Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction

Efficacy of different interventions on the morbidity of the palatal donor area after free gingival graft and connective tissue graft: A systematic review

This review aimed to evaluate the efficacy of different interventions used on the palatal donor area in the treatment of postoperative pain after free gingival graft and connective tissue graft techniques, and their impact in the oral-health related quality of life (OHRQOL). This study was conducted according to PRISMA. A search was conducted in four electronic databases and the grey literature. The interventions found were grouped according to biological plausibility and mechanisms of action: Mechanical Barriers; Topical Drugs; Hemostatic Agents; Other Therapies (photobiomodulation, ozonotherapy and others). Fifty-four studies were included and 43 different interventions were reported. The most commonly reported intervention was collagen hemostatic sponge, either alone or combined with other interventions, followed by platelet-rich fibrin and photobiomodulation. Postoperative pain evaluation using the Visual Analogue Scale (VAS) generally indicated that interventions improved pain over time. However, comparing the superiority of interventions is challenging, as studies often combine different interventions with different mechanisms of action. OHRQOL also showed improvement over time, but the comparison between interventions is limited, since few studies used a validated tool. The methodological diversity among studies is considerable, requiring a cautious interpretation of individual studies.

Treatment of Submucous Alveolar Cleft With Hard- and Soft-Tissue Reconstruction in the Aesthetic Zone: A Case Report

OBJECTIVE

This case report offers information on accurate diagnostic and soft- and hard-tissue reconstruction periodontal surgery deal with "black triangles" in the aesthetic zone of anterior teeth caused by submucous alveolar cleft, which is rare and easily overlooked.

CLINICAL CONSIDERATIONS

Vertical and horizontal bone augmentation was conducted via guided tissue regeneration and alveolar bone grafting (ABG) at the cleft site where favorable bone grafting conditions were absent. A customized, vascularized interpositional periosteal-connective tissue (VIP-CT) flap was applied as the barrier membrane to maintain the stability of bone replacement graft and provide soft-tissue foundation for gingival papilla growth. Adjustment on the contact point position of the anterior teeth and the shapes of crowns induced growth of the gingival papillae with resin restoration. The radiological and clinical parameters, and smiling photographs demonstrated a satisfactory treatment outcome.

CONCLUSIONS

When the inflammation and local alveolar bone destruction in the anterior area are disproportionate, submucous alveolar cleft should be considered a potential etiology. Surgical treatment combined with resin restoration substantially improved the affected area.

CLINICAL SIGNIFICANCE

The hard- and soft-tissue defects can be improved through ABG and VIP-CT flap in a single surgery.

3D Bioprinting and Artificial Intelligence-Assisted Biofabrication of Personalized Oral Soft Tissue Constructs

Regeneration of oral soft tissue defects, including mucogingival defects associated with the recession or loss of gingival and/or mucosal tissues around teeth and implants, is crucial for restoring oral tissue form, function, and health. This study presents a novel approach using three-dimensional (3D) bioprinting to fabricate individualized grafts with precise size, shape, and layer-by-layer cellular organization. A multicomponent polysaccharide/fibrinogen-based bioink is developed, and bioprinting parameters are optimized to create shape-controlled oral soft tissue (gingival) constructs. Rheological, printability, and shape-fidelity assays, demonstrated the influence of thickener concentration and print parameters on print resolution and shape fidelity. Artificial intelligence (AI)-derived tool enabled streamline the iterative bioprinting parameter optimization and analysis of the interaction between the bioprinting parameters. The cell-laden polysaccharide/fibrinogen-based bioinks exhibited excellent cellular viability and shape fidelity of shape-controlled, full-thickness gingival tissue constructs over the 18-day culture period. While variations in thickener concentrations within the bioink minimally impact the cellular organization and morphogenesis (gingival epithelial, connective tissue, and basement membrane markers), they influence the shape fidelity of the bioprinted constructs. This study represents a significant step toward the biofabrication of personalized soft tissue grafts, offering potential applications in the repair and regeneration of mucogingival defects associated with periodontal disease and dental implants.

A comparative analysis of soft tissue volumetric alterations utilizing root mean square and positive and negative average calculations through two software

OBJECTIVES

Clinicians and researchers analyze standard tessellation language (STL) files to assess soft tissue volumetric changes over time. Various software programs are available for this purpose. This study aimed to compare the root mean square (RMS), the average of positive deviations (AVG(+)), and the average of negative deviations (AVG(-)) obtained from metrology-grade and nonmetrology-grade software at the shortest and normalized distances when conducting a 3D comparison of a region of interest using multiple scans of the same patient over time.

METHODS

Forty-five intraoral scans from 11 patients who underwent soft tissue augmentation procedures were used to evaluate RMS, AVG(+), and AVG(-) at both the shortest and normalized distances using metrology-grade (Geomagic Control X, 3D Systems) and nonmetrology-grade (Medit Design, Medit Link) software programs. All scans of each patient were first aligned and combined into a single STL file using proprietary dental software. The region of interest, where the soft tissue procedure was performed, was then isolated, and the combined file was separated into individual scans for further comparison. Each aligned and cut scan was then compared with the others to assess RMS, AVG(+) and AVG(-) at the shortest and normalized distances using Geomagic Control X and Medit Design. A total of 344 previously aligned and cut scans were compared, resulting in 86 deviation measurements for each software and measurement mode. After assessing normality and homoscedasticity using the Shapiro-Wilk and Levene's tests, respectively, a two-way analysis of variance was performed to determine significant differences in RMS, AVG(+), and AVG(-), considering the software (Geomagic Control X and Medit Design) and measurement mode (shortest and normalized). Pearson correlation and R-squared values were also calculated for each software's RMS, AVG(+), and AVG(-). Statistical significance was set at 0.05.

RESULTS

The RMS and AVG(+) measurements calculated using Medit Design were statistically greater than those obtained with Geomagic Control X at both the shortest and normalized distances (p < 0.001). No statistically significant differences were observed when comparing AVG(-) (p > 0.05). A significant correlation was observed between the RMS (R = 0.804; p < 0.001), AVG(+) (R = 0.833; p < 0.001), and AVG(-) obtained (R = 0.613; p < 0.001), obtained with Geomagic Control X and Medit Design.

CONCLUSIONS

Significant differences were observed when comparing deviations of different scans of the same patient over time, using RMS and AVG(+) at both shortest and normalized distances with metrology-grade (Geomagic Control X) and non-metrology-grade software (Medit Design). No statistically significant differences were found in AVG(-).RMS and AVG(+) demonstrated a very strong correlation between Medit Design and Geomagic Control X, along with a strong correlation in AVG(-).

CLINICAL SIGNIFICANCE

The RMS, AVG(+), and AVG(-) deviations obtained from Geomagic Control X and Medit Design cannot be directly compared, as each software employs its own algorithm. Caution is necessary when interpreting RMS, AVG(+), and AVG(-) measurements reported in the dental literature.

Free gingival graft shrinkage on periosteal bed and denuded alveolar bone recipient site: a randomized clinical trial

OBJECTIVE

There are several techniques to increase keratinized tissue, and free gingival grafting (FGG) is one of the most predictable methods. One of the main disadvantages of this method is the significant tissue shrinkage of the graft, so it is desirable to find a method that is associated with less shrinkage. The purpose of the present study was to compare graft shrinkage rates and postoperative pain intensity following FGG augmentation on periosteal beds and denuded alveolar bone.

METHODS & MATERIALS

A total of 22 FGGs with a thickness of 1 to 1.5 mm were placed in the area between the mandibular premolars. The recipient site for FGG was a periosteal bed in the control group and denuded alveolar bone in the experimental group. Dimensions of the grafts were recorded clinically by a periodontal probe as well as taking photographs, and the pain intensity was assessed with VAS scale, 1, 2, 4 and 8 weeks after surgery. The percentage of tissue shrinkage was calculated, and the two groups were compared.

RESULTS

A total of 22 patients (7 males and 15 females) completed the study and of these, 10 patients were in the experimental group (denuded bone bed), and 12 patients were in the control group (periosteal bed). At all times, the percentage of shrinkage in length, width and area in the control group (periosteum) was higher than the test group (bone). The highest percentage of shrinkage in all 3 parameters occurred in the control group related to the time between baseline and 1st week. In the experimental group, the highest percentage of length changes occurred between baseline and the 1st week and the highest percentage of width and area changes occurred between weeks 1 and 2. Changes in length, width and area between baseline and the first week and between baseline and week 8 were significant between the two groups. The mean pain in the control group (periosteum) was higher than the experimental group and only in the first week this difference was statistically significant.

CONCLUSION

It can be concluded that epithelialized gingival graft placed on the denuded bone bed is associated with less pain and discomfort in the recipient area at one week postoperatively and was associated with less tissue shrinkage during 8 weeks of follow-up compared to FGG placement on the periosteal bed.

Efficacy of Acellular dermal matrix simultaneous with implant placement: A systematic review and meta-analysis of clinical trials

PURPOSE

The vertical soft tissue thickness over the implant is essential for long-term procedure success and for biological integration of the suprabony soft tissue component, consequently, development of alternatives to autogenous soft tissue grafts such as allogeneic and xenogeneic grafts were needed. Acellular dermal matrix (ADM) is utilized to provide structural support for angiogenesis, revascularization and tissue remodeling in soft tissue augmentation, recession, and increasing the keratinized tissue width. At this point, the aim of this systematic review was to evaluate the amount of soft tissue height (STH) gained after augmenting the ADM in combination with the dental implants.

METHODS

A systematic search was performed in five databases. The primary outcome measure was STH change. Secondary outcomes included marginal bone loss (MBL) and pocket probing depth (PPD) at implant sites.

RESULTS

Six studies, with 200 participants, and reported pre- and post-operative mean of vertical tissue thickness, MBL, and PPD around implants were included in the meta-analysis. The pooled mean difference (MD) of STH was 0.84 (95 % CI:0.28 to 1.39) with a p-value < 0.0001. A total of three studies, reported MBL. The pooled MD of MBL around implants, comparing the mean change from baseline to 12 months. The random effect model revealed a MD of 0.07mm (95 % CI: -0.21 to 0.35 mm, p= 0.6325). Calculation of pooled MD of PPD at implant sites, comparing ADM groups to the control groups in three studies; the random effect model revealed a MD of -0.13mm (95 % CI: -0.47 to 0.22 mm, p= 0.4742).

CONCLUSION

While Acellular dermal matrix significantly improves vertical soft tissue thickness, it does not significantly impact marginal bone loss or pocket probing depth.

Effect of Connective Tissue Grafts in the Regenerative Treatment of Intrabony Defects: A Systematic Review and Meta-Regression Analysis

AIM

To assess the effect of connective tissue graft (CTG) in the treatment of periodontal intrabony defects (IDs), focusing on changes in postoperative gingival recession (GR) depth and regenerative outcomes.

METHODS

A systematic search was conducted across MEDLINE-PubMed, EMBASE, Cochrane CENTRAL, and Google Scholar for articles published through December 31, 2024. Randomized controlled trials (RCTs) comparing treatment outcomes in IDs treated with or without CTG were included in a meta-regression analysis. A mixed-effect linear regression model was employed to estimate the effect of CTG on postoperative GR depth, probing depth (PPD) reduction, clinical attachment level (CAL) gain, and bone fill (BF).

RESULTS

Twenty-three studies were selected, with five RCTs (176 IDs) included in the meta-regression. Of these, two RCTs compared bone graft (BG) + CTG to BG + resorbable membrane (MB), one compared periosteal vs. nonperiosteal CTG combined with BG, one compared open flap debridement (OFD) + CTG to OFD alone, and one compared BG + CTG to either OFD or MB. The use of CTG was significantly associated with a reduction in GR (mean effect size of 0.981 mm, 95% CI: 0.573 to 1.389, p = 0.001), PPD (mean effect size of 1.160 mm, 95% CI: 0.318 to 2.002, p = 0.010), as well as improvements in CAL (mean effect size of 1.105 mm, 95% CI: 0.420 to 1.790, p = 0.004) and BF (mean effect size of 1.382 mm, 95% CI: 0.595 to 2.169, p = 0.002).

CONCLUSION

Within the limitations of the study, the use of CTG in periodontal regenerative therapy for IDs appears beneficial in reducing postoperative GR and might further enhance regenerative outcomes compared to treatments without CTG.

Treatment of a Gingival Recession With In-Office Orthodontic Aligners and Gingival Graft

OBJECTIVE

Gingival recession is a complication that can occur after orthodontic treatment, and its cause is still very controversial in the literature. The objective of this study was to report a clinical case of orthodontic retreatment conducted with in-office aligners and root coverage using free gingival graft, connective tissue graft, and Emdogaim for a patient with severe gingival recession.

CLINICAL CONSIDERATIONS

This report presents a potential solution to correct a gingival recession with in-office clear aligner. A mandibular left lateral incisor whose root was positioned buccally to the bone plate, likely due to improper bonding of a fractured orthodontic retainer. The treatment consisted of 10 in-office aligners, which effectively repositioned the root within the alveolus. After the orthodontic retreatment, the patient underwent gingival grafting surgery, which was successful due to the accurate positioning of the root in the socket, influencing bone deposition in the area. Subsequent 4-year follow-up showed treatment stability, mainly in the soft tissue area.

CONCLUSION

Within the limitations of this case report, the in-office aligners facilitated individualized and precise movements, allowing for torque adjustments when necessary. Besides that, the improved root positioning facilitated successful surgical procedures for covering the gingival recession, including the free gingival graft (FGG) and connective tissue graft with Emdogain (CTG + Emdogain).

CLINICAL SIGNIFICANCE

This case report presents an orthodontic treatment alternative for the multidisciplinary correction of a gingival recession, meeting the esthetic and functional demands of an adult patient.

Technique to Protect the Palatal Donor Area After Taking a Free Gingival Graft: The Patchwork Technique

The objective is to describe a technique to protect the donor area after taking a free gingival graft. A partial de-epithelialization of the palatal area is performed with a lentil bur mounted in a dental turbine. A partial thickness flap is then created to harvest the superficial connective tissue layer. Subsequently, two collagen sponges are placed into the wound. The sponges are compressed and secured by two sling stitches. Once hemostasis is obtained, a uniform layer of flow composite is placed and light-cured. Finally, a sling stitch is added to secure and compress the composite layer. Postoperatively, the donor area showed satisfactory healing after 14 days, with partial healing after the first revision and complete epithelialization during the second revision, with no reported pain or discomfort. Thus, the patchwork technique may be a more straightforward, predictable, and cost-effective alternative that protects the donor area, improves healing, and reduces pain.

Clinical Observations of Soft Tissue Dimensions Around Teeth and Implants After Free Gingival Graft

INTRODUCTION AND AIMS

The histological and morphological differences in soft tissue between natural teeth and peri-implant may result in different clinical effectiveness to free gingival graft (FGG). This research aims to investigate the different efficacy of FGG in augmenting keratinized tissue width (KTW) between tooth and implant sites while evaluating its medium-term stability over a 2- to 5-year follow-up.

METHODS

In this study, 29 patients underwent FGG to address insufficient clinical scenarios when KTW <2 mm at the buccal aspect, including 37 implant sites and 33 natural teeth sites both in posterior regions were included. The KTW and gingival margin position (GMP) of these sites was assessed by measuring the intra-oral photographs which were taken at 0 days (T0), 3-month (T1), 6-month (T2), 12-month post-surgery (T3), and 2 to 5 years follow-up (T4).

RESULTS

The results revealed that KTW increased significantly in both groups. However, the natural teeth group showed significantly less graft shrinkage (GS) than the implants group. (Teeth: 2.05 ± 0.51 mm and 25.42% ± 6.45%; Implants: 3.18 ± 0.65 mm and 38.92% ± 5.39%, P <.01). From T1 to T4. The gingival margin coronally advanced by 0.47 ± 0.51 mm and 0.18 ± 0.43 mm for the natural teeth and implants group, respectively (P<.05).

CONCLUSIONS

A greater KTW reduction after FGG was observed at implants versus natural teeth. And, the graft surrounding implants after crown restoration was stable for up to 2 to 5 years.

CLINICAL RELEVANCE

By comparing the changes in KTW around natural teeth and implants following FGG to investigate whether there are differences between them and the degree of differences. Additionally, this allows us to explore whether the restorations impact the effect of FGG. This research can assist clinicians in selecting an appropriate amount of soft tissue during surgery to achieve treatment goals, reduce postoperative discomfort for patients, and enhance predictability in clinicians' ability to increase keratinized tissue. Furthermore, by observing changes in the position of GMP around natural teeth and implants, the effectiveness of FGG in root coverage can be understood, thus improving the predictability of FGG for root coverage.

Bioactive materials for post-operative healing and pain relief following palatal epithelialized graft harvesting: A meta-analysis of randomized clinical trials

BACKGROUND/PURPOSE

Palatal epithelial graft harvesting requires secondary healing, and various materials have been used to accelerate this and reduce discomfort. However, comparisons against standardized controls remain limited, especially in randomized clinical trials. This meta-analysis assessed the efficacy of bioactive materials of hyaluronic acid, platelet-rich fibrin, collagen, and cyanoacrylate in promoting healing and reducing pain after epithelial graft harvesting.

MATERIALS AND METHODS

Clinical trials were identified from PubMed, Scopus, Web of Science and Embase up to August 2024. The efficacies of bioactive materials were assessed using Review Manager Analysis, with odds ratios calculated for complete wound healing and mean differences in Visual Analog Scale (VAS) scores for pain.

RESULTS

Of 787 references, 9 clinical trials met eligibility: 6 on healing and 7 on pain. Meta-analysis showed significant improvement in complete epithelialization for the overall materials vs. control (OR = 4.28). Subgroup analysis showed improvements for HA (OR = 4.80) and PRF (OR = 12.81), but not cyanoacrylate. Similar results were seen for VAS pain scores on days 1-3 and day 7, with benefits for the overall materials and individually for HA, PRF, and collagen, except cyanoacrylate. High heterogeneity was found on days 1-3 (I2 = 66) and day 7 (I2 = 90 %). Subgroup analysis reduced most heterogeneity, except for HA on days 1-3 (I2 = 91 %).

CONCLUSION

HA, PRF, and collagen may relief pain, and HA and PRF might aid healing after epithelialized gingival graft harvest (no trials recruited in evaluating the collagen's effect on wound healing). Cyanoacrylate may not support pain relief or healing. Further trials are needed.

Incorporation of Greater Palatal Artery Pathway Projection into a Static Surgical Guide

Background/Objectives: The purpose of this study was to develop a digital workflow to incorporate the mucosal projection of the pathways of the greater palatal artery into a static surgical guide used for free gingival graft harvesting and connective-tissue grafting techniques. Methods: A cone-beam computed tomography file was uploaded and segmented using specific tools from digital design software. The artery pathways were identified and marked on cone-beam computed tomography. A standard tessellation file format was obtained and uploaded into three-dimensional mesh-processing software; this was merged into an intraoral scan file. New files were obtained and uploaded into three-dimensional modeling software. The final model with projections of the artery pathways was generated using specific tools. The digital model was uploaded into guided surgery planning software to design a digital surgical guide that could later be printed with the artery pathways marked on its surface. Results: The static surgical guide to the palatal mucosa could be used during a surgical approach for marking the safe-zone area against the artery pathways. Conclusions: The proposed technique is a viable method for visualization and marking the artery pathway projection on a static surgical guide when performing free gingival graft harvesting and connective-tissue grafting techniques.

Characterization of oral biomarkers during early healing at augmented dental implant sites

AIM

The aim of this study is to assess early wound healing expression of local angiogenic biomarkers following connective tissue graft (CTG) at dental implant sites.

METHODS

Twenty-eight subjects with single dental implants exhibiting a soft tissue dehiscence were included and randomly treated with CTG, either with coronally advanced flap (CAF) or with tunnel technique (TUN). Peri-implant crevicular fluid (PICF) was collected at the midfacial and midlingual aspect of the implant sites at baseline and at 3, 7, 14, 30, and 90 days after the surgical intervention. The expression of angiogenin (ANG), fibroblast growth factor-2 (FGF-2), platelet-derived growth factor (PDGF), tissue inhibitor of metalloproteinases-2 (TIMP-2), and vascular endothelial growth factor (VEGF) was investigated over a period of 3 months. Patient-reported outcomes, clinical measurements, and ultrasonography scans at multiple time points were also evaluated.

RESULTS

The longitudinal regression revealed a significant difference in the expression of VEGF and TIMP-2 between CAF- and TUN-treated sites over 3 months (p = .033 and p = .004, respectively), whereas no significant differences were observed for ANG, FGF-2 and PDGF between the two groups. At 7 days, a direct correlation was observed between ANG levels and ultrasonographic color velocity in the CAF group (p < .001) and between ANG levels and ultrasonographic color power in the TUN group (p = .028). VEGF levels and ultrasonographic mean perfused area of the CTG were significantly correlated at the 7-day time point (p < .001 for both CAF and TUN). The expression of VEGF at 7 days was directly associated with mucosal thickness gain at 1 year (p < .001 for both groups). Early TIMP-2 expression showed an inverse correlation with time to recovery (p = .002). TIMP-2 levels at 3 months exhibited inverse correlations with mean dehiscence coverage (p = .004) and the rate of complete dehiscence coverage (p = .012).

CONCLUSION

PICF biomarkers can be used to monitor early wound healing events following soft tissue grafting at implant sites. VEGF and TIMP-2 showed correlations with the 1-year clinical and volumetric outcomes, as well as with post-operative patient-reported outcomes and Doppler Ultrasonographic tissue perfusion-related parameters.

Gingival color with implant-supported fixed prostheses (ISFP) and the impact on esthetic outcomes

OBJECTIVES

To: 1) analyze possible differences in the CIEDE2000 lightness, chroma and hue of the gingiva at the free gingival margin (FGM) and the middle zone of keratinized gingiva (MZ) between participants with an ISFP in the maxillary anterior region and participants with natural dentition and healthy gums; and 2) examine the perceptibility/acceptability of the differences in CIEDE2000 lightness, chroma and hue and in overall color, using the Euclidean and CIEDE2000 formulae.

METHODS

The L*, a* and b* color coordinates were measured in 60 adult participants (30 with an ISFP and 30 with healthy teeth and gums) using a Spectroshade™ Micro spectrophotometer. From these coordinates, the changes in lightness (ΔL'), chroma (ΔC') and hue (ΔH') CIEDE2000 between the participants with and without an ISFP were quantified. The one sample t-tests were used to test whether there were significant changes in lightness, chroma and hue between the participants with and without an ISFP, and effect size was assessed with Cohen's d. The authors examined the differences in CIEDE2000 lightness, chroma and hue, and the overall color differences between the participants in pairs (with ISFP-without ISFP), comparing results with the published perceptibility and acceptability thresholds.

RESULTS

Statistically significant differences were found (p < 0.05) between participants with and without an ISFP in all color attributes at both zones, with all color attributes observed to be lower in the gingiva of participants with an ISFP. In both gingival zones, the ISFP had a large effect on lightness (Cohen's d > 0.8) and a medium effect on hue (Cohen's d between 0.5 to 0.8). The mean gingival color difference of participants with and without an ISFP was 8.72 units in the MZ and 9.60 units at the FGM, using CIEDE2000.

CONCLUSIONS

CIEDE2000 lightness, chroma and hue are significantly lower in participants with an ISFP, both at the FGM and the MZ, with particularly marked differences in lightness. The average color difference between healthy gingiva next to natural teeth and the gingiva adjacent to an ISFP is clinically unacceptable.

CLINICAL RELEVANCE

Gingival color needs to be considered an indicator of success, given the potential unesthetic gray show-through of transmucosal abutments with ISFPs. Unacceptable color changes caused by poorly planned ISFPs can lead patients to demand treatment be repeated with more esthetic materials or mucogingival surgery to "camouflage" the discoloration.

Effectiveness of restorative materials on combined periodontal-restorative treatment of gingival recession with cervical lesion: A systematic review

Introduction

Gingival recession associated with non-carious cervical lesions (NCCL) is a common finding in the majority of the population. Sometimes, periodontal surgery using connective tissue graft (CTG), which is the gold standard in the treatment of gingival recession, needs to be combined with adhesive restoration to restore sufficient convergence profile. Thus, this systematic review aims to evaluate periodontal-restorative therapy using CTG combined restorative material to treat gingival recession with NCCL.

Methods

This study, following PRISMA guidelines, involved a literature search across PubMed, Scopus, Embase, and Google Scholar for articles from 2014 to June 2023 using keywords related to connective tissue grafts, cervical lesions, and gingival recession combined using AND/OR as Boolean operator. It included randomized controlled trials (RCTs), prospective studies, case series, or reports involving adult subjects with gingival recession and non-carious cervical lesions treated with CTG and restorative care, with at least 6 months of follow-up. Data were independently extracted by two reviewers, with discrepancies resolved by consensus. Risk of bias was assessed using the Cochrane RoB 2.0 tool, ROBINS-I, and the JBI Critical Appraisal tool.

Results

8 out of 1175 publications were selected for final analysis. Selected publications consist of randomized clinical trials, prospective studies, case series, and a case report. The restorative materials used include resin composite, resin-modified glass ionomer (RMGI), and giomers. It has been reported that the restoration showed no negative effect on the surrounding gingival tissue after surgical treatment. Resin composites and RMGI showed similar clinical results as restorative materials whereas giomers was reported to be less effective for the combined treatment of gingival recession associated with NCCL.

Conclusion

Therefore, the combination of surgical and restorative treatment provides stable clinical outcome and good emergence profile in gingival recession associated with NCCL. Root coverage with CTG is successful on teeth with cervical fillings.

From tradition to innovation: a bibliometric analysis of the evolution of periodontal plastic surgery

PURPOSE

The aim of this study was to conduct a bibliometric analysis of the periodontal plastic surgery literature to identify trends, research gaps, and key themes within the field and to establish a perspective on documented research.

METHODS

This bibliometric study examined research outputs on mucogingival surgery indexed in the Web of Science database from 1990 to 2023. The Science Mapping Analysis Tool (SciMAT) software was used to visualize and predict research trends on this topic.

RESULTS

An analysis of publication distribution by year revealed a decline in the number of publications between 1984 and 1995, followed by an overall upward trend after 1996 despite occasional decreases. The United States contributed the most with 593 publications, and Wang HL (n=74) was the most prolific author. The most frequently used keyword was "gingival recession" (n=625). Overall, the publications received 44,859 citations, averaging 25.49 citations per publication.

CONCLUSIONS

Researchers have made significant efforts to improve clinical practices and procedures in periodontal plastic surgery, resulting in an increase in studies over recent years. By analyzing thematic maps and clusters-using indicators such as frequency, citations, and centrality-researchers can identify the strengths, weaknesses, and gaps in current research.

The top 100 most cited publications on free gingival graft between 2000 and 2023: a bibliometric and visualized analysis

BACKGROUND

Free gingival graft (FGG) is considered as a well-established periodontal surgical technique to achieve sufficient keratinized tissue width and thickness and subsequently enhance gingival health and stability. This bibliometric research aims to reveal research focuses and trends about FGG.

METHODS

Articles published on FGG were retrospectively retrieved from the Web of Science Core Collection database from 2000 to 2023. Statistical and visual analyses were performed to characterize their quantity, journals, countries and regions, institutions, authors and keywords by CiteSpace software.

RESULTS

The top 100 most cited articles comprised 80 original research papers and 20 reviews, with an average citation count of 56. Notably, 75% of these works (n = 75) were classified in the Q1 category of the Journal Citation Reports (JCR). The most influential article authored by Dr. Cairo F. in 2014 has received 251 citations. Specifically, 27 high-level papers published in Journal of Periodontology accounted for 1,849 citations. The United States with 30 articles published and the University of Michigan with 11 articles were the most productive country and institution, respectively. Prof. Wang Hom-lay published 6 articles with a total of 608 citations. Additionally, collagen matrix and dental implants have garnered significant attention over the past decades.

CONCLUSION

Our analysis offers a comprehensive overview and in-depth analysis of the future development trends and potential research directions of FGG, which can inspire both clinical and scientific researchers.

Adjacent free gingival grafting in the anterior region to avoid color inconsistency: A clinical report

Keratinized mucosa surrounding dental implants fulfills both esthetic and functional purposes, while regular free gingival graft (FGG) surgeries often lead to color and texture mismatch. The present clinical report describes a novel surgical technique designed for situations with inadequate keratinized mucosa width and color inconsistency around implants in the esthetic zone. The rationale for this technique is reviewed.

Hard and soft tissue alterations after the application of different soft tissue grafting materials during immediate dental implant placement: a systematic review and Bayesian network meta-analysis

BACKGROUND

The aim of this review is to compare the clinical outcomes of different soft tissue grafting materials (connective tissue graft (CTG), platelet-rich fibrin (L-PRF), allogenic and xenogenic substitutes) applied in immediate implant placement with each other.

METHODS

Through an electronic search regarding the study's main question ("In patients with non-restorable teeth, who receive immediate dental implants (P), what is the best adjunctive soft tissue grafting approach among different autogenous, allogenous, and xenogenous grafts (I), to achieve the desired hard and soft tissue structure (O), compared to sites without grafting (C)?") in PubMed, Scopus, and ISI Web of Science, randomized controlled clinical trials (RCTs) using different soft tissue grafts were identified and analyzed using a Bayesian random-effect network meta-analysis framework. The pink esthetic score (PES), marginal interproximal bone level changes (MIBL), buccal bone thickness changes (BBT), keratinized tissue width changes (KTW), soft tissue thickness changes (STT), papilla height changes (PH), midfacial gingival margin level changes (MGML) were defined as desired outcomes of the study; except for the MIBL with 12 - 24 months of follow-up, 6 - 12 months is considered for other outcomes.

RESULTS

After duplication removal, 903 studies were identified through the electronic search; from which 21 RCTs were included in the review. Among all comparisons in different outcomes, only CTG demonstrated a significantly higher gain in STT compared to not placing soft tissue graft. However, CTG in MIBL, KTW, STT, PH, and MGML, and uni-layer xenogenic collagen matrix in PES were the superior treatments, according to the treatment ranking based on surface under cumulative ranking (SUCRA).

CONCLUSIONS

At the time of immediate implantation, there is no significant difference between different soft tissue grafts regarding the clinical outcomes of implants. However, the utilization of CTG can be suggested in cases with thin soft tissue. The acceptable efficacy of allogenic and xenogenic materials and the non-significant difference between them and CTG indicate supporting evidence for the application of these materials to specific clinical situations simultaneously with immediate implantation.

SYSTEMATIC REVIEW REGISTRATION

CRD42024568586.

Socket Preservation Using Platelet-Rich Fibrin and Free Gingival Grafts

OBJECTIVE

The present randomised controlled trial is based on the null hypothesis that there is no difference in crestal bone levels (CBLs) following socket preservation (SP) using platelet-rich fibrin (PRF) and free gingival graft (FGG). The aim was to evaluate CBLs following SP using PRF and FGG.

METHODS

This study is a parallel-arm randomised controlled trial. Patients in the test and control groups underwent SP using PRF and FGG, respectively. Intraoral visual examination was performed to clinically assess signs of swelling, pus/abscess, and stability of sutures and graft. Self-rated postoperative pain was assessed after 1 week and 6 months using the visual analogue scale (VAS). At the 6-month follow-up, cone-beam computed tomography was performed to evaluate CBL in mesiodistal and buccolingual dimensions. The preoperative cone-beam computed tomographic images were superimposed with those taken at the 6-month follow-up to compare CBLs. Statistical comparisons were performed and level of significance was set at P < .05.

RESULTS

The test and control groups each comprised 13 individuals with comparable ages. All teeth included in the test and control groups were located in the maxillary aesthetic zone. At the 1-week follow-up, VAS scores were higher in the control than in the test group (P < .01). At the 6-month follow-up, none of the participants reported self-rated pain. The change in buccolingual dimension was greater in the control group than in the test group (P < .05).

CONCLUSIONS

Both FGG and PRF are effective techniques for SP; however, the latter technique is more effcacious in maintaining buccolingual dimensions of the extraction socket.

Autologous platelet concentrates in root coverage procedures

Gingival recessions are vastly prevalent among the general population. With regards to their treatment, recent advancements in periodontal and microsurgical procedures, focusing on minimal invasiveness and patient-centered therapies, have propelled a shift in their contemporary treatment, highlighting the field of biologics and bioactive mediators. Among different classes and types of biologics, autologous platelet concentrates (APCs), also referred to as autologous blood-derived products, are commonly used and preferred among many clinicians. These are essentially obtained via venipuncture (intravenous access) followed by centrifugation, for which numerous protocols and preparation methods have been used, leading to varieties of blood-derived products. In this review, via a systematic search, we explored the efficacy of the different utilized preparation methods and centrifugation protocols of APCs (e.g., platelet-rich plasma (PRP), platelet-rich fibrin (PRF), leucocyte-PRF, advanced-PRF, concentrated growth factor (CGF), etc.) for the treatment of type 1 gingival recessions (RT1, without interproximal attachment loss or noticeable tooth displacement), as well as their effectiveness relative to a common control (treatment with flap advancement alone without any additional material). Based on the available literature from randomized trials found in our systematic search, we observed that utilization of PRF can significantly enhance treatment outcomes when performing a coronally advanced flap, in terms of the amount of root coverage. The improvement in root coverage was further enhanced in the presence of baseline keratinized tissue width, and with an increasing relative magnitude (the more the baseline keratinized tissue width, the better the root coverage outcomes when using PRF). The efficacy of these products needs to be further explored with different graft substitutes and matrices, as well as relative to other commonly applied biologics, through well-conducted and adequately-powered randomized clinical trials.

How to explain the beneficial effects of leukocyte- and platelet-rich fibrin

The survival of an organism relies on its ability to repair the damage caused by trauma, toxic agents, and inflammation. This process involving cell proliferation and differentiation is driven by several growth factors and is critically dependent on the organization of the extracellular matrix. Since autologous platelet concentrates (APCs) are fibrin matrices in which cells, growth factors, and cytokines are trapped and delivered over time, they are able to influence that response at different levels. The present review thoroughly describes the molecular components present in one of these APCs, leukocyte- and platelet-rich fibrin (L-PRF), and summarizes the level of evidence regarding the influence of L-PRF on anti-inflammatory reactions, analgesia, hemostasis, antimicrobial capacity, and its biological mechanisms on bone/soft tissue regeneration.

Tissue Perfusion and Biomarkers Assessment Following Root Coverage Procedures

AIM

To assess tissue perfusion changes and wound healing biomarker levels after root coverage procedures with coronally advanced flap in combination with the cross-linked xenogeneic collagen matrix (CCMX), loaded either with a placebo or recombinant human platelet-derived growth factor-BB (rhPDGF).

METHODS

This study was designed as a secondary analysis from a previously published clinical trial, and it assessed the tissue perfusion changes over 6 months around multiple gingival recession defects, treated with either with CCMX alone (control) or with CCMX + rhPDGF (test). High frequency Doppler ultrasonography (HFUS) scans were obtained at sites of interest at baseline, 2 weeks, 3 months, and 6 months after surgery. Dynamic tissue perfusion measurements (DTPMs) were performed at the midfacial, interproximal, and transverse aspects of the teeth by an operator, blinded to treatment allocation, using a software package. The expression of different wound healing biomarkers from the gingival crevicular fluid was also assessed.

RESULTS

The regression analyses showed similar tissue perfusion changes between the two groups throughout the majority of the 6 months. DTPMs at 2 weeks showed the test group to have significantly higher perfusion relief intensity (pRI, p < 0.001), mean perfused area (pA, p < 0.001), mean blood flow intensity (FImean, p = 0.021), and total blood flow intensity (FItot, p = 0.021) at the graft region of interest (ROI) compared to control sites. The test sites also exhibited significantly greater pA (p = 0.033) and blood flow intensity "blue" (FIblue, meaning flow away from the transducer, p = 0.035) at the level of the flap compared to the control sites. At 2 weeks, FIblue of the graft was directly correlated with the final mean root coverage (p = 0.008) and complete root coverage (p = 0.003). FImean and FItot of the graft exhibited a direct correlation with volume gain at 6 months (p = 0.031 for both parameters). The final GT gain was correlated to the early DTPMs (pA and FIblue) of the graft and the flap. The two groups exhibited different expressions of IL-1β, PDFG-BB, and VEGF over 3 months, with the 1-week levels of PDGF-BB that were associated with time to recovery.

CONCLUSIONS

HFUS allowed exquisite assessment of tissue perfusion occurring at the entire surgical reconstructive regions and also within the flap and the graft. Sites treated with CCMX + rhPDGF exhibited higher DTPMs, primarily within the graft and flap ROIs at the 2-week timepoint compared to sites augmented with CCMX + saline. Early DTPMs at the graft and flap ROIs showed associations with PROMs and the final clinical outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04462237.

Discriminating between the maxillary tuberosity and the alveolar tuberosity- a critical pictorial review

PURPOSE

The maxillary tuberosity, a critical anatomical landmark in dentistry and maxillofacial surgery, is burdened by terminological confusion. This inconsistency hampers clinical practice and communication across disciplines.

METHOD

Different resources were used to argue for the necessity of standardising the terminology related to maxillary tuberosity to enhance diagnostic precision and ultimately improve patient outcomes.

RESULTS

Most clinical and surgical studies dealing with the distal alveolar bone of the maxilla erroneously indicate it as "maxillary tuberosity". By recognising the diverse definitions of this structure, errors and misinterpretation of studies could be reduced, and interdisciplinary collaboration could be improved. The term "alveolar tuberosity" is recommended to refer specifically to the distal end of the alveolar process of the maxilla. Anatomically, the maxillary tuberosity belongs to the body of the maxilla and forms part of the posterior wall of the maxillary sinus; therefore, it should not be located in the alveolar process.

CONCLUSION

Adhering to the Terminologia Anatomica will clarify the critical clinical and surgical landmarks and enhance communication in clinical and academic settings.

Hyaluronic acid efficacy in root coverage procedures: a systematic review and meta-analysis

BACKGROUND

Treatment of gingival recessions through surgical approaches is a common periodontal intervention. There is a rise in using biologics in root coverage procedures. As it has been shown that hyaluronic acid (HA) promotes wound healing, this review aimed to assess its efficacy in the treatment of gingival recessions.

METHODS

An electronic search was conducted across several databases (Medline/ PubMed, Embase, Scopus, Web of Science) supplemented by manual searching. The effectiveness of using HA was evaluated using various outcome measures, with the primary indicators being complete and mean coverage, recession depth, and recession width. Meta-analysis was performed to estimate the differences between test and control sites.

RESULTS

A total of 9 studies were eligible for inclusion. The overall analysis showed no significant difference between coronally advanced flap (CAF) + HA and control groups (CAF alone or CAF + sub-epithelial connective tissue graft) in terms of mean root coverage with a mean difference of 8.23 (95% confidence interval -3.06 to 19.53) and p = 0.12.

CONCLUSIONS

The current evidence suggests that the local application of HA may have some slight benefits over CAF alone in certain parameters. Nevertheless, its application does not add significant benefits to connective tissue graft. Given the high heterogeneity among the studies, further research with extended follow-up periods is necessary to better understand the clinical implications of using hyaluronic acid in this context.

TRIAL REGISTRATION

CRD42024580649.

A narrative review of papilla preservation techniques in clinical dentistry

The interdental papilla is closely associated with oral health and dental aesthetics. Interproximal papilla is an essential component of pink aesthetics as well as an indispensable prerequisite for the health of oral tissues. The loss of papillary height not only considerably affects final esthetic results, but also brings a series of periodontal complications. The deficiency of papilla can be induced by iatrogenic factors, particularly the flap technique, which is usually employed in oral surgeries. Therefore, preservation of the interdental papilla must be a consideration of flap designs. To avoid papilla defects secondary to conventional flaps, papilla-preserving flap designs have been widely studied in clinical practice. With numerous papilla preservation techniques (PPTs) increasingly being employed, not only is the postoperative pink aesthetic better maintained, but the predictability of surgical outcomes has been significantly enhanced. However, there is a lack of adequate literature that provides a comprehensive overview of PPTs in the field of dentistry. This review summarizes the latest developments in papilla preservation flap designs in the field of oral surgery, with a particular emphasis on their indications, limitations, incision characteristics, and clinical benefits. This review may provide optimal protocols for the personalized treatment.

Effect of free gingival graft dimension on postsurgical shrinkage in posterior implant placement: A prospective parallel cohort study

STATEMENT OF PROBLEM

The impact of free gingival graft (FGG) dimensions on the postsurgical shrinkage of keratinized tissue width (KTW) and surface area in posterior implant sites is unclear. Standardized assessments of how graft dimensions influence KTW and surface area shrinkage rates over a 6-month period after FGG are lacking.

PURPOSE

The purpose of this prospective parallel cohort study was to examine the impact of the graft dimensions on the postsurgical shrinkage of KTW and surface area over a 6-month follow-up period after FGG in the posterior regions.

MATERIAL AND METHODS

Thirty partially edentulous participants with insufficient buccal KTW in the posterior regions were recruited. Before implant placement, participants received FGG procedures and were categorized into single-tooth and dual-tooth groups according to the range of recipient area. Intraoral scanning was performed before and after FGG and at subsequent follow-ups for 6 months. The KTW and surface area shrinkage rates of the grafted area were calculated and statistically analyzed by using the Student t test and ANOVA, and Bonferroni post hoc tests were performed to compare the shrinkage rate of KTW at various edentulous sites (α=.05).

RESULTS

The mean ±standard deviation KTW shrinkage rate was 18.84 ±5.11% over 6 months postoperatively, and the mean ±standard deviation SA shrinkage rate was 21.53 ±5.70%. The dual-tooth group had a statistically significantly higher KTW shrinkage rate (28.42 ±2.46%) when the second molar edentulous sites were involved (P<.05). Differences in surface area shrinkage rates between the single-tooth and dual-tooth groups over 6 months were statistically similar (P=.239). However, grafts in the second molar area exhibited significantly higher surface area shrinkage rates compared with those at the premolar and first molar areas (P<.001).

CONCLUSIONS

The dimension of free gingival graft tissues did not significantly affect surface area shrinkage rates, and a mean 25% shrinkage rate occurred in the second molar areas.

The "HAT-TRICK" technique: A modification of soft tissue grafting using volume stable collagen matrix and cross-linked hyaluronic acid. Part B: Clinical applications in the esthetic zone

Soft tissue deficiency around dental implants can negatively impact outcomes in terms of esthetics and long-term stability. While autogenous connective tissue grafting is still considered the gold standard treatment, alternative approaches are being proposed primarily to enhance patient comfort and avoid invasive procedures such as two-sites surgeries using xenogeneic collagen matrices. Despite the advantages, the quality of the regenerated tissues remains unpredictable and, in many cases, questionable, highlighting the need for alternative and innovative approaches. After introducing in a previous technical note, the "HAT-TRICK" technique, to address these challenges in pontic sites, the present study highlights the "HAT-TRICK" technique for thickening the keratinized gingiva in both immediate and delayed implant placement sites within the esthetic zone. The "HAT-TRICK" technique is demonstrated through two clinical cases, accompanied by a digital comparison conducted at baseline and after one year of follow-up in order to assess and quantify the augmented areas.

Effectiveness of keratinized mucosa augmentation procedures around dental implants based on risk assessment: A 5-year retrospective cohort study

PURPOSE

To compare the effectiveness of keratinized mucosa (KM) augmentation with different techniques for the treatment of dental implants based on risk assessment.

METHODS

Thirty-nine patients who underwent KM augmentation at implant sites in the posterior mandible were included. Three techniques were used based on anatomy-guided risk assessment: an apically positioned flap (APF) alone, an APF plus a free gingival graft (APF plus FGG), and an APF plus a collagen matrix (APF plus CM). Clinically effective KM augmentation was defined as remaining KM ≥ 2 mm after the intervention. The effective rate, implant/prosthesis survival rates, and bone/soft tissue parameters were analyzed. The correlation between local anatomical characteristics and different techniques was also determined. The associations between the effectiveness of KM augmentation and related factors were analyzed using a linear model.

RESULTS

Overall, 74 sites received KM augmentation in the posterior mandible, for an effective rate of 94.6% at the 1-year follow-up and 93.2% at the 5-year follow-up. The KM width in the APF plus FGG group (3.85 ± 1.22 mm) was greater than that in the APF alone (3.05 ± 0.90 mm) (P = 0.016) and APF plus CM (3.21 ± 1.17 mm) groups (P = 0.038) at 5 years post-surgery. There was no significant difference in the effective/ineffective outcomes at the 1-year or 5-year follow-up among the three groups.

CONCLUSIONS

Comparable effective outcomes were achieved with three KM augmentation techniques following the decision-making criterion based on risk assessment.

Production of Polyvinyl Alcohol/Amoxicillin - Chitosan/Collagen Hybrid Bilayer Membranes for Regeneration of Gingival Tissues

Periodontal diseases, if untreated, can cause gum recession and tooth root exposure, resulting in infection and irreversible damage. Traditional treatments using autologous grafts are painful and often result in postoperative complications. Scaffolds offer a less invasive alternative, promoting cell proliferation and healing without additional surgery, thus enhancing comfort for patients and doctors. This study developed Chitosan (Chit)/Collagen (Col) film surfaces and drug-loaded Polyvinyl Alcohol (PVA)/Amoxicillin (AMX) nanofibers using solvent casting and electrospinning methods, respectively. The surfaces are characterized by scanning electron microscopy (SEM), mechanical testing, Fourier Transform Infrared Spectroscopy (FTIR), and differential scanning calorimetry (DSC). Biocompatibility and antimicrobial properties are assessed using NIH/3T3 fibroblast cells and bacterial cultures. SEM images confirmed the structural integrity of AMX-loaded 13% PVA nanofibers, while FTIR analysis validated the compositional integrity of PVA/AMX nanofibers and Chit/Col film hybrid surfaces. Cell studies showed over 90% viability for Chit/Col film + PVA/AMX nanofiber hybrid bilayer membranes, confirming their biocompatibility. The antimicrobial assessment indicated that the Chit/Col film + PVA/AMX (0.2%) nanofiber hybrid bilayer membrane exhibited superior efficacy against Streptococcus mutans. These findings suggest that this hybrid bilayer membrane can enhance cell growth, promote proliferation, and enable controlled drug release, offering significant promise for regeneration of gingival tissues.

In vitro ultrastructure and biodegradation of activated plasma albumin gel derived from human samples: A prospective observational study

BACKGROUND

In soft tissue regeneration, the clinical efficacy of fibrin membranes has been a pressing concern. The key to this efficacy lies in the stability of membrane and its controlled absorption. Human serum albumin, with its influence on the formation and stability of fibrin networks, could hold the key to developing a more stable alternative. This study investigates the ultrastructure and biodegradability of plasma albumin-activated gel, a potential game-changer in the field.

METHODS

Blood samples were collected from the participants and centrifuged to obtain the concentrated growth factor. The poor platelet plasma syringe was placed inside the activated plasma albumin gel device. The ultrastructure of the membrane was examined using a scanning electron microscope (SEM). The weight difference was measured over 21 days to investigate the biodegradability of the samples.

RESULTS

Twenty-two samples were prepared from six individuals (three males and three females). Based on SEM images, activated albumin gel after 21 days in Hank's solution exhibited a significant decrease in density and evident signs of surface degradation. The weight was significantly reduced after 21 days (p < 0.05).

CONCLUSION

In the present study, the investigation of the ultrastructure and biodegradability of activated albumin gel showed that, based on the observed weight difference, the amount of biodegradation is high, and it may be necessary to use a thicker membrane compared to the conventional thickness of the connective tissue graft.

KEY POINTS

Enhanced stability and biocompatibility: The study highlights plasma albumin-activated gel's potential as a soft tissue scaffold, demonstrating significant biodegradation and structural changes that support cell infiltration and nutrient exchange, essential for tissue regeneration. Controlled degradation profile: Plasma albumin gel offers a prolonged biodegradation period compared to conventional fibrin membranes, making it suitable for applications requiring stable, long-lasting scaffolds in soft tissue regeneration. Future clinical applications: Findings suggest that thicker plasma albumin membranes may be needed for optimal effectiveness, paving the way for further exploration in clinical trials and animal models to validate this approach in soft tissue grafting.

PLAIN LANGUAGE SUMMARY

This study investigates plasma albumin-activated gel as a promising material for supporting soft tissue repair, particularly in periodontal regeneration. Traditional materials, such as fibrin membranes, are often used to aid healing, but their rapid breakdown can limit effectiveness in the body. Plasma albumin, a protein naturally found in human blood, might offer a more stable alternative by forming a longer-lasting structure. In this study, researchers processed blood samples from participants to create the gel, examining its structure under a powerful microscope and tracking changes in weight over 21 days to assess its breakdown. Results showed that the gel gradually became less dense and more porous, allowing for cell movement and nutrient flow-both critical for tissue repair. Additionally, a significant reduction in weight indicated a controlled breakdown over time. These findings suggest that plasma albumin-activated gel may serve as a more durable scaffold for soft tissue regeneration, potentially improving healing outcomes in periodontal applications where a stable, longer-lasting material is needed.

Soft tissue elasticity at teeth and implant sites. A novel outcome measure of the soft tissue phenotype

AIM

To assess ultrasonographic tissue elasticity at teeth and implant sites and its variation after peri-implant soft tissue augmentation with a connective tissue graft (CTG).

METHODS

Twenty-eight patients, each contributing with one clinically healthy dental implant exhibiting a soft tissue dehiscence (PSTD), were included. Implant sites were augmented with CTG and monitored over 12 months. Ultrasonographic strain elastography, expressed as strain ratios (SR1, SR2, and SR3, respectively) was assessed at baseline, 6-, and 12-month, and compared with the corresponding contralateral homologous natural tooth. SR1 assessed the strain/elasticity of the midfacial coronal portion of the soft tissue in comparison to the natural tooth crown/implant-supported crown, SR2 evaluated the strain of the midfacial coronal soft tissue in relation to the one of the alveolar mucosa, while SR3 depicted the strain of the midfacial soft tissue in relation to the interproximal soft tissue on the transverse ultrasound scan.

RESULTS

SR1 in natural dentition and at implant sites was 0.20 ± 0.08 and 0.30 ± 0.14, respectively (p = .002), indicating that the coronal portion of the soft tissue around teeth is generally more elastic than its counterpart around dental implants. Soft tissue augmentation with CTG promoted an increased stiffness of the midfacial coronal portion of the soft tissue over 12 months (p < .001 for SR1, SR2, and SR3). Strain ratios at the 12-month time points were significantly higher than the values observed at 6 months (p < .001). Regression analysis demonstrated that strain elastography ratios in natural dentition were significantly associated with keratinized gingiva width, and gingival thickness. At implant sites, SR1 was significantly associated with keratinized mucosa width and mucosal thickness (p < .001 for both correlations), SR2 was significantly associated with keratinized mucosa width (p = .013), and SR3 was significantly associated with the surgical technique performed in combination with CTG (p = .022).

CONCLUSION

Ultrasound strain elastography captures and quantifies tissue elasticity and its changes after soft tissue augmentation. A different baseline tissue elasticity was observed between teeth and dental implants in the most coronal aspect of the soft tissue. The main factors affecting tissue elasticity-related outcomes were the keratinized tissue width, and mucosal thickness.

Chitosan-based dressing for management of palatal donor site: A randomized clinical trial

AIMS

This study aimed to evaluate the effectiveness of a chitosan-based dressing (CD) in achieving early wound healing and hemostasis at palatal donor sites in patients undergoing free gingival graft (FGG) surgery.

METHODS

Thirty-two patients requiring FGG were treated in this randomized controlled clinical trial. Complete epithelialization (CE) and color match (CM) at donor sites were assessed by a blinded examiner on postoperative days 7, 14, 21, and 28. Donor sites were compressed for 2 min with wet gauze (WG) alone in control group (CG) or WG + CD in test group (TG) immediately after graft harvesting, and immediate bleeding (IB) was recorded (yes/no). Delayed bleeding (DB) (for 1 week), and number of analgesic tablets consumed, and VAS scores for pain (for 2 weeks) were recorded by patient every day.

RESULTS

Twenty-eight patients (14 in each group) were included in final analysis. The prevalence of CE (at weeks 2 and 3) and VAS scores for CM scores were higher in TG but the intergroup differences were statistically significant only for CM (at week 4). Number of patients exhibiting IB and DB was significantly fewer in the TG (p < .05). Although average pain scores and analgesic consumption were higher in TG up to 5 days, differences between two groups were not statistically significant at any time point.

CONCLUSION

Our data suggests that the application of CD increased re-epithelialization and accelerated wound healing process, although it did not reach statistical significance. Moreover, CD was found to significantly reduce bleeding complications, but it did not decrease the pain levels.

Harvest of epithelialized gingival grafts without application of hemostatic sutures: A randomized clinical trial using laser speckle contrast imaging

BACKGROUND

This randomized controlled trial with two parallel arms and a 1:1 allocation ratio aimed to compare early microvascular healing (primary outcome), surgical times, and patient-reported outcomes (PROM) after harvesting palatal epithelialized gingival grafts (EGG), where hemostasis was achieved with sutures and hemostatic sponges (control) or with a sutureless approach (test).

METHODS

From a total of 33 patients, 34 EGG were harvested. Thirty-two were randomized to the test/control group (n = 16) and two were excluded. Early palatal microvascular healing was assessed at 7, 14, and 30 days with laser speckle contrast imaging (LSCI). Postoperative bleeding, pain, discomfort, and analgesic consumption were assessed over 2 weeks with a dedicated questionnaire.

RESULTS

A faster onset and resolution of postharvest hyperemia was observed in the test group where peak blood flow was reached at 7 days. No significant blood flow differences were observed between the groups at any of the evaluated timepoints. The mean surgical time was 13 min shorter in the test (p = 0.00). No significant differences were observed for postoperative bleeding and analgesic consumption at any timepoint.

CONCLUSIONS

The tested approach represents a viable alternative to the standard one, providing no relevant differences in microvascular, clinical, and patient-related results, but with significantly shorter surgical times.

Management of Soft Tissue Defects Around Single Implants: A Systematic Review of the Literature

OBJECTIVES

The aim of this systematic review was to assess the effectiveness of the available techniques for the management of peri-implant soft tissue defects around single implants in the anterior region.

MATERIAL AND METHODS

A comprehensive search was conducted in PubMed (MEDLINE), Web of Science (all databases), and Cochrane, using keywords and MeSH terms related to the topic. This systematic review included prospective interventional studies with a minimum of 10 patients and at least 6 months of follow-up.

RESULTS

A total of 13 articles were included, with eight focusing on outcomes related to buccal soft tissue dehiscence coverage procedures and the remaining five investigating interventions aimed at augmenting soft tissue thickness. Coronally advanced flap in combination with connective tissue graft was the most effective technique for buccal soft tissue dehiscence coverage in the medium and long term. In terms of increasing soft tissue thickness, both connective tissue graft and acellular dermal matrix demonstrated satisfactory short-term outcomes; however, their long-term efficacy remains unclear.

CONCLUSIONS

Soft tissue augmentation procedures resulted in satisfactory outcomes, in terms of buccal soft tissue dehiscence coverage and soft tissue thickness increase, around single implants in the esthetic area. Peri-implant plastic surgery has improved both the esthetic appearance and quality of life of patients.

PROSPERO REGISTRATION CODE

CRD42023398424.

Efficacy of a Novel Melatonin-Loaded Gelatin Sponge in Palatal Wound Healing

OBJECTIVES

The aim of this research was to assess both clinically and histologically the effect of a topically applied melatonin-loaded gelatin sponge on palatal wound healing after graft harvesting.

METHODS

Twenty-six patients for whom free palatal graft procurement was indicated were divided equally into 2 groups. In the test group, the donor site was covered by a melatonin-loaded gelatin sponge, and in the control group the site was covered by a placebo-loaded gelatin sponge. Wound healing was evaluated on the day of surgery and at 7 and 14 days postsurgery using photo-digital planimetry. Histologic specimens were taken to verify healing type and rate. Pain was assessed via Visual Analogue Scale (VAS) for 7 days from the day of the surgery.

RESULTS

At the 7-day interval, photo-digital planimetry showed a significant decrease in the traced raw area (P = .04) in the test group compared with the control group and a significant increase in the mean area of immature epithelia (P = .04). At the 14-day interval, there was no statistically significant difference in any area of interest. Histologically, the application of melatonin was associated with accelerated healing and superior maturation at all follow-up time points. No significant differences were noted in VAS scores between the 2 groups.

CONCLUSIONS

Melatonin-treated tissue showed marked clinical improvement in the first week postsurgery, indicating an increased rate of healing. Similarly, histologic analysis revealed significant maturation at both time intervals. A melatonin-loaded gelatin sponge is a novel palatal wound dressing that can be used to improve wound healing outcomes and reduce patient morbidity.

Patient Experience and Wound Healing Outcomes Using Different Palatal Protection Methods After Free Gingival Grafts: A Systematic Review

(1) Background: A free gingival graft (FGG) is a common technique used to reconstruct or enhance the area of keratinized mucosa, while a connective tissue graft (CTG) is utilized to boost soft tissue thickness, thereby promoting stability in interproximal marginal bone levels. Most reported complications following FGG procedure are associated with the donor site. In addition to a painful, open wound in the palate, the most frequent complications linked to FGG harvesting include excessive bleeding, postoperative bone exposure, and recurrent herpes lesions. Numerous methods for securing the donor site after a free gingival graft surgery have been documented in research publications. The main objective of this systematic review was to assess various techniques for protecting the palate after graft harvesting and their impact on patient experience, with a focus on pain management. The secondary objective was to evaluate these techniques in relation to donor site wound healing. (2) Methods: The search was performed across four databases: Medline (PubMed Central), Scopus, Web of Science, and Embase, in accordance with PRISMA guidelines and the recommendations set forth in the Cochrane Handbook for Systematic Reviews of Interventions. The initial search took place on 9 October 2023, followed by an update on 28 June 2024. The search utilized the following keywords: ("wound" OR "injury") AND ("graft" OR "free gingival graft" OR "graft harvesting") AND ("healing" OR "recovery") AND "palate". (3) Results: After conducting the follow-up search, a total of 958 papers were identified: 193 from PubMed, 314 from Scopus, 101 from Web of Science, and 350 from Embase. Ultimately, of the 49 papers that remained, 11 were excluded due to not fulfilling the inclusion criteria, leaving 38 full-text papers on free gingival grafts (FGG) for qualitative analysis. (4) Conclusions: Various methods for palatal protection after free gingival grafts (FGG) are described in the literature, stemming from biological, physical, or chemical sources. Most studies in this review examined platelet-rich fibrin and suggested that it provides no benefits for patients' subjective experiences or wound healing outcomes. While photobiomodulation appears to support wound epithelialization, it does not influence pain perception. Alternatives such as propolis, hyaluronic acid, and medicinal plant extracts show potential for palatal protection; however, further research is needed to thoroughly evaluate their effectiveness.

Adjunctive therapy for root coverage with concentrated growth factor versus platelet-rich fibrin membranes: a systematic review and bayesian network meta-analysis

OBJECTIVES

To assess the differences between adjunctive therapy with Concentrated Growth Factor (CGF), Platelet-rich Fibrin (PRF) membranes, and available control groups in the clinical outcomes of root coverage.

MATERIALS AND METHODS

Randomized controlled clinical trials (RCTs) were identified in Pubmed/Medline, Scopus, and ISI Web of Science databases to assess the treatments after 6 months using a Bayesian random-effect network meta-analysis (NMA) framework regarding reduction in pocket depth (PD), clinical attachment loss (CAL), recession depth (RD), and width (RW), as well as, keratinized tissue width (KTW) and thickness (KTT) gain, and complete (CRC) and mean (MRC) root coverage percentages.

RESULTS

Thirty-two RCTs were included, from which 27, 18, 12, eight, one, and one studies investigated PRF, connective tissue graft (CTG), flap alone, CGF, enamel matrix derivative (EMD), and dehydrated amniotic membrane, respectively. Thirty studies comprising CTG and flap-alone arms other than CGF and PRF were added to NMA. No significant difference has been found between CGF and PRF; however, CGF have a higher probability of being a better treatment than PRF in PD, CAL, and RW reduction and KTW gain, and PRF has a higher probability for being better in MRC, CRC, KTT gain, and RD reduction. PRF was significantly superior to flap-alone in terms of KTT gain and RD reduction. CGF had the highest probability of being the best treatment in PD and RW reduction, but in other outcomes, CTG was superior. PRF was significantly superior to flap-alone in terms of KTT gain and RD reduction.

CONCLUSIONS

Both adjunctive CGF and PRF demonstrated improvements regarding root coverage outcomes. Although there is no significant difference between PRF and CGF, these two membranes might have different impacts on different outcomes. Further studies are required for a more comprehensive conclusion, especially on CGF.

CLINICAL RELEVANCE

CTG is recommended for achieving ideal results in root coverage procedure. Since PRF and CGF both have a higher probability for being superior to flap alone, both could be suggested in cases which less than ideal outcomes are acceptable and minimization of patient discomfort is necessary.

Efficacy of autologous platelet concentrates for root coverage of Miller's Class I and II gingival recession defects: A systematic review and meta-analysis

Background

This systematic review and meta-analysis aimed to assess the efficacy of autologous platelet concentrate (APCs) in comparison with coronally-advanced flap alone or in combination with connective tissue graft or other biomaterials or bioactive agents for root coverage (RC) of Miller's Class I and II gingival recession defects by measuring the keratinized mucosa width (KMW).

Materials and Methods

This systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines. An electronic search of the literature was conducted in PubMed, EMBASE, Scopus, Cochrane, Web of Science, Magiran, Scientific Information Database, and Irandoc for randomized clinical trials (RCTs) that used APCs for RC in their intervention group. Eligible articles were retrieved by assessment of titles and abstracts and then the full texts. The risk of bias was assessed by the Cochrane Library Risk of Bias Assessment Tool. Meta-analysis was carried out by RevMan 5.3 software. In the case of homogeneity, variables were reported as weighted mean difference (WMD) with 95% confidence interval (CI) for each group.

Results

The search yielded 689 articles; out of which, 32 were eligible for study inclusion. Meta-analysis did not show any additional effect for RC and KMW with APCs. Clinical parameters were as follows: RC: WMD = -1.57 mm (95% CI: -2.49, -0.659; P = 0.001) and KMW: -0.106 mm (95% CI: -0.3222, 0.110; P = 0.337).

Conclusion

The application of APCs for RC of Miller's Class I and II gingival recession defects does not seem to improve the clinical parameters.

Assessing the effectiveness of advanced platelet rich fibrin in treating gingival recession: a systematic review and meta-analysis

OBJECTIVES

The literature lacks comprehensive evidence on the efficacy of advanced platelet rich fibrin(A-PRF) in treating gingival recession. Therefore, this systematic review and meta-analysis aimed to evaluate the effectiveness of A-PRF in the treatment of gingival recession.

MATERIALS AND METHODS

We adhered to the guidelines of PRISMA in searching the following databases: PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus to include all the eligible studies according to the prespecified inclusion and exclusion criteria. We conducted our search up to February 28, 2024. We conducted a meta-analysis of the primary and secondary clinical outcomes to measure the changes from baseline to 6 months after surgery.

RESULTS

Our review included 10 randomized clinical trials in which 146 participants with 457 recession defects were included. We found that combination of A-PRF with various surgical techniques, such as coronally advanced flap (CAF) connective tissue graft (CTG), VISTA, tunneling, and pinhole surgical technique, demonstrated promising outcomes but varied by comparison group. We observed that CTG with CAF showed a higher reduction in recession depth in comparison to A-PRF with CAF. This review indicated no statistical or clinical differences in recession width, width of keratinized gingiva, probing depth, and clinical attachment level between the study and control groups.

CONCLUSIONS

Due to the less invasive nature of A-PRF, it provides a better clinical option to improve the outcomes of treating gingival recession. However, more well-designed RCTs with standardized approaches are needed to confirm these results.

Microbial Dynamics in Periodontal Regeneration: Understanding Microbiome Shifts and the Role of Antifouling and Bactericidal Materials: A Narrative Review

Periodontal regeneration is a multifaceted therapeutic approach to restore the tooth-supporting structures lost due to periodontal diseases. This manuscript explores the intricate interactions between regenerative therapies and the oral microbiome, emphasizing the critical role of microbial balance in achieving long-term success. While guided tissue regeneration (GTR), bone grafting, and soft tissue grafting offer promising outcomes in terms of tissue regeneration, these procedures can inadvertently alter the oral microbial ecosystem, potentially leading to dysbiosis or pathogenic recolonization. Different grafting materials, including autografts, allografts, xenografts, and alloplasts, influence microbial shifts, with variations in the healing timeline and microbial stabilization. Biologics and antimicrobials, such as enamel matrix derivatives (EMD) and sub-antimicrobial dose doxycycline (SDD), play a key role in promoting microbial homeostasis by supporting tissue repair and reducing pathogenic bacteria. Emerging strategies, such as enzyme-based therapies and antifouling materials, aim to disrupt biofilm formation and enhance the effectiveness of periodontal treatments. Understanding these microbial dynamics is essential for optimizing regenerative therapies and improving patient outcomes. The future of periodontal therapy lies in the development of advanced materials and strategies that not only restore lost tissues but also stabilize the oral microbiome, ultimately leading to long-term periodontal health.

Volumetric assessment of volume stable collagen matrix in maxillary single implant site development: A randomized controlled clinical trial

INTRODUCTION

The stability of soft tissue volume around dental implants is an important factor for the final esthetic outcome. The main objective of this study was to compare volume stable collagen matrix (VCMX) versus connective tissue graft (CTG) in the augmentation of soft tissue profiles in single implant sites with a class I Siebert ridge defect.

MATERIALS AND METHODS

Twenty patients (14 females and 6 males) were enrolled in the present study. After implant placement and augmentation of the buccal defect by VCMX or CTG, post-operative evaluation of the volumetric changes at the augmented implant site was carried out at 3, 6, and 9 months as primary outcome, clinical and radiographic soft tissue thickness were carried out at baseline and 9-month intervals, visual analog scale (VAS) and oral health impact profile-14 (OHIP14) were recorded 2 weeks after the surgery.

RESULTS

A statistically significant difference in soft tissue volume was found between baseline and 3, 6, and 9 months postoperatively in both groups with the highest value at 9 months (136.33 ± 86.80) (mm3) in VCMX and (186.38 ± 57.52) (mm3) in CTG. Soft tissue thickness was significantly increased in both groups at 9 months in comparison to baseline. However, there was a significantly higher increase in soft tissue thickness at 9 months in CTG (3.87 ± 0.91) than in VCMX (2.94 ± 0.31). Regarding the radiographic soft tissue thickness, there was a statistically significant increase in both groups at 9 months in comparison to baseline. However, there was a statistically higher increase in the radiographic soft tissue thickness at 9 months in CTG (3.08 ± 0.97) than in VCMX (2.37 ± 0.29). VAS showed a statistically lower value in VCMX (0.4 ± 0.7) than CTG (2.8 ± 1.48). The OHIP recorded lower values in the VCMX group than the CTG group with no statistical significance. In addition, there was no difference in the PES between the two groups.

CONCLUSION

The present study showed that CTG and VCMX were both effective in soft tissue augmentation around implants in the esthetic zone. However, CTG proved more efficient in increasing peri-implant soft tissue volume and mucosal thickness around single implants at a 9-month follow-up period. VCMX was associated with less pain or discomfort and reduced patient morbidity, as reflected by the significantly reduced VAS value in the VCMX group.

Digital three-dimensional assessment of free gingival graft remodeling over 12 months

OBJECTIVE

To digitally evaluate the three-dimensional (3D) remodelling of FGG used to treat RT2 gingival recessions and lack of keratinized tissue on mandibular incisor teeth.

METHODS

Data from 45 patients included in a previous multicentric RCT were analyzed. Silicone impressions were taken before (baseline) and 3, 6 and 12 months after standardized FGG placement. Casts were scanned and images were superimposed, using digital software, to obtain measurements of estimated soft tissue thickness (eTT; 1, 3, and 5 mm apical to baseline gingival margin). In addition, soft tissue volume (STV) and creeping attachment (CA) were assessed.

RESULTS

All patients exhibited postoperative eTT and STV increases, at all time points. The greatest mean thickness gain was observed at eTT3 (1.0 ± 0.4 mm) at 12 months. At 12 months, STV was 52.3 ± 21.1 mm3, without relevant changes compared to the 3- and 6-month follow-up. CA, which was observed as early as six months postoperatively, was evident in ∼85 % of teeth at 12 months.

CONCLUSIONS

Application of FGG was an effective phenotype modification therapy, as shown by the significantly increased tissue thickness postoperatively. Despite the use of FGG technique not aiming for root coverage, digital 3D assessment documented the early and frequent postoperative occurrence of CA, which helped improve recession treatment outcomes.

CLINICAL SIGNIFICANCE

The use of 3D assessment methodology allows precise identification of the tissue gain obtained with FGG, which, regardless of technique, results in predictable phenotype modification and frequent occurrence of creeping attachment.

Gingival open-wound to increase keratinized tissue in implant rehabilitation-A technical note

Keratinized tissue augmentation around implants guarantees long-term success and maintenance of implant rehabilitations. Free gingival grafting is often described as the gold standard, especially when dealing with limited residual keratinized tissue height. Traditionally, an epithelio-conjunctive graft is harvested, either on the palate or the tuberosity, to reconstruct the missing keratinized soft tissues. This article introduces an innovative approach to increase keratinized tissue around implants, benefiting from second-intention gingival healing. This original surgical approach is interesting because it does not involve autogenous grafting or biomaterials. Its main goals are to enhance predictability while reducing the numerous per and post-operative risks related to autogenous harvesting. The success of this technique depends on the observance of fundamental principles: protection against bacterial contamination (immunocompetence of the patient), phenotypic induction (preoperative presence of keratinized tissue), space maintenance, and stabilization of flaps.

Correction of Peri-Implant Soft Tissue Fenestration With Bony Dehiscence Associated With Intrabony Defect: A 2-Year Case Report

Soft and hard tissue deficiencies around dental implants which can potentially compromise implant survival are commonly encountered. Complicated interventions are often required to address and resolve combinations of soft and hard tissue defects. This case report describes the management of peri-implant soft tissue fenestration accompanied by bony dehiscence associated with intrabony defect through soft tissue modification. A 51-year-old female was referred to the Periodontics and Oral Medicine Clinic with labial soft tissue fenestration at the maxillary left canine implant-supported crown. The patient complained of discomfort and malodor at the implant site. The implant showed mucosal fenestration and 6 mm probing depth (PD) with profuse bleeding at the distolabial site without mobility. A cone beam computed tomography (CBCT) demonstrated labial bony dehiscence associated with a 5.56-mm intrabony defect at mesial and distal surfaces. The implant was diagnosed as peri-implantitis with soft tissue deficiency. The treatment comprised oral hygiene instruction, debridement of the implant and all natural teeth, and mucogingival surgery with free connective tissue graft by the envelope technique. Two weeks after debridement, the mucosal margin of the implant disappeared, presenting soft tissue dehiscence of 4 × 4 mm. Mucogingival surgery was performed 3 weeks later. A 2-year follow-up revealed a stable mucosal margin with PD ranged 2-4 mm. In conclusion, modification of the soft tissue thickness around the implant together with excellent plaque control by the patient successfully maintained peri-implant health.

Dimensional changes in free gingival grafts at implant sites in the reconstructed mandible: a retrospective study

OBJECTIVE

To evaluate the dimensional changes in free gingival grafts (FGG) at implant sites in mandibular reconstruction patients.

METHODS

Patients who received FGG 4 months after implant placement in the reconstructed mandible with no keratinized mucosa (KM) present were invited for re-examination after 36.7 ± 16.8 months (3.06 ± 1.4 years). Immediately after graft extraction (T0), graft width (GW), graft length (GL), graft thickness (GT), graft dimension (GD), and vertical bone height were documented. Re-examination (T1) included clinical examinations (GW, GL, GD, peri-implant probing depths, and modified Sulcus Bleeding Index), radiographic examination (marginal bone level), and medical chart review.

RESULTS

Twenty patients and 62 implants (47 in fibula flaps and 15 in iliac flaps) were included. A significant decrease in GW (51.8%), GL (19.2%), and GD (60.2%), were found between T0 and T1 (p < .001). The univariate analysis showed that GW change was not significantly associated with reconstruction technique, baseline GL, baseline GT, baseline GD, implant location, or type of prosthesis. Implant survival rate of 100% was observed at follow-up.

CONCLUSIONS

Within the limitations of the study, free gingival grafts at implant sites in the reconstructed mandible undergo dimensional change that result in a reduction of approximately 60% of the original graft dimension. Graft width decreased over 50%.

CLINICAL RELEVANCE

FGG is the standard of care intervention for increasing the amount of KM around implants. This study was the first to evaluate the dimensional change in FGG at implant sites in mandibular reconstruction patients after a medium-term follow-up.

CLINICAL TRIAL REGISTRATION

Clinical trial registration is not applicable as this study comprehends a retrospective analysis.

Oronasal Fistula Closure and Defect Reconstruction: Two Case Reports Using Periodontal Plastic Surgery Principles

OBJECTIVES

Oronasal fistulas are common sequelae following cleft lip and palate surgery and can significantly impact a patient's quality of life. They result from various factors, including surgical techniques, tissue management, and patient-specific factors. This case report explores the modern approach to oronasal fistula closure using periodontal plastic surgery principles.

MATERIALS AND METHODS

The report presents two cases of patients with oronasal fistulas due to previous maxillofacial surgical intervention. These patients underwent microsurgical procedures that involved partial flap thickness preparation of the fistula areas, the use of connective tissue grafts from the palate, and meticulous suturing techniques to ensure graft integrity. The procedures were performed in stages, and postoperative care was provided.

RESULTS

Both cases demonstrated successful fistula closure and graft survival. The patients reported improvements in breathing, speech, aesthetics, and quality of life. The second case also included guided bone regeneration and implant placement.

CONCLUSIONS

Oronasal fistulas resulting from maxillofacial surgery can be effectively treated using periodontal plastic surgery techniques, significantly improving patients' quality of life and aesthetic outcomes. This approach represents a valuable addition to the existing repertoire of oronasal fistula closure methods.

Soft Tissue Augmentation After Tooth Extraction Improves Implant Health: Findings From a Clinical Trial

Background Soft tissue augmentation is a critical procedure in dental implantology aimed at improving peri-implant health and aesthetics. Various materials are used for this purpose, but their comparative effectiveness remains under-researched. This study aimed to evaluate the effects of soft tissue augmentation utilizing two different materials after tooth extraction on peri-implant clinical and radiographic outcomes. Methodology A randomized controlled trial was conducted with 30 participants requiring extraction of non-restorable mandibular posterior teeth. Participants were randomly assigned to receive connective tissue graft (CTG), Fibro-gide (FG), or spontaneous healing (SH) in a 1:1:1 allocation ratio. Two months post-treatment, dental implants were placed. Six months after the functional loading of the dental implant, peri-implant health was assessed using the Plaque Accumulation Index, bleeding on probing (BOP), pocket depth, mucosal recession, and marginal bone level. Results At the six-month follow-up, the SH group exhibited significantly higher Plaque Index and BOP percentages (6.43 ± 1.23 and 70%, respectively) compared to the CTG group (0.40 ± 0.32 and 8.3%, respectively) and FG group (0.45 ± 0.44 and 9.7%, respectively). The mean probing pocket depth was also significantly higher in the control group (5.13 ± 0.64 mm), while the CTG and FG groups showed minimal changes (3.83 ± 0.39 mm for both groups). Additionally, gingival recession was higher in the control group (0.65 ± 0.18 mm) compared to the CTG and FG groups (0.03 ± 0.08 mm for both groups). Radiographic analysis revealed greater marginal bone loss in the control group (0.40 ± 0.05 mm) compared to the CTG and FG groups, which demonstrated minimal bone loss (0.17 ± 0.08 mm and 0.20 ± 0.00 mm, respectively). Conclusions The study findings indicate that FG is as effective as CTG in maintaining peri-implant health, outperforming SH. These findings suggest that FG can be a viable alternative to CTG in soft tissue augmentation after tooth extraction, offering a new option for clinicians in the management of extraction sites before dental implant placement.

Xenogeneic Collagen Matrix Versus Free Gingival Graft for Augmenting Peri-Implant Keratinized Mucosa Around Dental Implants: A Systematic Review and Meta-Analysis

OBJECTIVES

There is a growing evidence to suggest augmenting peri-implant keratinized mucosa in the presence of ≤ 2 mm of keratinized mucosa. However, the most appropriate surgical technique and augmentation materials have yet to be defined. The aim of this systematic review and meta-analyses was to evaluate the clinical and patient-reported outcomes of augmenting keratinized mucosa around implants using free gingival graft (FGG) versus xenogeneic collagen matrix (XCM) before commencing prosthetic implant treatment.

MATERIAL AND METHODS

Electronic databases were searched to identify observational studies comparing implant sites augmented with FGG to those augmented with XCM. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool.

RESULTS

Six studies with 174 participants were included in the present review. Of these, 87 participants had FGG, whereas the remaining participants had XCM. At 6 months, sites augmented with FGG were associated with less changes in the gained width of peri-implant keratinized mucosa compared to those augmented with XCM (mean difference 1.06; 95% confidence interval -0.01 to 2.13; p = 0.05). The difference, however, was marginally significant. The difference between the two groups in changes in thickness of peri-implant keratinized mucosa at 6 months was statistically significantly in favor of FGG. On the other hand, XCM had significantly shorter surgical time, lower postoperative pain score, and higher color match compared to FGG.

CONCLUSIONS

Within the limitation of this review, the augmentation of keratinized mucosa using FGG before the placement of the final prosthesis may have short-term positive effects on soft tissue thickness. XCM might be considered in aesthetically demanding implant sites and where patient comfort or shorter surgical time is a priority. The evidence support, however, is of low to moderate certainty; therefore, further studies are needed to support the findings of the present review.

Novel digital technique for measuring the volumetric healing process of free gingival grafts surrounding dental implants

The objective of the present study was to analyze and describe a new digital technique for analyzing the volumetric healing process of free gingival grafts in both donor and recipient locations surrounding a dental implant, as well as to compare the reliability of conventional and digital techniques for measuring the width of the free gingival graft in the recipient location throughout the healing process.

Materials and methods

Ten patients presenting with mucositis linked to a dental implant were included. A preoperative soft tissue width <2 mm, with probing pocket depth <5 mm, edema and inflammation and bleeding on probing was determined A digital impression was taken of both donor and recipient locations using an intraoral scan, generating a Standard Tessellation Language digital file both preoperatively (STL1) and after 1 week (STL2), 1 month (STL3), 3 months (STL4), and 6 months (STL5) of follow-up. Afterwards, the digital files (STL1-STL5) were aligned using a reverse engineering morphometric software, and Student's t-test was used to analyze changes in volume at the donor and recipient locations. Additionally, widths were measured both clinically and digitally so as to compare the reliability of these measurement techniques. The repeatability and reproducibility of both these measurement techniques were also analyzed using Gage R&R statistical analysis.

Results

Gage R&R found that the total variability of the digital technique was 0.6% (among the measures of each operator) and 7.6% (among operators); as variability was under 10%, the results were repeatable and reproducible. In addition, there were statistically significant differences between donor and recipient locations in healing process volume (mm3) after one week (p = 0.0110), one month (p = 0.0007), three months (p < 0.0001) and six months (p = 0.0004) of follow-up.

Conclusion

The digital measurement technique provided accurate, repeatable, and reproducible results when analyzing the volumetric and linear measures of the healing process in both the donor and recipient locations of a free gingival graft surrounding a dental implant, with significantly higher tissue volume in the recipient location.