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de Almeida MCL, Rocha RGG, Magno MB, Lima RR, Saito MT. Performance of multiple therapeutic approaches for palatal wound healing after soft tissue graft removal - an overview of systematic reviews. Clin Oral Investig 2024; 28:347. [PMID: 38819478 DOI: 10.1007/s00784-024-05733-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To overview the literature to answer the following question: "What is the performance of different therapies on wound healing and postoperative discomfort after palatal ASTG removal?" METHODS SRs that evaluated the wound healing (WH), postoperative pain, bleeding, and analgesic consumption of patients submitted to de-epithelialized/free gingival grafts (FGG) or subepithelial connective tissue grafts (SCTG) removed from the palate were included. The searches were conducted on six white and two gray databases up to December 2023. Methodological quality was evaluated through AMSTAR 2. The synthesis of results was described as a narrative analysis. RESULTS Ten SRs (involving 25 randomized clinical trials) related to low-level laser therapy (LLLT) (3), platelet-rich fibrin (PRF) (4), cyanoacrylate tissue adhesives (CTA) (2), and ozone therapy (OT) (1) were included in this overview. All techniques demonstrated improvements in WH. LLT, PRF, and CTA reduced pain and analgesic consumption. PRF and CTA reduced bleeding. Regarding methodological quality, the SRs were classified as critically low (2), low (5), moderate (2), or high quality (1). CONCLUSIONS In SRs related to LLLT, PRF, CTA, and OT, the use of different therapies after palatal ASTG removal improved WH and postoperative discomfort. Due to the studies' low methodological quality and high heterogeneity, data should be interpreted with caution. CLINICAL RELEVANCE The present overview compiles the evidence of SRs related to different therapies for WH and patients' postoperative experience and reveals that different treatments can significantly improve the clinical outcomes of patients who require ASTG removal for periodontal or peri-implant surgeries. REGISTRATION PROSPERO registration number: CRD42022301257.
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Affiliation(s)
- Maria Clara Lopes de Almeida
- Graduate Program in Dentistry, Federal University of Pará, Augusto Correa Avenue, n. 1, Belém, PA, 66075-110, Brazil
| | | | - Marcela Baraúna Magno
- School of Dentistry, Veiga Almeida University, Rio de Janeiro-RJ, Brazil
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Rafael Rodrigues Lima
- Graduate Program in Dentistry, Federal University of Pará, Augusto Correa Avenue, n. 1, Belém, PA, 66075-110, Brazil
- Laboratory of Structural and Functional Biology, Federal University of Pará, Belém, PA, Brazil
| | - Miki Taketomi Saito
- Graduate Program in Dentistry, Federal University of Pará, Augusto Correa Avenue, n. 1, Belém, PA, 66075-110, Brazil.
- Graduate Program in Epidemiology and Health Vigilance, Evandro Chagas Institute, BR 316, km 7, Ananindeua, PA, 67030000, Brazil.
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2
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Huang JP, Wang YY, Dai A, Sun P, Ding PH. A combination technique of strip free gingival grafts and xenogeneic collagen matrix in augmenting keratinized mucosa around dental implants: a single-arm clinical trial. BMC Oral Health 2024; 24:634. [PMID: 38811896 PMCID: PMC11137898 DOI: 10.1186/s12903-024-04184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/26/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The aim of this study was to assess the outcomes of the combination technique of strip free gingival grafts (SFGG) and xenogeneic collagen matrix (XCM) in augmenting the width of keratinized mucosa (KMW) around dental implants, and compare its efficacy with the historical control group (FGG). METHODS Thirteen patients with at least one site with KMW ≤ 2 mm after implant surgery were included and received SFGG in combination with XCM. Another thirteen patients with the same inclusion and exclusion criteria from the previous trial received FGG alone. The same outcomes as the previous trial were evaluated. KMW, thickness of keratinized mucosa (KMT), gingival index (GI) and probing depth (PD) were measured at baseline, 2 and 6 months. Postoperative pain, patient satisfaction and aesthetic outcomes were also assessed. RESULTS At 6 months after surgery, the combination technique could attain 3.3 ± 1.6 mm of KMW. No significant change could be detected in GI or PD at 6 months compared to those at 2 months (p > 0.05). The postoperative pain and patient satisfaction in VAS were 2.6 ± 1.2 and 9.5 ± 1.2. The total score of aesthetic outcomes was 3.8 ± 1.2. In the historical FGG group, 4.6 ± 1.6 mm of KMW was reported at 6 months, and the total score of aesthetic outcomes was higher than the combination technique (4.8 ± 0.7 vs. 3.8 ± 1.2, p < 0.05). CONCLUSIONS The combination technique of SFGG and XCM could increase KMW and maintain peri-implant health. However, this combination technique was associated with inferior augmentation and aesthetic outcomes compared with FGG alone. TRIAL REGISTRATION This clinical trial was registered in the Chinese Clinical Trial Registry with registration number ChiCTR2200057670 on 15/03/2022.
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Affiliation(s)
- Jia-Ping Huang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Yi-Yu Wang
- Department of Prosthodontics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, 310006, Zhejiang, China
- Department of Stomatology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Anna Dai
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Ping Sun
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, Zhejiang, China.
| | - Pei-Hui Ding
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, Zhejiang, China.
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Oliveira JA, da Silveira MI, Soares LFF, Alves RDO, Carrera TMI, Azevedo MR, Oliveira GJPLD, Pigossi SC. Wound-healing agents for palatal donor area: A network meta-analysis. Clin Oral Implants Res 2024; 35:359-376. [PMID: 38315151 DOI: 10.1111/clr.14241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/18/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The aim of this systematic review and network meta-analysis (NMA) was to assess the efficacy of different wound-healing agents for palatal donor area management after soft tissue graft harvesting. METHODS Electronic searches in six databases were conducted for publications up to October 2023. Studies with data from patients undergoing therapeutic approaches using agents for palatal healing after gingival graft harvesting were included. Data about postoperative pain, wound-healing and postoperative complications reported for each agent were extracted. Three different tools were used for the risk of bias within studies evaluation (Murad tool for case series and case report, RoB 2.0 tool for randomized studies and ROBINS-I tool for non-randomized studies). A Bayesian random effects NMA was conducted for postoperative pain levels and wound healing. RESULTS Eighty-four publications were included in the systematic review (qualitative analysis), with 14 of these subjected to NMA (quantitative analysis). The summarized results from the qualitative and quantitative analysis showed that all wound-healing agents evaluated promoted better pain control and wound healing compared to spontaneous healing and hemostatic sponges alone. The NMA outcomes reveal that leucocyte- and platelet-rich fibrin (L-PRF) was the most effective agent in reducing postoperative pain in all analyzed periods. Moreover, the L-PRF seems to accelerate wound healing and reduce postoperative complications compared to other agents. CONCLUSION In conclusion, the L-PRF was the most effective agent in reducing postoperative pain, accelerating wound healing and reducing postoperative complications after harvesting soft tissue grafts from the palatal area.
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Affiliation(s)
- Jovânia Alves Oliveira
- School of Dentistry, Alfenas Federal University (Unifal-MG), Alfenas, Minas Gerais, Brazil
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | | | - Lélio Fernando Ferreira Soares
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP - São Paulo State University (FOAr/UNESP), Araraquara, São Paulo, Brazil
| | - Roberta de Oliveira Alves
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | - Thaísa Macedo Iunes Carrera
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | - Mayra Resende Azevedo
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | | | - Suzane Cristina Pigossi
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
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Silva ALM, de Souza JAC, Nogueira TE. Postoperative local interventions for the palate as a gingival graft donor area: a scoping review. Clin Oral Investig 2023; 27:6971-7006. [PMID: 37851129 DOI: 10.1007/s00784-023-05296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This scoping review aimed to systematically identify evidence-based interventions to stimulate healing or protect the harvested palate of patients undergoing gingival grafting. MATERIAL AND METHODS The study followed guidelines from the Joanna Briggs Institute and PRISMA-ScR (protocol available at osf.io/zhafn). PubMed, Embase, and seven other databases were searched on November 2022, with additional monitoring until April 2023. The inclusion criteria focused on studies evaluating outcomes related to the donor area (palate) and interventions for healing or protecting it, regardless of publication year and language. Data from the included publications was extracted and presented through narrative text, tables, and figures. RESULTS Eighty-one studies (including 64 clinical trials, four case series, five theses, and eight systematic reviews) and 37 clinical trial records were included. The number of studies on this topic has significantly increased, reflecting a growing interest in the field. Thirty-six interventions with published results and 12 interventions with unpublished results from clinical trial registers were identified. Some promising interventions that showed potential for improving patient-reported outcomes include cyanoacrylate adhesive, platelet-rich fibrin (PRF), and the combination of palatal stents and healing agents. CONCLUSIONS Thirty-six interventions with published results were identified for postoperative use on the harvested palate, showing varying levels of evidence and conflicting effectiveness for specific outcomes. CLINICAL RELEVANCE Postoperative discomfort and pain in the palate are commonly experienced by patients undergoing grafting procedures using this region as the donor area. Awareness of the available options and their levels of evidence is crucial for informed decision-making.
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Affiliation(s)
- Ana Luiza Mustafé Silva
- Faculty of Dentistry, Postgraduate Program in Dentistry, Universidade Federal de Goiás, CEP, Goiânia, Goiás, 74605-220, Brazil
| | - João Antônio Chaves de Souza
- Faculty of Dentistry, Postgraduate Program in Dentistry, Universidade Federal de Goiás, CEP, Goiânia, Goiás, 74605-220, Brazil
| | - Túlio Eduardo Nogueira
- Faculty of Dentistry, Postgraduate Program in Dentistry, Universidade Federal de Goiás, CEP, Goiânia, Goiás, 74605-220, Brazil.
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Mounssif I, Bentivogli V, Rendón A, Gissi DB, Maiani F, Mazzotti C, Mele M, Sangiorgi M, Zucchelli G, Stefanini M. Patient-reported outcome measures after periodontal surgery. Clin Oral Investig 2023; 27:7715-7724. [PMID: 37940683 PMCID: PMC10713745 DOI: 10.1007/s00784-023-05362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES The present study aimed to explore the impact of different periodontal surgical treatments on the quality of life and postoperative morbidity. MATERIALS AND METHODS The present study is a single-center, prospective, observational cohort trial. One hundred fifty-five patients, referred to the Periodontal Department of Bologna University who needed periodontal surgical treatment, were recruited. The self-reported perception of the postoperative course was assessed using the following anonymous questionnaires: Italian oral health impact profile (I-OHIP-14), visual analog scale (VAS) to evaluate the intensity of the pain, and 5-point Likert scale. RESULTS Patients reported a mean OHIP-14 total score of 9.87±8.5 (range 0-42), significantly influenced by the female sex, flap extension, and periodontal dressing. A mean VAS score of 2.96±2.39 (range 0-9) was calculated, and was found to be influenced by the presence of vertical releasing incisions and palatal flap extension. Of the 155 subjects, 40 (25.8%) patients reported bleeding as a post-surgical complication, 96 (61.9%) swelling, 105 (67.7%) eating discomfort, and 44 (28.4%) reported speech discomfort. CONCLUSIONS Within the limitations of the nature of the present study, periodontal surgical procedures have a low impact on patients' quality of life evaluated through the OHIP-14 and VAS pain questionnaires. CLINICAL RELEVANCE Periodontal surgical procedures are safe procedures, with a limited duration of postoperative discomfort as well as the incidence of complications.
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Affiliation(s)
- Ilham Mounssif
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Valentina Bentivogli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Alexandra Rendón
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Davide B Gissi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesco Maiani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Claudio Mazzotti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Monica Mele
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Matteo Sangiorgi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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6
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De Angelis P, Rella E, Manicone PF, Liguori MG, De Rosa G, Cavalcanti C, Galeazzi N, D'Addona A. Xenogeneic collagen matrix versus connective tissue graft for soft tissue augmentation at immediately placed implants: a prospective clinical trial. Int J Oral Maxillofac Surg 2023; 52:1097-1105. [PMID: 36801183 DOI: 10.1016/j.ijom.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/21/2023]
Abstract
The advantages of immediate implant placement for patients include a reduced number of surgical procedures and a shorter overall treatment time. Disadvantages include a higher risk of aesthetic complications. The aim of this study was to compare xenogeneic collagen matrix (XCM) versus a subepithelial connective tissue graft (SCTG) used for soft tissue augmentation in combination with immediate implant placement without provisionalization. Forty-eight patients requiring a single implant-supported rehabilitation were selected and assigned to one of two surgical procedures: immediate implant with SCTG (SCTG group) or immediate implant with XCM (XCM group). Marginal changes in the peri-implant soft tissue and the facial soft tissue thickness (FSTT) were assessed after 12 months. Secondary outcomes included peri-implant health status, aesthetics, patient satisfaction, and perceived pain. All of the implants placed were successfully osseointegrated, resulting in 1-year survival and success rates of 100%. The patients in the SCTG group had a significantly lower mid-buccal marginal level (MBML) recession (P = 0.021) and a greater increase in FSTT (P < 0.001) than the patients in the XCM group. Using xenogeneic collagen matrix during immediate implant placement significantly increased FSTT from the baseline, leading to good aesthetic and patient satisfaction results. However, the connective tissue graft yielded better MBML and FSTT results.
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Affiliation(s)
- P De Angelis
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.
| | - E Rella
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - P F Manicone
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - M G Liguori
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - G De Rosa
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Cavalcanti
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - N Galeazzi
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - A D'Addona
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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7
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Tavelli L, Majzoub J, Kauffmann F, Rodriguez MV, Mancini L, Chan HL, Kripfgans OD, Giannobile WV, Wang HL, Barootchi S. Coronally advanced flap versus tunnel technique for the treatment of peri-implant soft tissue dehiscences with the connective tissue graft: A randomized, controlled clinical trial. J Clin Periodontol 2023; 50:980-995. [PMID: 36935199 DOI: 10.1111/jcpe.13806] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/27/2023] [Accepted: 03/10/2023] [Indexed: 03/21/2023]
Abstract
AIM To evaluate the efficacy of coronally advanced flap (CAF) versus tunnel technique (TUN) in covering isolated mid-facial peri-implant soft tissue dehiscences (PSTDs). MATERIALS AND METHODS Twenty-eight participants presenting with isolated non-molar implants exhibiting PSTDs were enrolled and randomized to receive either CAF or TUN, both with a connective tissue graft (CTG). The primary outcome of the study was the percentage of mean PSTD coverage at 12 months. Secondary endpoints included the frequency of complete PSTD coverage, changes in keratinized mucosa width (KMW) and horizontal mucosal thickness (MT), as assessed with transgingival probing, 3D optical scanning and ultrasonography, professional aesthetic evaluation and patient-reported outcome measures (PROMs). RESULTS At 12 months, the mean PSTD coverage of the CAF and TUN groups was 90.23% and 59.76%, respectively (p = .03). CAF-treated sites showed a substantially higher frequency of complete PSTD coverage (p = .07), together with significantly greater gain of KMW (p = .01), increase in MT (p = .02), volumetric gain (p < .01) and professional aesthetic outcomes (p = .01). Both interventions showed an improvement in patient-reported aesthetics and a reduction of the anxiety related to the appearance of the implant compared to baseline, with the CAF group obtaining significantly higher scores (p = .03 for both PROMs). CONCLUSIONS CAF + CTG resulted in superior PSTD coverage outcomes, greater gain in KMW and MT, and better PROMs than TUN + CTG for the treatment of isolated PSTDs (ClinicalTrials.gov NCT03498911).
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
| | - Jad Majzoub
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Frederic Kauffmann
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten, Germany
| | - Maria Vera Rodriguez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Postgraduate Periodontics, Division of Periodontics, Columbia University College of Dental Medicine, New York City, New York, USA
| | - Leonardo Mancini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Oliver D Kripfgans
- Biointerfaces Institute and Department of Biomedical Engineering, College of Engineering, Ann Arbor, Michigan, USA
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - William V Giannobile
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
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8
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Tavelli L, Barootchi S, Stefanini M, Zucchelli G, Giannobile WV, Wang HL. Wound healing dynamics, morbidity, and complications of palatal soft-tissue harvesting. Periodontol 2000 2023; 92:90-119. [PMID: 36583690 DOI: 10.1111/prd.12466] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/17/2022] [Accepted: 05/26/2022] [Indexed: 12/31/2022]
Abstract
Palatal-tissue harvesting is a routinely performed procedure in periodontal and peri-implant plastic surgery. Over the years, several surgical approaches have been attempted with the aim of obtaining autogenous soft-tissue grafts while minimizing patient morbidity, which is considered the most common drawback of palatal harvesting. At the same time, treatment errors during the procedure may increase not only postoperative discomfort or pain but also the risk of developing other complications, such as injury to the greater palatine artery, prolonged bleeding, wound/flap sloughing, necrosis, infection, and inadequate graft size or quality. This chapter described treatment errors and complications of palatal harvesting techniques, together with approaches for reducing patient morbidity and accelerating donor site wound healing. The role of biologic agents, photobiomodulation therapy, local and systemic factors, and genes implicated in palatal wound healing are also discussed.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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9
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Meza-Mauricio J, Mourão ERST, Oliveira Marinho K, Vergara-Buenaventura A, Mendoza-Azpur G, Muniz FWMG, Santamaria MP, Faveri M. Effect of collagen sponge and flowable resin composite on pain management after free gingival graft harvesting: A randomized controlled clinical trial. Eur J Oral Sci 2023; 131:e12935. [PMID: 37169726 DOI: 10.1111/eos.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
The aim of this study was to compare the effect of the application of a flowable resin composite coating, over a collagen sponge stabilized with suture, on postoperative pain after free gingival graft harvesting. Thirty-two free gingival grafts were harvested from the palate in 32 patients, who were subsequently randomized to have only a collagen sponge stabilized with sutures applied to the palatal wound (control), or to have the collagen sponge coated with a flowable resin composite (test). Patients were observed for 14 days, and the pain level was evaluated by using a numerical rating scale. The consumption of analgesics during the postoperative period and the characteristic of the graft were also analyzed. The patients in the test group reported having experienced significantly less pain statistically than the patients in the control group throughout the study. The consumption of analgesics was lower in the test group. The dimensions of harvested grafts in the control and test groups showed no significant differences in height, width, and thickness. In conclusion, the addition of flowable resin composite coating to the hemostatic collagen sponge on the palatal wound following free gingival graft harvesting helped to minimize postoperative pain.
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Affiliation(s)
| | | | - Kelson Oliveira Marinho
- Department of Periodontology and Oral Implantology, Dental Research Division, University of Guarulhos, São Paulo, Brazil
| | | | | | | | | | - Marcelo Faveri
- Department of Periodontology and Oral Implantology, Dental Research Division, University of Guarulhos, São Paulo, Brazil
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10
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Tavelli L, Barootchi S, Rasperini G, Giannobile WV. Clinical and patient-reported outcomes of tissue engineering strategies for periodontal and peri-implant reconstruction. Periodontol 2000 2023; 91:217-269. [PMID: 36166659 PMCID: PMC10040478 DOI: 10.1111/prd.12446] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/25/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
Scientific advancements in biomaterials, cellular therapies, and growth factors have brought new therapeutic options for periodontal and peri-implant reconstructive procedures. These tissue engineering strategies involve the enrichment of scaffolds with living cells or signaling molecules and aim at mimicking the cascades of wound healing events and the clinical outcomes of conventional autogenous grafts, without the need for donor tissue. Several tissue engineering strategies have been explored over the years for a variety of clinical scenarios, including periodontal regeneration, treatment of gingival recessions/mucogingival conditions, alveolar ridge preservation, bone augmentation procedures, sinus floor elevation, and peri-implant bone regeneration therapies. The goal of this article was to review the tissue engineering strategies that have been performed for periodontal and peri-implant reconstruction and implant site development, and to evaluate their safety, invasiveness, efficacy, and patient-reported outcomes. A detailed systematic search was conducted to identify eligible randomized controlled trials reporting the outcomes of tissue engineering strategies utilized for the aforementioned indications. A total of 128 trials were ultimately included in this review for a detailed qualitative analysis. Commonly performed tissue engineering strategies involved scaffolds enriched with mesenchymal or somatic cells (cell-based tissue engineering strategies), or more often scaffolds loaded with signaling molecules/growth factors (signaling molecule-based tissue engineering strategies). These approaches were found to be safe when utilized for periodontal and peri-implant reconstruction therapies and implant site development. Tissue engineering strategies demonstrated either similar or superior clinical outcomes than conventional approaches for the treatment of infrabony and furcation defects, alveolar ridge preservation, and sinus floor augmentation. Tissue engineering strategies can promote higher root coverage, keratinized tissue width, and gingival thickness gain than scaffolds alone can, and they can often obtain similar mean root coverage compared with autogenous grafts. There is some evidence suggesting that tissue engineering strategies can have a positive effect on patient morbidity, their preference, esthetics, and quality of life when utilized for the treatment of mucogingival deformities. Similarly, tissue engineering strategies can reduce the invasiveness and complications of autogenous graft-based staged bone augmentation. More studies incorporating patient-reported outcomes are needed to understand the cost-benefits of tissue engineering strategies compared with traditional treatments.
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Affiliation(s)
- Lorenzo Tavelli
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
| | - Shayan Barootchi
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- IRCCS Foundation Polyclinic Ca’ Granda, University of Milan, Milan, Italy
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11
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Escobar M, Brum RS, Apaza-Bedoya K, Patrícia P, Benfatti CAM, Cruz ACC, Henriques BAPC. Dimensional Influence of Epithelialized Tissue Graft Harvested From Palate on Postoperative Pain: a Systematic Review. J Oral Maxillofac Res 2022; 13:e1. [PMID: 36382016 PMCID: PMC9617250 DOI: 10.5037/jomr.2022.13301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/30/2022] [Indexed: 11/22/2022]
Abstract
Objectives The aim of the present systematic review was to evaluate the dimensional influence of the epithelialized tissue graft harvested from the palate in the postoperative pain. Material and Methods Research was conducted in electronic databases Cochrane Library, Embase, LILACS, PubMed, Scopus, and Web of Science upwards May 15, 2022. Studies that reported the influence of graft dimensions of palatal epithelized harvesting on postoperative pain were eligible. The evaluation was made using the methodological quality assessment by Joanna Briggs Institute Critical Appraisal Checklist for randomized clinical trials and non-randomized studies and the level of evidence according to GRADE. Results Four studies were included. The clinical and methodological heterogeneity among studies led to an analysed narrative. The postoperative pain was assessed during the period of 1 to 28 postoperative days. It was determined by using visual analog scale in three studies, while the evaluation was performed indirectly based on analgesics intake in one study. According to three studies, bigger graft sizes were associated with higher postoperative pain. The methodological quality assessment categorized two study as high (one randomized control trial and one non-randomized), and two as moderate (one randomized control trial and one non-randomized). The data was considered moderate. Conclusions Based on the moderate certainty level, bigger graft sizes of palatal epithelized harvesting appear to promote more postoperative pain. Understanding the postoperative pain as a response to a graft extension may assist some clinical decisions regarding the surgical periodontal and peri-implant planning.
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Affiliation(s)
- Mario Escobar
- Centre of Education and Research on Dental Implants (CEPID), Department of Dentistry, Federal University of Santa Catarina; FlorianópolisBrazil.
| | - Renata Scheeren Brum
- Centre of Education and Research on Dental Implants (CEPID), Department of Dentistry, Federal University of Santa Catarina; FlorianópolisBrazil.,Dentistry Faculty, University of Southern Santa Catarina, Palhoça, SCBrazil.
| | - Karin Apaza-Bedoya
- Centre of Education and Research on Dental Implants (CEPID), Department of Dentistry, Federal University of Santa Catarina; FlorianópolisBrazil.
| | - Pauletto Patrícia
- Brazilian Centre for Evidence-Based Research, Department of Dentistry, Federal University of Santa Catarina, FlorianopolisBrazil.,Dentistry Faculty, Universidad de Las Américas (UDLA), QuitoEcuador.
| | - Cesar Augusto Magalhães Benfatti
- Centre of Education and Research on Dental Implants (CEPID), Department of Dentistry, Federal University of Santa Catarina; FlorianópolisBrazil.
| | - Ariadne Cristiane Cabral Cruz
- Centre of Education and Research on Dental Implants (CEPID), Department of Dentistry, Federal University of Santa Catarina; FlorianópolisBrazil.,Laboratory of Applied Virology; Department of Microbiology, Immunology and Parasitology; Federal University of Santa Catarina, FlorianópolisBrazil.
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12
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Hyaluronic Acid as an Adjunct to Coronally Advanced Flap Procedures for Gingival Recessions: A Systematic Review and Meta—Analysis of Randomized Clinical Trials. J Pers Med 2022; 12:jpm12091539. [PMID: 36143324 PMCID: PMC9501956 DOI: 10.3390/jpm12091539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 11/21/2022] Open
Abstract
Previous systematic reviews have reported that coronally advanced flap (CAF) + connective tissue graft (CTG) are the gold standard in root coverage procedures (RCP). Nevertheless, adjunctive treatment with hyaluronic acid (HA) has been proposed to aim at improving clinical outcomes and reducing patient morbidity. The aim of this systematic review and meta-analysis is to compare the use of HA as an adjunctive treatment to CAF procedures in Miller class I and II (recession type 1; RT1) gingival recession (GR) defects treatment with no adjunctive/other treatments. MEDLINE, The Cochrane Central Register of Controlled Trials, Web of Science, Scopus databases and gray literature were searched up to April 2022. The primary outcome variables were mean recession coverage (MRC) and reduction of the recession depth (RecRed). Weighted mean differences and 95% confidence intervals between treatments were estimated using a random-effect mode. From 264 titles identified, 3 RCTs reporting 90 GR defects in 60 patients were included. Overall analysis of MRC and RecRed were 0.27% (p = 0.01) and 0.40 mm (p = 0.45) in favor of CAF + HA compared to CAF alone/CAF + subepithelial connective tissue graft (SCTG), respectively, with a statistically significant difference only for MRC values. Nevertheless, due to the limited number and heterogeneity of the included studies, well-performed RCTs are needed to clarify a potential advantage of HA in RCPs in the future.
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YILMAZ M, KAYAALTI-YÜKSEK S, KARADUMAN B. The Effects of Cyanoacrylate on Clinical Healing and Self-Reported Outcomes Following Free Gingival Graft Surgery: A Randomized Clinical Study. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1012775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: This study aims to reveal the effects of cyanoacrylate application at the recipient bed and the donor site in free gingival graft surgery on graft dimensions, clinical healing parameters and patient-based outcomes.
Methods: Free gingival graft operations were conducted on individuals who were randomly assigned to control or test groups. In the test group, the graft was stabilized and the donor site was coated with cyanoacrylate. In the control group, 6/0 polyvinylidene fluoride sutures were used for stabilization, while the donor site was left untreated. Variables including re-epithelization, post-operative complications, pain, bleeding and quality of life at recipient site, and color match, graft dimensions at donor site were assessed for up to 6 months.
Results: Twenty-three individuals completed the study. No differences were observed in any variable between groups except horizontal dimension loss of the graft, which was more abundant in the cyanoacrylate group at six months (p>0.05, p
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Panda S, Khijmatgar S, Arbildo-Vega H, Das AC, Kumar M, Das M, Mancini L, Del Fabbro M. Stability of biomaterials used in adjunct to coronally advanced flap: A systematic review and network meta-analysis. Clin Exp Dent Res 2021; 8:421-438. [PMID: 34845864 PMCID: PMC8874057 DOI: 10.1002/cre2.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 12/26/2022] Open
Abstract
AIM The objective of this network meta-analysis was to rank different biomaterials used in adjunct to coronally advanced flap (CAF), based on their performance in root-coverage for Miller's Class I and II gingival recessions. MATERIALS AND METHODS An electronic database search was carried out in PUBMED, CENTRAL, SCOPUS, and EMBASE to identify the eligible articles and compiled into the citation manager to remove the duplicates. The primary outcome was keratinized gingival tissue width (KGW) and percentage of root coverage (%RC). The treatment effect of different biomaterials was estimated using predictive interval plots and ranked based on biomaterials performance, using multidimensional scale ranking. RESULTS CAF + connective tissue graft (CTG), CAF + platelet concentrate matrix (PCM) and acellular dermal matrix (ADM) ranked at the top positions in performance in improving KGW. The highest ranked materials in improving percentage of root coverage in gingival recession were CAF + collagen matrix (CM) + gingival fibroblasts (GF), CAF + ADM + platelet rich plasma (PRP) and CAF + ADM, as compared to CAF alone. CONCLUSION CTG, ADM, platelet concentrates, and CM + GFs, when used in adjunct to CAF, showed improved stability over ≥12 months of follow-up, better percentage of root coverage, and improved keratinized gingival width.
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Affiliation(s)
- Sourav Panda
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Oral Biology and Genomic Studies, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, India
| | - Heber Arbildo-Vega
- Department of General Dentistry, Dentistry School, Universidad San Martín de Porres, Chiclayo, Peru
| | - Abhaya Chandra Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Manoj Kumar
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Mohit Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Leonardo Mancini
- Department of life health and environmental sciences, University of L'Aquila, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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15
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Comparison between Tissue Adhesive Cyanoacrylate and Suture for Palatal Fibromucosa Healing: A Randomized Controlled Study. MATERIALS 2021; 14:ma14227009. [PMID: 34832409 PMCID: PMC8621616 DOI: 10.3390/ma14227009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022]
Abstract
Cyanoacrylate tissue adhesive is proposed to promote soft tissue healing in oral surgery and minimize complications (pain, inflammation, and bleeding) associated with wound healing by secondary intention. The objective was to compare cyanoacrylate tissue adhesive (test group) with suture (control group) in terms of postoperative complications, operative time, and wound healing in the palatal donor area after harvesting a de-epithelialized gingival graft. A randomized controlled clinical trial was performed in 24 patients randomly assigned to one of two study groups. Data were gathered on wound bleeding, operative time, postoperative pain, inflammation, hyperesthesia, necrosis, and donor area healing time. Operative time was almost 50% shorter in the tissue adhesive cyanoacrylate group, a significant between-group difference (p = 0.003). Spontaneous bleeding in the donor area during the first 24 h was observed in 11.1% of the tissue adhesive cyanoacrylate group versus 88.9% of the suture group—a significant difference. No significant between-group difference was observed in postoperative pain, inflammation, or degree of healing over time. There were no cases of hyperesthesia or wound necrosis. Utilization of tissue adhesive cyanoacrylate rather than suture in palatal de-epithelialized gingival graft harvesting reduces postoperative bleeding during the first 24 h, as well as the operative time.
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16
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Stefanini M, Tavelli L, Barootchi S, Sangiorgi M, Zucchelli G. Patient-reported outcome measures following soft-tissue grafting at implant sites: A systematic review. Clin Oral Implants Res 2021; 32 Suppl 21:157-173. [PMID: 34642984 DOI: 10.1111/clr.13767] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/08/2021] [Accepted: 04/24/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To review the available literature on patient-reported outcome measures (PROMs) following soft tissue augmentation at implant sites. MATERIALS AND METHODS A comprehensive electronic and manual search was performed to identify clinical studies that involved soft tissue augmentation around dental implants and reported PROMs, including post-operative morbidity, painkillers intake, quality of life, aesthetics and satisfactions. RESULTS Nineteen articles were included in the qualitative analysis. Autogenous grafts (free gingival graft and connective tissue graft), acellular dermal matrix and xenogeneic collagen matrix were utilized, either with a bilaminar- or an apically positioned flap approach. PROMs reported in the literature included perceived hardship of the procedure and pain during the surgery, post-operative morbidity, painkillers intake, number of days with discomfort, satisfaction, aesthetic evaluation, quality of life and willingness to undergo the treatment again. Most of the included studies showed similar PROMs between autogenous grafts and substitutes, in terms of post-operative morbidity, painkillers intake, quality of life, aesthetic assessment and satisfaction. Nevertheless, a trend towards lower post-operative discomfort was observed for graft substitutes. High scores for patient satisfaction and aesthetic evaluation were observed in all the interventions compared to non-grafted sites. CONCLUSIONS PROMs represent a crucial endpoint of clinical studies evaluating the outcomes of soft tissue grafts at implant sites. Most of the studies did not find significant differences in terms of patient morbidity and painkillers between autogenous grafts and substitutes. Soft tissue grafting can enhance patient satisfaction and aesthetic evaluation compared to non-grafted sites.
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Affiliation(s)
- Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Matteo Sangiorgi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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17
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Local application of hyaluronic acid in conjunction with free gingival graft: a randomized clinical trial. Clin Oral Investig 2021; 26:2165-2174. [PMID: 34623507 DOI: 10.1007/s00784-021-04197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the effect of the application of hyaluronic acid (HA) in conjunction with free gingival graft (FGG) on postoperative patient discomfort and wound healing. MATERIALS AND METHODS A total of 24 healthy non-smoker patients requiring FGG were recruited for the study. Subjects were randomly assigned into study groups, local application of HA on both donor and recipient sites and control group, application of normal saline. The FGG dimensions were evaluated using digital photographs. Post-operative pain was evaluated for 14 days. Color matching and patient satisfaction were evaluated at 6 months. RESULTS In this randomized clinical trial, 21 patients (mean age 23 years, (15 females and 6 males) completed the study. Baseline characteristics were comparable across treatment groups. Pain scores in donor sites were statistically significant and higher in control group than study group until day 7 (p < 0.05). Mean of the surface area of the graft at baseline in study vs control group were (169 ± 21), (183 ± 22) (2 mm), respectively. While at 6 months, were (147 ± 30) and (139 ± 32) (2 mm), in study and control group, respectively (p > 0.05). Color match showed no statistical significance difference. CONCLUSIONS Topical application of HA may exhibit significant improvement of postoperative pain and no significant difference in graft dimensions and patients' satisfaction. CLINICAL RELEVANCE Topical application of HA is recommended as a dressing material in FGG surgeries to reduce postoperative pain and accelerate healing.
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Veríssimo AH, Ribeiro AKC, Martins ARLDA, Gurgel BCDV, Lins RDAU. Comparative analysis of the hemostatic, analgesic and healing effects of cyanoacrylate on free gingival graft surgical wounds in donor and recipient areas: a systematic review. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:98. [PMID: 34406492 PMCID: PMC8373739 DOI: 10.1007/s10856-021-06573-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED To analyze the hemostatic, Dsurgical wounds in donor and recipient areas of free gingival grafts (FGG). Five databases (PubMed, Scopus, Science Direct, Cochrane and Web of Science) were searched up to March 2021 (PROSPERO CRD42019134497). The focus of the study (cyanoacrylate) was combined with the condition (periodontal surgery OR free gingival graft OR free soft tissue graft OR autografts), and outcome (healing OR epithelialization OR pain OR analgesia OR bleeding OR hemostasis OR hemostatic). Studies reporting cyanoacrylate isolated or associated with another substance in FGG stabilization and closure were investigated and assessed for the quality and risk of bias through the Cochrane Manual. Six studies with 323 participants were included. Evaluation of the quality and risk of bias highlighted a low risk for four articles, intermediate for one and unclear for another. The use of cyanoacrylate associated or not with the hemostatic sponge or the platelet-rich fibrin was more effective in healing (three studies), analgesia (four studies), and hemostasis in one study (p < 0.05). However, groups with the association in cyanoacrylate showed superior healing, and analgesic action to the isolated cyanoacrylate group. In addition, two studies demonstrated that cyanoacrylate use reduces surgery duration, one study showed that it reduces postoperative sensibility, and another present hemostatic effect (p < 0.05). There is scarce literature for the use of cyanoacrylate in FGG wounds indicates that it can promote a minor inflammatory response, reduce operation time, does not interfere with healing, relieves postoperative discomfort, and suggests the possibility immediate hemostasis. Its use presents an alternative to suturing in FGG surgeries. But, the limited number of cases and the relative heterogeneity of the included studies suggest caution in generalizing the indication. CLINICAL RELEVANCE Cyanoacrylate seems to present analgesic effects and less pain when applied to wound closure and covering donor and recipient areas reducing the need for postoperative analgesic medication; and has a healing effect in the closure of the donor area on the palate. In addition, it can reduce bleeding time after surgery, and prevents late bleeding during the first postsurgical week. Scientific justification: To evaluate the hemostatic, analgesic and healing actions of cyanoacrylate compared to the suture thread and other agents when used to close surgical wounds from periodontal free gingival graft surgical wounds in both the donor and recipient areas of the graft. MAIN FINDINGS The use of cyanoacrylate individually or in association with wound dressing agents presents analgesic effects because the patient reports less pain experienced when cyanoacrylate is applied to the wound closure and covering, thereby reducing the need for postoperative analgesic medication. In addition, a healing effect is observed in the closure of the donor area on the palate; as well as it seems to present hemostatic effects, reducing the bleeding time after surgery, and preventing late bleeding during the first postsurgical week. PRACTICAL IMPLICATIONS Dentists may cautiously apply cyanoacrylate after periodontal surgeries for free gingival graft in both the donor and recipient areas of the graft. However, they must consider the limitations of the surgery, tension-free positioning, the patient's dyscrasia and postoperative care, constituting a set of predictors for adequate clinical decision-making. Widespread use of such material for all patients and surgical configurations may not be recommended.
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Affiliation(s)
- Aretha Heitor Veríssimo
- Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, 59056-000, Brazil.
| | - Anne Kaline Claudino Ribeiro
- Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, 59056-000, Brazil
| | - Ana Rafaela Luz de Aquino Martins
- Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, 59056-000, Brazil
| | - Bruno Cesar de Vasconcelos Gurgel
- Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, 59056-000, Brazil
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Tirone F, Salzano S, Panuello P, Pozzatti L, Rodi D. Is the postoperative discomfort after connective tissue harvesting from the palate influenced by the use of a bipolar coagulator? A randomized controlled trial. Clin Exp Dent Res 2021; 7:1053-1060. [PMID: 33987929 PMCID: PMC8638320 DOI: 10.1002/cre2.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/14/2021] [Accepted: 04/27/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives This study aimed to determine the effect of the use of a bipolar coagulator on postoperative pain and complications when used during connective tissue harvesting from the palate. Material and methods A randomized controlled clinical trial was conducted with 57 sequential patients requiring a connective tissue graft for periodontal or implant surgery. All samples were harvested superficially and de‐epithelized outside the mouth. The patients were randomly allocated to two groups: in one group, the bipolar coagulator was used before suturing to control bleeding, and in the other group, the coagulator was not used. The surgeon was unaware of the randomization until the end of the harvesting phase. Self‐reported maximum pain, number of painkillers used, bleeding events, emergency visits at the clinic were recorded 7 days after surgery. Results Fifty patients were randomized and treated (seven were excluded for different reasons). The mean harvested area was 75.24 mm2 (SD, 33.96), and the mean thickness of the samples was 2.47 mm (SD, 0.75). The mean self‐reported pain value on the visual analog scale was 3.37 (SD, 2.30), and the mean number of pain medications used was 7.1 (SD, 6.60). Seven patients made an emergency visit each, and 17 delayed bleeding events were reported by 15 patients. No statistically significant differences were reported in postoperative pain, postoperative bleeding, and emergency visit to the clinic between the groups that did and did not use the bipolar coagulator. When smoking habits were taken into consideration, the number of pain medications was higher among male smokers and older smokers than among male non‐smokers and younger smokers. This study was not able to find a relationship between harvested sample dimension or thickness and postoperative discomfort. Conclusions The bipolar coagulator can be used during connective tissue harvesting from the palate to control bleeding without influencing postoperative pain.
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Affiliation(s)
- Federico Tirone
- Clinica Odontoiatrica Salzano Tirone, Private Practice, Cuneo, Italy
| | - Stefano Salzano
- Clinica Odontoiatrica Salzano Tirone, Private Practice, Cuneo, Italy
| | - Paola Panuello
- Clinica Odontoiatrica Salzano Tirone, Private Practice, Cuneo, Italy
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Cabanes-Gumbau G, Agustín-Panadero R, Revilla-León M, Zubizarreta-Macho Á. Prosthetically-Driven Full-Mouth Implant-Supported Prostheses Using Guided Surgical Implant Planning with Composite Resin Markers: A Case Report. J Prosthodont 2021; 30:561-568. [PMID: 33864311 DOI: 10.1111/jopr.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 11/28/2022] Open
Abstract
This report describes a prosthetically-driven implant planning method, guided by the alignment procedures between the cone beam computed tomography, intraoral digital scans, and digitized maxillary and mandibular interim complete dentures using intraoral composite resin markers as a common reference. The markers were attached to the keratinized oral mucosa of the edentulous ridges using cyanoacrylate and kept in place during the digitizing procedures. The technique provides a simpler and more economical alternative to conventional prosthetically-driven static implant planning methods.
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Affiliation(s)
| | - Rubén Agustín-Panadero
- Prosthodontic and Occlusion Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Marta Revilla-León
- AEGD Residency, Department of Comprehensive Dentistry, College of Dentistry, Texas A&M University, Dallas, Texas.,Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; and Researcher, Revilla Research Center, Madrid, Spain
| | - Álvaro Zubizarreta-Macho
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Madrid, Spain
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21
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Malpartida-Carrillo V, Tinedo-Lopez PL, Guerrero ME, Huamani-Echaccaya JL, Özcan M, Rösing CK. Outcome measurements following palatal soft tissue graft harvesting: A review. J Clin Exp Dent 2021; 13:e527-e535. [PMID: 33981402 PMCID: PMC8106935 DOI: 10.4317/jced.57625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/20/2020] [Indexed: 11/05/2022] Open
Abstract
Background Free gingival graft (FGG) and connective tissue graft (CTG) are two of the most commonly techniques performed in periodontal and peri-implant plastic surgery. Although several outcome measurements have been proposed for evaluation of palatal wound healing and patient morbidity, a comprehensive review about these variables is lacking. The objective of this review is to present comprehensive information about outcome measurements related to postoperative palatal wound healing and postoperative patient-reported morbidity after FGG or CTG procedures. Material and Methods An electronic search of English language dental literature in the Medline database via PubMed access was conducted from May 1994 to May 2020 following the PRISMA guidelines. Electronic search strategy complemented by hand search of impacting related dental journals, and the reference list of all included studies were used to complete data collection considering only clinical trials. Finally, inclusion criteria were applied to identify articles after full-text evaluation. Results A total of 111 articles were identified. After the exclusion of 34 articles based on title and abstract evaluation, 77 articles were full text screened. Following, 46 articles were excluded since they evaluated other surgical areas. Finally, 31 studies were selected and included for final evaluation. Outcome measurements were classified in variables collected by indexes and systems assessed professionally and patient-centered measurements. Visually-assessed measurements include indexes, photographs, bleeding and use of laboratory-aided measurements. Patients-centered outcomes comprise pain, discomfort and quality-of life, among others. Conclusions The most commonly used outcome measurements related to postoperative palatal wound healing are hydrogen peroxide test, tissue color match, visual inspection, and bleeding evaluation. Pain perception, analgesic consumption, discomfort sensation, burning sensation, and changes in feeling habits are the most commonly used outcome measurements related to postoperative patient-reported morbidity. Key words:Morbidity, patient comfort, periodontics, tissue harvesting, wound healing.
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Affiliation(s)
| | - Pedro-Luis Tinedo-Lopez
- DDS, MSc. Professor, School of Stomatology, Universidad Privada San Juan Bautista, Lima, Perú
| | - Maria-Eugenia Guerrero
- DDS, PhD. Professor, Department of Medico Surgical Stomatology, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | | | - Mutlu Özcan
- DDS, PhD. Professor, Center of Dental Medicine, Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Cassiano-Kuchenbecker Rösing
- DDS, PhD. Professor, Department of Periodontology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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22
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Mancini L, Tarallo F, Quinzi V, Fratini A, Mummolo S, Marchetti E. Platelet-Rich Fibrin in Single and Multiple Coronally Advanced Flap for Type 1 Recession: An Updated Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57020144. [PMID: 33562581 PMCID: PMC7915928 DOI: 10.3390/medicina57020144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
Background and Objectives: The aim of the present systematic review and meta-analysis was to investigate the efficacy of leukocyte–platelet-rich fibrin (L-PRF) in addition to coronally advanced flap (CAF) for the treatment of both single and multiple gingival recessions (GRs) compared to the CAF alone and to the adjunct of connective tissue graft (CTG). Root coverage outcomes using platelet concentrates have gained increased interest. In particular, it has been suggested that adding L-PRF to CAF may provide further benefits in the treatment of GRs. Materials and Methods: An electronic and manual literature search was conducted to identify randomized controlled trials (RTCs) investigating root coverage outcomes with CAF + L-PRF. The outcomes of interest included mean root coverage (mRC), recession reduction, keratinized tissue width (KTW) gain, gingival thickness (GT) gain, and patient-reported outcome measures (PROms) such as pain perception and discomfort. Results: A total of 275 patients and 611 surgical sites were analyzed. L-PRF in adjunct to single CAF seems to show statistically significant results regarding clinical attachment level (CAL) with a weighted means (WM) 0.43 95% CI (−0.04, 0.91), p < 0.0001, GT (WM 0.17 95% CI (−0.02, 0.36), p < 0.0001, and mRC (WM 13.95 95% CI (−1.99, 29.88) p < 0.0001, compared to single CAF alone. Interesting results were obtained from the adjunct of PRF to multiple CAF with respect to multiple CAF alone with an increase in the mRC WM 0.07 95% CI (−30.22, 30.35), p = 0.0001, and PPD change WM 0.26 95% CI (−0.06, 0.58), p < 00001. On the other hand, no statistically significant data were obtained when L-PRF was added to single or multiple CAF combined with CTG according to the included outcomes such as mRC (p = 0.03 overall). Conclusions: L-PRF is a valid alternative to CAF alone. L-PRF compared to CTG in single and multiple CAF showed statistically significant results regarding pain perception and discomfort PROms (p < 0.0001). However, CTG remains the gold standard for treating gingival recession.
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23
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Tavelli L, Barootchi S, Majzoub J, Chan HL, Giannobile WV, Wang HL, Kripfgans OD. Ultrasonographic tissue perfusion analysis at implant and palatal donor sites following soft tissue augmentation: A clinical pilot study. J Clin Periodontol 2021; 48:602-614. [PMID: 33465812 DOI: 10.1111/jcpe.13424] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/29/2020] [Accepted: 01/10/2021] [Indexed: 12/16/2022]
Abstract
AIM To describe the application of power Doppler Ultrasonography (US) for evaluating blood flow at implant and palatal donor sites following soft tissue augmentation with the connective tissue graft (CTG). MATERIALS AND METHODS Five patients exhibiting a peri-implant soft tissue dehiscence received treatment with a coronally advanced flap and corresponding CTG. Power Doppler US was used for assessing blood volume at baseline, 1 week, 1 month, 6 months and 12 months post-surgery for assessing blood-flow dynamics at the implant and palatal donor sites. The speed-weighted and power-weighted colour pixel density (CPPD) were computed from colour velocity (CV) and colour power (CP), respectively. RESULTS A mean increase in CV of 199.25% was observed at the midfacial region of the implant sites after 1 week compared to baseline. CV and CP were increased in all sites at 1 week and 1 month. At 6 and 12 months, the mean CV appeared lower than baseline at the implant sites. CCPD was increased at the palatal donor sites and at the great palatine foramen areas at the 1-week and 1-month post-operative evaluations. CONCLUSIONS Power Doppler US is a non-invasive and valuable tool for estimating tissue perfusion and CPPD variation during different phases of intra-oral soft tissue graft healing.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Jad Majzoub
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hsun-Liang Chan
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - William V Giannobile
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Biointerfaces Institute and Department of Biomedical Engineering, College of Engineering, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Oliver D Kripfgans
- Biointerfaces Institute and Department of Biomedical Engineering, College of Engineering, Ann Arbor, MI, USA.,Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
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24
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Escobar M, Pauletto P, Benfatti CAM, Cruz ACC, Flores-Mir C, Henriques BAPC. Effect of cyanoacrylate tissue adhesive in postoperative palatal pain management: a systematic review. Clin Oral Investig 2020; 25:3609-3622. [PMID: 33200283 DOI: 10.1007/s00784-020-03683-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/04/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To critically appraise available literature concerning the effect of cyanoacrylate tissue adhesive (CTA) in postoperative palatal pain management. MATERIALS AND METHODS Electronic databases (Cochrane, PubMed, LILACS, Scopus, and Web of Science) were searched, complemented with grey literature databases up to June 2020. Studies reporting the effect of cyanoacrylate tissue adhesive compared to any other methods in postoperative palatal pain management were considered eligible. The risk of bias among and across included studies was assessed. RESULTS Finally, four studies were considered eligible. Regarding free gingival graft (FGG), cyanoacrylate tissue adhesive with hemostatic sponge promoted less postoperative pain (PP) and analgesic consumption (AC). Also, cyanoacrylate tissue adhesive with platelet-rich fibrin produced less PP and more wound healing at the palatal area than cyanoacrylate tissue adhesive and wet gauze. Additionally, cyanoacrylate tissue adhesive promoted less PP and AC than wet gauze and suture. Concerning connective tissue graft (CTG), cyanoacrylate tissue adhesive, and suture produced similar PP, AC, and willingness for retreatment. CONCLUSIONS Based on the low certainty level, cyanoacrylate tissue adhesive appears to promote less PP and AC than wet gauze and suture regarding FGG. Additionally, cyanoacrylate tissue adhesive appears to increase the effect of hemostatic sponge, contributing to the reduction of PP and AC. Regarding CTG, cyanoacrylate tissue adhesive appears to promote similar PP, AC, and willingness for retreatment than the suture. Therefore, cyanoacrylate tissue adhesive has shown promising usefulness for PP management in FGG, but not a clear benefit for CTG. CLINICAL RELEVANCE The adoption of different agents for the protection of the palatal donor site following gingival harvesting procedures may provide better comfort to the patient.
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Affiliation(s)
- Mario Escobar
- Department of Dentistry, Center for Education and Research on Dental Implants, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Patrícia Pauletto
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Cesar Augusto Magalhães Benfatti
- Department of Dentistry, Center for Education and Research on Dental Implants, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Ariadne Cristiane Cabral Cruz
- Department of Dentistry, Center for Education and Research on Dental Implants, Federal University of Santa Catarina, Florianópolis, Brazil. .,Laboratory of Applied Virology, Federal University of Santa Catarina, Florianópolis, Brazil.
| | - Carlos Flores-Mir
- Faculty of Medicine and Dentistry, Department of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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25
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Tavelli L, Barootchi S, Di Gianfilippo R, Kneifati A, Majzoub J, Stefanini M, Zucchelli G, Wang HL. Patient experience of autogenous soft tissue grafting has an implication for future treatment: A 10- to 15-year cross-sectional study. J Periodontol 2020; 92:637-647. [PMID: 32946124 DOI: 10.1002/jper.20-0350] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/29/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patient-reported outcomes have received a great deal of interest in periodontal plastic procedures. However, their evaluation has mainly been short-term. Thus, the aim of this study was to evaluate the impact of soft tissue grafting procedures conducted over a decade ago on the willingness of a patients to undergo the surgery again. METHODS Subjects that received an autogenous soft tissue graft over 10 years ago were screened and invited for a survey. Their response was only analyzed if they were able to correctly identify the sites of the surgical procedures. Dichotomous questions and visual analogue scales (VASs) were used to assess self-reported pain, willingness to retreat and satisfaction. RESULTS Fifty-two patients were included in the analyses. Higher pain was reported for mandibular sites, and treated areas including ≥ 3 teeth (P < 0.01). Willingness to retreatment was 84.6% and it was negatively associated with self-reported pain measures, the arch location (mandible), and number of treated sites (≥3 teeth) (P < 0.01). Mean satisfaction rate was 86.9 ± 13.65 (VAS) and showed a positive correlation with willingness to retreat (P < 0.01). Having a complete root coverage at the recall visit was also significantly associated with higher patient satisfaction scores (P < 0.01). CONCLUSIONS Patient experience of previous autogenous soft tissue grafting has an influence on their decision to undergo future treatment. Willingness to retreat was negatively affected by mandibular sites, larger treated areas and the perceived pain, while presenting with complete root coverage was significantly associated with patient satisfaction.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Anas Kneifati
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Jad Majzoub
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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26
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Gil S, de la Rosa M, Mancini E, Dias A, Barootchi S, Tavelli L, Mendoza-Azpur G. Coronally advanced flap achieved higher esthetic outcomes without a connective tissue graft for the treatment of single gingival recessions: a 4-year randomized clinical trial. Clin Oral Investig 2020; 25:2727-2735. [PMID: 32974775 DOI: 10.1007/s00784-020-03587-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/14/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Limited long-term data are available when comparing the esthetic outcomes of coronally advanced flap (CAF) with or without a connective tissue graft (CTG). The aim of this study was to compare the 4-year esthetic outcomes of CAF vs CAF + CTG for the treatment of isolated maxillary gingival recessions. MATERIAL AND METHODS Forty-eight patients were randomly assigned for treatment either with CAF (control; N = 24) or to CAF + CTG (test group; N = 24). Patients were followed after the surgery until the final evaluation. A professional esthetic evaluation was performed using the Root coverage Esthetic Score (RES). Recession reduction, mean root coverage, and complete root coverage were also evaluated. RESULTS Forty-two patients completed the study at the 4-year recall. A significant recession reduction was evident at 4 years, without significant intergroup differences. The CAF group showed a statistically significant higher final RES compared with the CAF + CTG group (9.14 ± 1.08 vs 7.25 ± 1.29, respectively, p < 0.001). Regarding the individual components of RES, gingival margin and marginal tissue contour were significantly higher in the CAF group compared with that in the CAF + CTG group. CONCLUSIONS CAF presented with a significantly higher overall esthetic score than CAF + CTG, and in the individual RES components of marginal tissue contour and gingival margin after 4 years. CLINICAL RELEVANCE CAF without the addition of CTG provided higher esthetic outcomes for the treatment of isolated gingival recessions.
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Affiliation(s)
- Stephany Gil
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Calle Cantuarias 398, Miraflores, 15074, Lima, Peru
| | - Manuel de la Rosa
- Department of Periodontics, AME University Monterrey, Monterrey, Mexico
| | | | - Antonio Dias
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Calle Cantuarias 398, Miraflores, 15074, Lima, Peru
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Gerardo Mendoza-Azpur
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Calle Cantuarias 398, Miraflores, 15074, Lima, Peru.
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27
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Namadmalian Esfahani N, Khorsand A, Mohseni Salehimonfared S. The influence of harvesting free gingival graft on self-reported pain perception: A randomized two-arm parallel clinical trial. J Dent Sci 2020; 16:410-416. [PMID: 33384828 PMCID: PMC7770369 DOI: 10.1016/j.jds.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/04/2020] [Indexed: 11/29/2022] Open
Abstract
Background/purpose Free gingival graft (FGG) is used as an effective method to increase the width of keratinized tissue. However, it can cause pain at the donor site. Techniques accompanied by lesser tissue harvesting can reduce pain after surgery. The purpose of this study was to evaluate the self-reported pain perception following harvesting FGG using conventional and accordion methods. Materials and methods In this randomized clinical trial study, 31 patients with a deficiency of keratinized tissue around implant were investigated. Sixteen subjects in the accordion group and 15 subjects in the control group received conventional FGG. In the accordion group, FGG was harvested with a length of 60% of the mesiodistal length of the recipient area and with the same length as the mesiodistal length of the recipient area in the conventional group. The patients were asked to record their daily pain using a numerical rating scale. Results The severity of the pain after reaching to the peak on the second day was reduced and reached zero at day 14 in both groups. Pain severity showed no significant difference between the treatment groups. The highest level of pain was reported in the conventional group in those subjects under 50 years old, and the lowest one was in the conventional group's subjects above 50 years old. There was no difference between men and women in the reported pain between the treatment groups. Conclusion Harvesting graft with a smaller size in the accordion group has no effect on reducing pain. Registration number IRCT20190721044296N1.
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Affiliation(s)
| | - Afshin Khorsand
- Periodontics Department, Dental Faculty, Tehran University of Medical Sciences, Tehran, Iran
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28
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Barootchi S, Tavelli L, Gianfilippo RD, Eber R, Stefanini M, Zucchelli G, Wang HL. Acellular dermal matrix for root coverage procedures: 9-year assessment of treated isolated gingival recessions and their adjacent untreated sites. J Periodontol 2020; 92:254-262. [PMID: 32729954 DOI: 10.1002/jper.20-0310] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The long-term outcomes of acellular dermal matrix (ADM) for the treatment of isolated gingival recessions has not yet been evaluated. Thus, the aim of this study was to observe the root coverage outcomes of coronally advanced flap with ADM over time, and compare them with their adjacent untreated sites. METHODS Twelve patients (from 20) were available at the 9-year recall. Clinical parameters (recession depth, mean root coverage [mRC], keratinized tissue width [KTW], and gingival thickness) were evaluated and compared with the 1-year results, and the ADM-adjacent untreated sites (on mesial and distal) via mixed-modeling regression analyses. RESULTS From 1 to 9 years, the ADM-treated isolated recessions showed a relapse from 77% to 62% mRC (P <0.05). A similar pattern toward apical shift of the gingival margin was noticed for the ADM-adjacent untreated sites without baseline recession. However, ADM-adjacent untreated sites which had presented with recession at baseline but were not treated showed a significantly more apical shift of the gingival margin (almost two-fold). A significant increase in KTW was noted for all sites. Baseline KTW ≥2 mm was a significant predictor for the stability of the gingival margin at the ADM-treated, and the ADM-adjacent sites with baseline recession. CONCLUSIONS ADM-treated sites displayed recession relapse from 1 to 9 years. The untreated adjacent sites with a recession at baseline, showed a higher apical displacement of the gingival margin compared with the ADM-treated sites, and ADM-adjacent sites without a recession at baseline.
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Affiliation(s)
- Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Riccardo Di Gianfilippo
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Robert Eber
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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29
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Multilayered Connective Tissue Grafting Technique to Improve Aesthetics after Failed GBR: A Clinical Case Report of 16 Months Follow-Up. Case Rep Dent 2020; 2020:3906468. [PMID: 32774937 PMCID: PMC7396066 DOI: 10.1155/2020/3906468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/13/2020] [Accepted: 06/12/2020] [Indexed: 11/17/2022] Open
Abstract
Objective This case report describes soft-tissue management after a failed GBR procedure to enhance the soft-tissue quality, quantity, and aesthetic outcomes. Case Presentation. A 38-year-old patient visited the Dental Clinic of the Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, for a chief complaint of unsatisfactory aesthetics of the anterior maxillary area. Dental history disclosed failed preimplant vertical bone augmentation with GBR procedure in the area of the left maxillary central incisor resulting in a severe gingival recession of adjacent teeth and compromised soft-tissue quantity and quality and severe ridge atrophy (class III). Multilayered connective tissue grafting technique, in a two-step mucogingival surgery, was used to cover the gingival recessions, reach even gingival margin, and reconstruct the defect. Frenectomy was done after the second mucogingival surgery to relieve the muscle attachment. A definitive cantilever bridge was placed to restore the left and right maxillary central incisors, and a satisfactory aesthetic outcome was reached. Conclusions Multilayered connective tissue grafting technique might be successful in correcting soft-tissue quantity and quality in class III ridge defects.
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30
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Ehab K, Abouldahab O, Hassan A, Fawzy El-Sayed KM. Alvogyl and absorbable gelatin sponge as palatal wound dressings following epithelialized free gingival graft harvest: a randomized clinical trial. Clin Oral Investig 2020; 24:1517-1525. [PMID: 32144515 DOI: 10.1007/s00784-020-03254-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/26/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This randomized controlled trial compares for the first time effects of Alvogyl versus absorbable gelatin sponge as palatal wound dressings on postoperative pain, amount of analgesic consumption, post-surgical bleeding, and wound re-epithelization. MATERIALS AND METHODS Following sample size calculation, 36 systemically healthy patients requiring palatal mucosal graft harvesting were randomized to receive Alvogyl (intervention group, 18 patients) or absorbable gelatin sponge (control group, 18 patients) palatal dressings. Patient-reported VAS pain scores over 2 weeks were defined as primary outcome. Post-surgical bleeding, number of analgesics consumed, and complete re-epithelialization of the palatal wound for up to 5 weeks were defined as secondary outcomes. RESULTS Although significantly higher VAS pain scores were reported in the control as compared with the intervention group up to 12 days post-surgically (from (median [range]) 8.5 [2-10] to 1 [0-2] and from 6 [0-10] to 0 [0-2] respectively), with higher analgesics consumption (from 2 [1-3] to 1 [0-3] and from 1 [0-3] to 0 [0-2] tablets respectively), a multivariate regression analysis considering age, gender, graft width/length, tissue thickness, analgesics intake, and dressing type demonstrated no statistically significant effect of any factor, including dressing type on VAS pain scores. At 4 weeks, 22.2% of patients in the intervention group versus 11.1% in the control group demonstrated complete re-epithelization of their palatal engraftment site, before complete re-epithelization in both groups at 5 weeks. No post-surgical bleeding was reported with both dressings. CONCLUSIONS Within the study's limitations, results suggest Alvogyl as a practical palatal surgical dressing, comparable with absorbable gelatin sponge in cost, pain reduction, hemostasis, and re-epithelization properties. TRIAL REGISTRATION www.ClinicalTrials.gov Identifier: NCT03402321 CLINICAL RELEVANCE: Alvogyl could present a novel palatal wound dressing material, comparable with gelatin sponge.
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Affiliation(s)
| | - Omneya Abouldahab
- Oral Medicine and Periodontology Department, Faculty of Oral and Dental Medicine, Cairo University, Giza, Egypt
| | - Abdallah Hassan
- Periodontology Department, School of Dentistry, New Giza University, Giza, Egypt
| | - Karim M Fawzy El-Sayed
- Oral Medicine and Periodontology Department, Faculty of Oral and Dental Medicine, Cairo University, Giza, Egypt.
- Oral Medicine and Periodontology Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt.
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31
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Zucchelli G, Tavelli L, McGuire MK, Rasperini G, Feinberg SE, Wang HL, Giannobile WV. Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction. J Periodontol 2019; 91:9-16. [PMID: 31461778 DOI: 10.1002/jper.19-0350] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/27/2019] [Accepted: 08/10/2019] [Indexed: 12/14/2022]
Abstract
This state-of-the-art review presents the latest evidence and the current status of autogenous soft tissue grafting for soft tissue augmentation and recession coverage at teeth and dental implant sites. The indications and predictability of the free gingival graft and connective tissue graft (CTG) techniques are highlighted, together with their expected clinical and esthetic outcomes. CTGs can be harvested from the maxillary tuberosity or from palate with different approaches that can have an impact on graft quality and patient morbidity. The influence of CTGs on soft tissue thickness and keratinized tissue width are also discussed.
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Affiliation(s)
- Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Michael K McGuire
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Private practice, Houston, TX, USA.,Department of Periodontics, University of Texas, Dental Branch Houston and Health Science Center at San Antonio, San Antonio, TX, USA
| | - Giulio Rasperini
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Stephen E Feinberg
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - William V Giannobile
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical Engineering, College of Engineering and Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
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32
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Tavelli L, Barootchi S, Namazi SS, Chan H, Brzezinski D, Danciu T, Wang H. The influence of palatal harvesting technique on the donor site vascular injury: A split‐mouth comparative cadaver study. J Periodontol 2019; 91:83-92. [DOI: 10.1002/jper.19-0073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/19/2019] [Accepted: 06/03/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Shayan Barootchi
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Sharon S. Namazi
- Division of AnatomyDepartment of SurgeryUniversity of Michigan Medical School Ann Arbor MI
| | - Hsun‐Liang Chan
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - David Brzezinski
- Division of AnatomyDepartment of SurgeryUniversity of Michigan Medical School Ann Arbor MI
| | - Theodora Danciu
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
- Department of Oral and Maxillofacial PathologyUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Hom‐Lay Wang
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
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AlSarhan MA, Al Jasser R, Tarish MA, AlHuzaimi AI, Alzoman H. Xenogeneic collagen matrix versus connective tissue graft for the treatment of multiple gingival recessions: A systematic review and meta-analysis. Clin Exp Dent Res 2019; 5:566-579. [PMID: 31687192 PMCID: PMC6820582 DOI: 10.1002/cre2.210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 11/09/2022] Open
Abstract
A systematic review and meta‐analysis was performed to understand the efficacy of xenogeneic collagen matrix (CMX) compared with connective tissue graft (CTG) for the treatment of multiple adjacent gingival recessions (MAGRs). A literature search was performed for published randomized controlled trials in adult patients (≥18 years old) with Multiple Adjacent Miller class I and II gingival recessions (MAGRs). The assessments included recession depth, Recession width, complete root coverage, mean root coverage, probing depth, clinical attachment level, and keratinized tissue width. Pooled data were analyzed using fixed‐ and random‐effects models, and Forest plots were constructed. Heterogeneity within studies was calculated to assess publication bias. Four randomized controlled trials were included based on the eligibility criteria. Although the recession depth, complete root coverage, and mean root coverage were significantly lower with CMX (p = .017 and p = .001, p = .001, respectively), there was no statistically significant difference in the Recession width between CMX and CTG (p = .203). CMX showed significantly lower Probing Depth than CTG (p = .023); however, no significant difference in clinical attachment level (p = .060) and keratinized tissue width (p = .052) was observed between the groups. Owing to the heterogeneity in the included studies, firm conclusions cannot be drawn regarding the noninferiority of CMX compared with CTG. Long‐term studies are therefore needed to conclusively establish the relative efficacy of CMX in MAGR.
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Affiliation(s)
- Mohammed A AlSarhan
- Department of Periodontics & Community Dentistry, College of Dentistry King Saud University Riyadh Saudi Arabia
| | - Reham Al Jasser
- Department of Periodontics & Community Dentistry, College of Dentistry King Saud University Riyadh Saudi Arabia
| | - Mohammad Abdullah Tarish
- Department of Preventive Dental Science ELM University Riyadh Saudi Arabia.,Capital Health Region Ministry of Health Kuwait Kuwait
| | - Anas I AlHuzaimi
- College of Dentistry King Saud University Riyadh Saudi Arabia.,Medical Services Ministry of Interior Riyadh Saudi Arabia
| | - Hamad Alzoman
- Department of Periodontics & Community Dentistry, College of Dentistry King Saud University Riyadh Saudi Arabia
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Oral Applications of Cyanoacrylate Adhesives: A Literature Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8217602. [PMID: 31008113 PMCID: PMC6441539 DOI: 10.1155/2019/8217602] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/03/2019] [Indexed: 02/08/2023]
Abstract
Cyanoacrylate adhesives have been used in medicine and dentistry with some controversial opinions. The aim of this review was to summarize the relevant literature regarding the use of cyanoacrylate adhesives for oral wounds during dental and surgical procedures, with focus on the applications, indications, advantages, and disadvantages. In conclusion, in vivo and clinical studies have demonstrated in the last few years convincing results regarding the safety, efficacy, ease of application, and feasibility of all types of cyanoacrylate adhesives used in intra- and extraoral procedures.
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