Clinical evaluation and biological understanding of the early step-by-step healing after periodontal microsurgery: A case report with PES analysis comparing initial and 31-day result

The influence of the gingival phenotype on implant survival rate and clinical parameters: a systematic review

OBJECTIVE

The goal of this systematic review was to verify whether the gingival phenotype (thick or thin) could impact the dental implant survival rate by affecting the marginal bone.

METHODS

The search was carried out on PubMed/MedLine, PubMed Central, and B-On databases. The research question was: "Does gingival phenotype positively or negatively influence marginal bone loss around dental implants?" The inclusion criteria were: any clinical trial/study, comparative study, prospective or retrospective articles, systematic review that addressed at least a 1-year follow-up with an assessment of the marginal bone loss (MBL) around dental implants, articles that reported the gingival phenotype (thin or thick) and were published in the last 13 years. The exclusion criteria were narrative or other reviews, letters to the editor, and commentaries. Data extraction included the author's name, year of publication, type of study, sample size, number of implants, method used, and outcomes presented. The extracted data was summarized and presented in the results section. Critical Appraisal tool in JBI Systematic Reviews was used to determine the possibility of bias.

RESULTS

A total of 62 articles were found, but eight articles were relevant to compose this study. After deep evaluation, it was possible to observe the implant success rate for both gingival phenotypes, thin and thick, was greater than 91% within a follow-up of up to 5 years. Therefore, it is unclear whether the thickness of the gingival tissue surrounding the implant can directly influence the marginal bone level. The gingival phenotype may be indirectly involved in the survival rate of dental implants, as it can be a risk factor for peri-implantitis, leading to marginal bone loss beyond what is expected.

DISCUSSION

The thin gingival phenotype is one of the main risk factors for additional bone loss. It is crucial to know how to preserve the healthy condition.

CONCLUSION

Within the results found, the gingival phenotype is indirectly related to implant survival rate and clinical parameters, which were respectively high and non-conclusive. Therefore, a higher risk of peri-implantitis is suggested when a thin phenotype is present.

Evaluating the effectiveness of low-level laser therapy in patients undergoing lower third molar extraction: A double-blinded randomized controlled trial

BACKGROUND

The use of low-level laser is a therapeutic resource that has been widely used in medicine in general, which has properties capable of modulating inflammatory effects such as pain, edema, and trismus resulting from oral surgeries for the extraction of impacted third molars. This study aimed to evaluate the effect of laser therapy at two different wave frequencies (660nm and 808nm) in patients undergoing impacted 3rd third lower molar extraction. For this, 30 patients were selected and randomly distributed into three groups with 10 individuals each (Control Group, 660nm Group, and 808nm Group).

MATERIAL AND METHODS

Each participant, according to their experimental group, received irradiation before the start of each surgery and immediately after the surgical procedure. The data regarding edema, pain intensity, and trismus collected before the surgeries, immediately after, and after seven days were spreadsheeted and analyzed to determine the mean and standard deviation. After the Shapiro-Wilk normality test, differences between the experimental groups were determined using Multiple Analyses of Variance, considering a significance level of 5% (p<0.05).

RESULTS

The results showed no statistically significant difference between the experimental groups in the analyzed items. Despite this, both groups irradiated with 660nm and 808nm frequencies experienced a reduction in the perception of postoperative pain, thus suggesting the benefit of using low-power laser therapy as an adjunct in the surgical treatment of impacted lower third molars.

CONCLUSIONS

Despite the results showing no differences between the groups, using LLLT resulted in lower pain perception in the irradiated participants compared to those in the control group. This fact supports the use of LLLT as an adjuvant therapy in patients undergoing oral surgery procedures to remove impacted third molars.

Microsurgery in periodontics and oral implantology: a systematic review of current clinical applications and outcomes

OBJECTIVES

The aim of this systematic review was to comprehensively explore the current trends and therapeutic approaches in which an operating microscope (OM) is used in periodontics and dental implant surgeries.

MATERIALS AND METHODS

A systematic search strategy was built to detect studies including various surgical techniques performed under an OM. PubMed, EMBASE, and SCOPUS databases were searched. No limitations in terms of time and language were applied. The data regarding the study design, type of procedure, treatment groups, and surgical outcomes were collected and analyzed descriptively. In addition, a bibliometric analysis was performed concerning the co-authorship and keyword co-occurrence network.

RESULTS

Out of 1985 articles, finally, 55 met the inclusion criteria. Current periodontal and implant microsurgery trends consist of: periodontal therapy, dental implant microsurgery, soft tissue grafting and periodontal plastic surgery, bone augmentation, ridge preservation, and ortho-perio microsurgery. The bibliometric analysis revealed "guided tissue regeneration", "periodontal regeneration" and "root coverage" being the most repeated keywords (landmark nodes). 132 authors within 29 clusters were identified, publishing within the frameworks of "periodontal and implant microsurgery".

CONCLUSION

Within its limitations, this systematic review provides an overview of the latest trends in periodontal and implant microsurgery when considering the use of an OM as the magnification tool. Also, it discusses the reported success and outcomes of the mentioned procedures.

Minimally invasive periodontal regeneration with the buccal approach: a systematic review and meta-analysis of clinical studies

OBJECTIVE

The aim of this study was to investigate clinical periodontal parameters after treatment using the Minimally Invasive Surgical Technique (MIST), Modified Minimally Invasive Surgical Technique (M-MIST), and/or any technique for papilla preservation, such as Entire Papilla Preservation (EPP), modified-papilla preservation technique (M-PPT), or simplified-papilla preservation technique (SPPT).

METHODS

The focus question was "For patients with periodontal intrabony defects (P), what is the best minimally invasive regenerative approach (I), comparing MIST, M-MIST, and papilla preservation techniques' outcomes (C) to improve PD, CAL, GR, and periodontal stability (O)?" An online search was conducted on PubMed, Cochrane Library, and Embase. Only randomized clinical trials and case series with a minimum of 10 enrolled patients were included. The risk of bias was evaluated using the Critical Appraisal tools in JBI Systematic Reviews. The meta-analysis compared the data obtained for the periodontal parameters analyzed, and the heterogeneity was verified.

RESULTS

After the screening, nine articles were included. Seven studies applied MIST and its modifications; two used M-PPT, one SPPT, and one approached EPP. A general statistically significant PD reduction and CAL gain were noted between the groups, comparing baseline and follow-up for all articles, independently of the technique or materials used. Also, all studies showed a non-significant increase in the gingival recession. Four studies had a low risk of bias, four had a moderate risk, and only 1 had a high risk. Moderate heterogeneity was found in one analysis for CAL (65.73%); moderate and substantial heterogeneity was found in the PD results (71.91% and 89.19%); and no heterogeneity was found within all analyses for gingival recession (0%).

CONCLUSION

MIST, M-MIST, and papilla preservation techniques demonstrated their potential and efficacy to improve periodontal conditions of sites with intrabony defects with minimal morbidity.