ionomer restoration (CTG+R) or with connective tissue graft only (CTG). Evaluation included bleeding on probing and probing depth, 5 different bacteria targets in the subgingival plaque assessed at baseline, 45, and 180 days post treatments, and 9 inflammatory mediators were also assessed in the GCF.

Results

The levels of each target bacterium were similar during the entire period of evaluation (p?>?0.05), both within and between groups. The highest levels among the studied species were observed for the bacterium associated with periodontal health. Additionally, the levels of all cyto/chemokines analyzed were not statistically different between groups (p?>?0.05).

Conclusion

Within the limits of the present study, it can be concluded that the presence of subgingival restoration may not interfere with the subgingival microflora and with GCF inflammatory markers analyzed.

Clinical relevance

This approach usually leads to the placement of a subgingival restoration. There is a lack of information about the microbiological and immunological effects of this procedure. The results suggest that this combined approach may be considered as a treatment option for the lesion included in this study.     

Subepithelial connective tissue graft in a localized, plaque-induced ulcerative gingival recession: a case report

The transposition of connective tissue to increase the zone of keratinized tissue or cover exposed root surfaces has become an integral part of the surgical dental practice. An effort to expand the surgical protocol to gingival recession of ulcerative etiology is presented. Parameters such as pathogenesis, clinical characteristic, and histopathology are analytically discussed. Furthermore, different aspects of the mucogingival therapy phase of the grafting procedure are presented.     

Connective tissue growth factor in drug-induced gingival overgrowth

BACKGROUND: Drug-induced gingival overgrowth is a known side effect of certain chemotherapeutic agents used for the treatment of systemic disorders. The pathogenesis and mechanisms responsible for this condition are not fully understood. This study assesses for the presence and localization of connective tissue growth factor (CTGF) in drug-induced gingival overgrowth tissues. CTGF immunostaining was compared with sections stained with transforming growth factor (TGF)-beta1 and CD31 antibodies in order to investigate possible pathogenic mechanisms. METHODS: Gingival overgrowth samples were obtained from patients undergoing therapy with phenytoin (n = 9), nifedipine (n = 4), cyclosporin A (n = 5), and control tissues from systemically healthy donors (n = 9). Tissue sections were subjected to peroxidase immunohistochemistry and were stained with CTGF and TGF-beta1 polyclonal primary antibodies. Possible relationships between CTGF staining and angiogenesis were also studied using an anti-CD31 antibody as a marker for endothelial cells. Staining was analyzed by computer-assisted quantitative and semiquantitative methodology at 5 defined sites in all samples based on the location of specific landmarks including epithelium and underlying connective tissues. RESULTS: Cellular and extracellular CTGF content in phenytoin gingival overgrowth tissues was significantly (P<0.05) higher compared to the other gingival overgrowth tissues and the controls. Higher CTGF staining in phenytoin gingival overgrowth tissues was accompanied by an increased abundance of fibroblasts and connective tissue fibers. No strong association of CTGF staining with TGF-beta1 or CD31 staining was found. CONCLUSIONS: The data from the present study show significantly higher CTGF staining in phenytoin-induced gingival overgrowth tissues compared to controls, cyclosporin A-, or nifedipine-induced gingival overgrowth. Moreover, semiquantitative analyses of histologic samples support the concept that the phenytoin overgrowth tissues are fibrotic. These associations suggest a possible role for CTGF in promoting development of fibrotic lesions in phenytoin-induced gingival overgrowth.     

Preferential attachment of human gingival fibroblasts to the resin ionomer Geristore

The resin ionomer Geristore has been used extensively for root perforation repairs. The purpose of this study was to evaluate oral in vitro biocompatibility of the resin ionomer Geristore compared to two other dental perforation repair materials, Ketac-Fil and Immediate Restorative Material (IRM). Growth and morphology of human gingival fibroblasts (HGFs) was determined using scanning electron microscopy (SEM) of HGFs cells grown on test materials as well as cytotoxicity assays using eluates from test materials. SEM analysis showed that HGFs attached and spread well over Geristore with relatively normal morphology. SEM showed that fibroblasts did not attach and spread well over Ketac-Fil or IRM as cells appeared much fewer with rounded and different morphology than fibroblasts grown on Geristore. Cytotoxicity assays indicated that HGFs proliferated in the presence of Geristore eluates and not in the presence of Ketac-Fil or IRM eluates. In vitro interpretation indicates that Geristore is less cytotoxic to gingival fibroblasts.     

Connective tissue graft for gingival recession treatment: assessment of the maximum graft dimensions at the palatal vault as a donor site

BACKGROUND: The palatal masticatory mucosa is widely used as a connective tissue donor site in gingival recession treatment. However, concern has been raised regarding the potential risk of damaging the greater palatine artery (GPA) due to anatomical variations in the palatal vault. The anatomy of the palatal vault in terms of size and shape may affect the maximum dimensions of the graft that can be safely taken from the palatal vault. In a cohort of patients free of periodontal disease, the purpose of this study was to assess the maximum dimensions of the graft, particularly the height and length, that could be safely taken from the palatal vault. METHODS: Plaster impressions were made from 198 patients free of periodontal disease. Because the connective tissue graft is usually taken from an area extending from the mid-palatal aspect of the canine to the mid-palatal aspect of the second molar, this interval was measured and represented the maximum length dimension. The emergence of the GPA was assumed to be localized at the junction of the vertical and horizontal palatal walls of vault, and its course was marked on the plaster casts. The maximum height of the graft corresponded to the distances measured from the gingival margin to the marked course of the GPA of each tooth at its interproximal and mid-palatal aspects. RESULTS: The length of the maximum available tissue graft was 31.7 +/- 4.0 mm. The distance extending from the gingival margin to the greater palatine artery ranged from 12.07 +/- 2.9 mm at the canine level to 14.7 +/- 2.9 mm at the mid-palatal aspect of the second molar level. Therefore, in the premolar area, it was possible to harvest a connective tissue graft measuring 5 mm in height in all cases and 8 mm in height in 93% of cases. CONCLUSION: Our findings suggest that the maximum available tissue graft as measured in the palatal vault was large enough to allow a safe withdrawal from this donor site in a high percentage of our patient population free of periodontal disease.     

Connective tissue attachment formation following exclusion of gingival connective tissue and epithelium during healing

The present investigation was designed to evaluate the potential for reformation of connective tissue attachment on exposed and planed root surfaces by preventing the dentogingival epithelium and the gingival connective tissue from interfering with healing following periodontal surgery. Following the elevation of soft tissue flaps, the buccal and proximal alveolar bone of 24 teeth (48 roots) was removed to mid-root level in 6 monkeys and the exposed root surfaces were carefully planed in order to remove the root cementum. Before the flaps were repositioned and sutured, a membrane (Millipore® filter) was placed over the denuded part of the root surfaces of 16 teeth (test teeth) in order to prevent the epithelium and the gingival connective tissue from interfering with healing. The membrane was adjusted to cover the tooth surfaces from midcrown level to approximately l mm apical to the bone crest. No membranes were placed around the remaining 8 teeth (control teeth) before flap repositioning. The animals were sacrificed 6 months after surgery. The jaws were removed and histological sections of test and control teeth including their buccal periodontal tissues were produced. Nine of the test teeth had to be excluded from examination due to technical failures in the surgical procedure or tissue preparation. New cementum with inserting collagen fibers was observed on all remaining 14 test roots. The length of this newly formed fibrous attachment corresponded to approximately 50% of the distance from the apical extension of root planing to the cemento-enamel junction. In the majority of the control teeth no new attachment had formed but a “long” junctional epithelium was lining the root surfaces to the apical extension of root planing. In 3 control roots a small amount of new cementum with inserting collagen fibers was found in the most apical area of root planing. The results showed that the reformation of a connective tissue attachment was considerably favored by the placement of membranes which prevented the dentogingival epithelium and the gingival connective tissue from interfering with healing.     

Occurrence of gingival recession in adults

The occurrence of gingival recession was investigated in adults by age and gender and in relation to their dental status and frequency of toothbrushing. A total of 258 dentate subjects were clinically examined. Their mean age was 46 years and they had an average of 19.4 natural teeth. Gingival recession was recorded as present if any root surface was clearly visible without retraction of the gingival tissue. Recession was found on at least one tooth surface in 68% of subjects. Mean number of surfaces with recession was 7.2 for women and 10.4 for men. Subjects with gingival recession had fewer natural teeth than did those without recession. The two groups did not differ from each other in the number of filled teeth and decayed teeth. Mandibular teeth had more surfaces with recession than did maxillary ones. Sites of recession occurred quite symmetrically. Frequent toothbrushers had, both in the maxilla and mandible, more surfaces with recession than had those brushing their teeth infrequently. Frequent toothbrushing had a greater association with recession among women and in the youngest age group.     

Subepithelial connective tissue graft used with platelet-rich plasma in treatment of gingival recession

This paper describes the use of subepithelial connective tissue graft with platelet rich plasma in the treatment of gingival recession. There was complete root coverage in both the cases and the coverage is still maintained after 4 years. Clinical Relevance: Subepithelial connective tissue grafting with platelet-rich plasma may be an effective way to treat gingival recessions. Use of platelet-rich plasma provides the clinician with an autologous source of growth factors to accelerate healing.     

上皮下结缔组织移植术在牙龈退缩治疗中的应用

目的:观察上皮下结缔组织移植术在牙龈退缩手术治疗中的疗效. 方法:对8 例上下前牙及前磨牙牙龈退缩的病例行上皮下结缔组织移植术,并进行了12 个月的随访观察.结果:治疗前平均龈退缩为4.3 mm,平均探诊深度为2.3 mm.治疗后12 个月复查时,平均根面覆盖为3.0 mm(即平均71%的根面覆盖,自60%～80%不等),探诊深度平均为1.6 mm,表明有3.6 mm的临床附着增加(从2～5 mm不等).结论:皮下结缔组织移植术可以在保持浅袋的同时取得可靠的根面覆盖和临床附着增加.