Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of Miller class I and II gingival recessions: a controlled randomized clinical trial

Background The aim of this study was to evaluate whether the combination of enamel matrix derivative (EMD) with subepithelial connective tissue graft (SCTG) plus coronally advanced flap (CAF) would improve the treatment outcomes of Miller class I and II gingival recessions when compared with the same technique (SCTG plus CAF) alone. Methods The study was designed as a randomized, parallel, controlled, double-blinded clinical trial. Forty-two patients were randomly assigned in the test group (SCTG plus EMD) and in the control group (SCTG). Patients had at least one gingival recession ≥ 2 mm. The clinical parameters were evaluated at baseline and at 14 d, 1, 3, 6 and 12 mo follow-up time poin…

Influence of a bioceramic root end material and mineral trioxide aggregates on fibroblasts and osteoblasts

The biocompatibility of materials used in endodontic treatment is of high importance, because they can come in contact with periradicular tissues and there is a risk of possible systemic toxicity. The aim of the present study was to investigate the in vitro reaction to a bioceramic based root end material in comparison to mineral trioxide aggregates (MTA) as the established gold standard.The root end materials grey MTA Angelus (GMTA), white MTA Angelus (WMTA), ProRoot MTA, and EndoSequence Root Repair Material (ERRM) were incubated with human periodontal ligament fibroblasts and osteoblasts (10(4)cells/ml) for up to 96h. Cell proliferation (RFU) was determined by means of the Alamar Blue as…

The effectiveness of a novel optical probe in subgingival calculus detection

:  Objectives:  The aim of the present study was to evaluate the effectiveness of a novel optical calculus detection system under in vivo conditions. Methods:  One hundred and seventy-six tooth surfaces from 44 adult teeth that were indicated for extraction were selected for the present study. The patients were randomly assigned to one of the two experimental groups. In group A (n = 96), clinical presence or absence of subgingival calculus deposits was determined using the light-emitting diode-based optical probe (OP). In group B (n = 80), the subgingival deposits were first recorded with the OP followed by root surface debridement until no subgingival deposits could be detected by the devi…

Short-Term Results in Evaluating a Gingiva-Adhesive Hydrophobic-Chlorhexidine-Gel for Chronic Periodontitis

Background and Aims: Oral mucosa and interproximal spaces of the teeth could favor the colonization of periodontopathogenic bacteria, which could be targeted by chemical antiplaque agents such as chlorhexidine, present in different oral hygiene products, thus improving the control of biofilm growth and delaying microbial accumulation. The study aimed to evaluate whether the use of a hydrophobic gel with good gingival adhesion for 14 days after the scaling and root planing of patients with chronic periodontitis would improve the treatment outcome, when compared with the use of a regular hydrophyllic gel.Material and Methods: Patients with moderate disease were included in two study groups. A…

Complications Associated with Recession Coverage Procedures

Various surgical techniques have been proposed to obtain predictable and esthetic root coverage. In general, these techniques may include the use of pedicle soft tissue grafts, free soft tissue grafts, and soft tissue graft substitutes. Overall, these surgical procedures have been shown to be safe, effective, and well-tolerated by the patients. However, as with any surgical procedure, complications and treatment failures can occur. Therefore, the clinician should have a thorough knowledge of potential complications associated with these procedures and strategies for their prevention and management. This chapter provides an overview of the most common complications and atypical healing respo…

The determination of the initial straight length in root canals of mandibular premolars--an in vitro study.

Abstract The aim of the present roentgenographic in vitro study was to determine the initial straight length from the cemento-enamel junction (CEJ) to the appearance of a root canal curvature in human mandibular premolars. A total number of 282 mandibular premolars were examined. Exclusion criteria comprised root caries, extensive restorations and endodontically treated teeth. The teeth were fixed and digitally radiographed by means of a specially developed fixation device with standardized and reproducible distances with the parallel technique (Heliodent MD; Merlin 2.1). The distances from the CEJ to the first curvature (> 5°) (distance I), from the first curvature to a second curvature (d…

Changes in anatomic position of root canal orifices in pluriradicular teeth following re-location during endodontic treatment

Abstract Direct access to the root canals in posterior teeth for endodontic treatment is most frequently facilitated by the straightening of the coronal parts of the root canals, having as a consequence the relocation of the canal orifices on the map of the floor of the pulp chamber ( Christie and Thompson, 1994 ). This procedure intentionally moves the coronal aspect of a canal away from the center of the chamber, while simultaneously removing internal dentin from the pulp chamber walls. The aim of this study was to evaluate the displacement resulting from the relocation of root canal orifices during the initial phase of rotary root canal treatment in molars using the dental operating micr…

Etiology and Prevalence of Gingival Recession

Gingival recession is a highly prevalent problem affecting individuals of all ages worldwide. Before considering any therapeutic strategies for gingival recession defects, it is important to identify the underlying etiological factors that contributed to the development of the clinical condition. The main etiological factors for gingival recession are plaque-induced periodontal inflammation and mechanical trauma caused by improper toothbrushing habits. Several other predisposing and precipitating factors have also been implicated in the etiology of gingival recession. The aim of this chapter is to summarize the different etiological factors contributing to the development of gingival recess…

The impact of some behavioral aspects on periodontal disease in a group of Romanian students - an epidemiological survey.

Abstract Aims To investigate the prevalence of periodontitis in a young population representative for the North-western part of Romania (Transylvania) and to identify possible risk indicators of periodontitis. Methods The study is a cross-sectional epidemiological survey. The subjects were students randomly sampled from three universities in Cluj-Napoca and high school students from the neighboring city of Bistrita. The sample size of the population was calculated. Overall, 623 subjects aged 16–35 years were evaluated, of which 488 were university students and 135 high school students. A structured questionnaire was administrated to collect information on socio-behavioral status and oral hy…

New insights into the cellular makeup and progenitor potential of palatal connective tissues

The present study investigated the regenerative potential of connective tissues harvested from two palatal areas widely used as donor sites for muco-gingival surgical approaches. Connective tissue grafts (CTGs) were obtained by de-epithelialisation of a free gingival graft (deCTG) and by a split flap approach from a previous donor site (reCTG). Two types of mesenchymal stem cell (MSCs) were isolated and were named de-epithelialised MSCs (deMSCs) and re-entry MSCs (reMSCs). The cells were characterised and cellular functionality was investigated. CTGs were evaluated using immunohistochemical and ultrastructural approaches. No significant differences were observed regarding the frequency of c…

Radiographic Investigation of Location and Angulation of Curvatures in Human Maxillary Incisors

The aim of this radiographic study was to evaluate the degree and location of root canal curvatures of human maxillary incisors. A total of 286 extracted human maxillary incisors (145 central and 141 lateral incisors) were included in this investigation. Exclusion criteria were teeth with extensive carious lesions, restorations, and root canal treatment. For this in vitro study, the teeth were fixed in a special device and digitally x-rayed with the parallel technique. The distances from the cementoenamel junction (CEJ) to the first curvature and the according angle were recorded. The results were analyzed descriptively, and p values were calculated with the Wilcoxon Mann-Whitney test. The …

Mandibular Molar Root Resection Versus Implant Therapy: A Retrospective Nonrandomized Study

AbstractSuccess rates for both periodontal and implant therapy are often dependent on site and tooth type. For periodontally involved mandibular molars, the decision to hemisect or to extract and place an implant is often complicated. The purpose of the present study was to evaluate the outcomes of the aforementioned treatment modalities for mandibular molars in a private practice setting. A retrospective chart review was performed. In one group of patients (n = 32), 56 mandibular first or first and second molars were treated by hemisection (Group H). A second group (n = 28) received 36 implants in the mandible to replace periodontally involved first or first and second molars (Group I). Al…

Association between chronic dental infection and acute myocardial infarction.

Introduction: In patients with cardiovascular diseases several risk factors such as high blood pressure, diabetes, smoking and drinking habits, genetic disposition, and chronic inflammation must be considered. The aim of this study was to investigate whether there is a correlation between dental origin infections and the presence of an acutemyocardialinfarction(AMI).Methods:Atotalof125 patients who had experienced a myocardial infarction and 125healthyindividualswereincludedinthisstudy.Theoral examination was carried out following the consent of the ethics committee and the National Board for Radiation Protection and included the number of teeth, endodontically treated teeth, periodontal sc…

Recession Coverage Using Soft Tissue Substitutes

Today, a variety of surgical procedures can be used to successfully treat gingival recession defects. Among them, the autogenous connective tissue graft in conjunction with a coronally advanced flap is commonly considered the gold standard procedure. However, the most significant disadvantages of this procedure are the potential morbidity associated with autogenous tissue harvesting and the limited availability of donor tissue. For these reasons, alternative surgical procedures using membranes, enamel matrix derivative, and soft tissue graft substitutes have been proposed and tested. The aim of the present chapter is to provide an overview on the use of soft tissue substitutes as a possible…

The adjunctive use of a controlled-release chlorhexidine chip following treatment with a new ultrasonic device in supportive periodontal therapy: a prospective, controlled clinical study

Abstract:  Objective:  The aim of this randomised, split-mouth, controlled clinical trial was to evaluate the effectiveness of a controlled-release chlorhexidine chip (CHX chip) as an adjunctive therapy to scaling and root planing (SRP) with a newly developed ultrasonic device in supportive periodontal therapy (SPT). Materials and methods:  Twenty patients with moderate-to-severe chronic periodontitis, displaying at least four sites with probing depth (PD) ≥5 mm and persistent bleeding on probing (BOP), were recruited for the study. The target sites were randomly treated with either a newly developed piezo-driven ultrasonic device VectorTM- or ultrasonic system (VUS) + CHX chip or VUS alone…

Treatment of intrabony defects using guided tissue regeneration and autogenous spongiosa alone or combined with hydroxyapatite/beta-tricalcium phosphate bone substitute or bovine-derived xenograft.

The aim of this case-control study was to investigate the clinical regeneration of deep intrabony defects using guided tissue regeneration (GTR) with autogenous spongiosa (ASB) alone or using GTR with a mixture of ASB with a bovine-derived xenograft (BDX) or a synthetic composite bone substitute (hydroxyapatite/beta-tricalcium phosphate [HA/beta-TCP]).Sixty-four patients with a total of 93 intrabony defects of 2- or 3-wall morphology and an intrabony component (IC)or=4 mm participated in this study. Defects were treated with a bioabsorbable membrane and ASB alone or ASB mixed with HA/beta-TCP or BDX. Clinical parameters measured at baseline and 12 months after surgery included IC, bleeding …

Definition of Gingival Recession and Anatomical Considerations

The gingiva is an integral part of the periodontium that covers the cervical portions of the teeth and the alveolar processes of the jaws. In health, the closely adapted gingival tissues provide effective protection against mechanical trauma and bacterial invasion and also play a critical role in aesthetics. Therefore, a recession of the gingival margin not only affects the aesthetic appearance but may cause several adverse consequences due to exposure of the root surface. This chapter provides a definition of gingival recession and gives a basic overview of the anatomical characteristics of the gingiva. A basic understanding of the macroscopic and microscopic features of healthy gingiva is…

Clinical parameters and aMMP-8-concentrations in gingival crevicular fluid in pregnancy gingivitis.

BACKGROUND During pregnancy hormonal changes may increase the risk for developing gingivitis. The aim of this study was to evaluate the signs of gingival inflammation and the enzyme activity of matrix metalloproteinase-8 (aMMP-8) in the gingival crevicular fluid of pregnant women. METHODS After approval by the ethics commission, a total of 40 volunteers participated in the study; group 1 (n = 20, age: 32 +/- 4 years) with pregnant women, and group 2 (n = 20, age: 30 +/- 10 years) with age-matched non-pregnant women as controls. After obtaining anamnestic data, the dental examination included assessment of oral hygiene, gingival inflammation, probing pocket depth, and recession. Gingival cre…

Radiographic Investigation of Frequency and Location of Root Canal Curvatures in Human Mandibular Anterior Incisors In Vitro

The aim of the present in vitro study was to evaluate the degree and location of root canal curvatures of mandibular anterior incisors. A total of 396 extracted human permanent anterior incisors (248 central and 148 lateral) were included in this investigation. Exclusion criteria were teeth with extensive carious lesions, restorations, and root canal treatment. The specimens were fixed in a special device and digitally x-rayed (Heliodent MD; Sirona, Benzheim, Germany; Merlin 2.1, Olympus/PerkinElmer, Waltham, MA) with the parallel technique. The distances from the cementoenamel junction (CEJ) to the first curvatures as well as the according angles were recorded. The results were analyzed de…

Immediate Implant Placement in Fresh Mandibular Molar Extraction Socket: 8-Year Results. A Case Report

Abstract Recently, successful implant placement in fresh extraction sockets has been reported. In this case report, we present the results of an immediate implant placement in a fresh extraction socket of a mandibular molar with simultaneous bone regeneration using a nonresorbable membrane and no other graft materials. Clinical and radiographic findings acquired 8 years after implant placement demonstrated a stable peri-implant situation and confirmed a satisfactory treatment result.

Classification of Gingival Recession

Gingival recession is a common finding in many patients and is clinically manifested by an apical displacement of the gingival margin in relation to the cemento-enamel junction (CEJ). Various classification systems have been proposed to classify gingival recession defects and to predict final root coverage outcomes. Among them, the Miller classification is still the most commonly used among dental practitioners and researchers. This chapter reviews the different classification systems available for gingival recession defects and explores the strengths and limitations of them.

Clinical evaluation of nanocrystalline hydroxyapatite paste in the treatment of human periodontal bony defects--a randomized controlled clinical trial: 6-month results.

The aim of this study was to compare the clinical outcome of intrabony periodontal defects following treatment with a novel nanocrystalline hydroxyapatite (NHA) paste to open flap debridement.Twenty-eight subjects, each displaying one intrabony defect with probing depth (PD)or =6 mm and radiographic evidence of an intraosseous componentor =3 mm participated in the present study. Subjects were allocated randomly to treatment with NHA paste (test group) or open flap debridement (control group). At baseline and at 6 months after surgery, the following clinical parameters were recorded by a masked examiner: plaque index, gingival index, PD, clinical attachment level (CAL), and gingival recessio…

Corrigendum to "Human periodontal fibroblast response to a nanostructured hydroxyapatite bone replacement graft in vitro" [Arch. Oral Biol. 53 July (7) (2008) 683-689].

Flapless application of enamel matrix derivative in periodontal retreatment: A multicentre randomized feasibility trial

AIM To investigate the potential benefit of enamel matrix derivative (EMD) as adjunct to re-instrumentation of residual pockets persisting after steps 1 and 2 of periodontal therapy. MATERIAL AND METHODS 44 adult patients participated in a multicentre feasibility randomized clinical trial with split-mouth design. They had presented at re-evaluation after initial non-surgical periodontal therapy (steps 1 and 2 of periodontal therapy) for generalized periodontitis with at least 2 teeth with residual probing pocket depths (PPD) ≥5 and ≤8 mm, with bleeding on probing (BOP). Two teeth with similar PPD were randomized to receive re-instrumentation either with (test) or without (control) adjunctiv…

Alveolar bone preservation in extraction sockets using non-resorbable dPTFE membranes: a retrospective non-randomized study.

Background: The aim of this study was to investigate the clinical regeneration of extraction sockets using high-density polytetrafluoroethylene (dPTFE) membranes without the use of a graft material. Methods: A total of 276 extraction sockets were evaluated in 276 subjects (151 males and 125 females; mean age, 50.2 years; age range: 24 to 73 years). After extraction, flaps were elevated and a dPTFE membrane was placed over the extraction site. The flaps were repositioned and sutured into place. Primary closure was not obtained over the membranes. The cemento-enamel junctions of the adjacent teeth were used as reference points. Measurements were taken postextraction and 12 months after surger…

Treatment of Gingival Recession: When and How?

Gingival recession is a common finding in daily clinical practice. Several issues may be associated with the apical shift of the gingival margin such as dentine hypersensitivity, root caries, non-carious cervical lesions (NCCLs), and compromised aesthetics. The first step in an effective management and prevention program is to identify susceptibility factors and modifiable conditions associated with gingival recession. Non-surgical treatment options for gingival recession defects include establishment of optimal plaque control, removal of overhanging subgingival restorations, behaviour change interventions, and use of desensitising agents. In cases where a surgical approach is indicated, co…

Roentgenographic in vitro investigation of frequency and location of curvatures in human maxillary premolars.

The aim of this study was to determine the location of the root canal curvature and measure the distance from the CEJ to the first curvature using in vitro methods. Extracted maxillary premolars (n = 358) were fixed and digitally radiographed using the parallel technique. Excluded from further analysis were teeth with root caries, artificial crowns, extensive fillings, or endodontic treatments. The results were descriptively analyzed and the cumulative frequencies were calculated. The median values of the distance between CEJ and first curvature were for the first right premolars 8.4 mm (buccal) and 8.5 mm (palatal), for the first left premolars 9.1 mm (buccal) and 8.9 mm (palatal). The med…

Ability of nanocrystalline hydroxyapatite paste to promote human periodontal ligament cell proliferation.

Recent studies indicate that nanocrystalline hydroxyapatite (nano-HA) paste represents a promising class of bone graft substitute. However, the underlying molecular mechanisms of nano-HA function have not yet been determined. This study was conducted to investigate the proliferation of human periodontal ligament (PDL) cells cultured in the presence of nano-HA paste and to characterize associated changes in intracellular signaling pathways. Cultured PDL cells were stimulated with nano-HA paste and enamel matrix derivative (EMD) in a soluble form. Proliferation of PDL cells was determined by incorporation of bromodeoxyuridine (BrdU) in the DNA of proliferating cells. In order to understand th…

In vitro and in vivo characterization of porcine acellular dermal matrix for gingival augmentation procedures

Recently, porcine acellular dermal matrix (PADM) has been proposed as a possible alternative to autogenous grafts in periodontal plastic surgery. The aim of the present study was to investigate the in vitro responses of four different oral cell lines cultured on a novel PADM. Furthermore, tissue reaction to PADM was evaluated histologically after subcutaneous implantation in mice.Human gingival fibroblasts (HGF), human osteoblast-like cells, human umbilical vein endothelial cells and human oral keratinocytes (HOK) were cultured and transferred on to the PADM. A tissue culture polystyrene surface served as the control. The viability of all tested cell lines on PADM was measured by using the …

Interdisciplinary approach for the treatment of periodontally compromised malpositioned anterior teeth: a case report

Today many adult patients with periodontal disease demonstrate positioning of teeth that comprise their ability for proper mechanical tooth cleaning of approximal tooth surfaces. With adequate combined periodontal-orthodontic treatment it is possible to re-establish a healthy and well-functioning dentition. However, while orthodontic treatment can realign periodontally affected teeth, esthetic appearance may be compromised by gingival recession due to alveolar bone dehiscences or fenestrations in combination with a thin gingival biotype. This article reports an interdisciplinary (periodontic, orthodontic, restorative) approach for the treatment of a periodontally compromised patient with an…

Early root surface colonization by human periodontal ligament fibroblasts following treatment with different biomaterials

The present in-vitro study examined the effects of different biomaterials on early root surface colonization by human periodontal ligament (PDL) fibroblasts using confocal-laser-scanning-microscopy (CLSM).Fifteen periodontally-diseased teeth were extracted, treated with scaling/root planing and longitudinally cut to obtain 30 root fragments. Fragments were treated either with 24% EDTA following application of enamel matrix derivative (EMD), 24% EDTA or EMD only, nanocrystalline hydroxyapatite (NHA) paste or oily calcium hydroxide suspension (OCHS) for 1 h each. The analogue untreated root specimens served as controls. Root fragments were incubated with human PDL fibroblasts and cellular pro…

The Correlation between Chronic Periodontitis and Oral Cancer

Infections are increasingly considered as potential trigger for carcinogenesis apart from risk factors like alcohol and tobacco. The discussion about human papilloma virus (HPV) in oral squamous cell carcinoma (OSCC) points at a general role of infection for the development of oral carcinomas. Furthermore, first studies describe a correlation between chronic periodontitis and OSCC, thus, characterizing chronic inflammation as being a possible trigger for OSCC. In front of this background, we present four well-documented clinical cases. All patients showed a significant anatomical relation between OSCC and clinical signs of chronic periodontitis. The interindividual differences of the clinic…

Influence of different biomaterials on the viability of Aggregatibacter actinomycetemcomitans

Abstract Objectives The aim of the present in vitro study was to evaluate the effects of different biomaterials used for regenerative periodontal surgery on the growth of the periodontopathogen Aggregatibacter actinomycetemcomitans . Methods Three commercially available biomaterials of synthetic origin (hydroxyapatite/beta-tricalcium phosphate, nanostructured hydroxyapatite paste, oily calcium hydroxide suspension), a bovine-derived xenograft as well as an enamel matrix derivative (EMD) were added in different concentrations to calibrated suspensions of A. actinomycetemcomitans ATCC 43718/33384 (serotype b/c). Equal aliquots (0.1 ml) for the viability assay were taken after 5 min, 1 h, 3 h,…

Application of enamel matrix derivative in conjunction with non‐surgical therapy for treatment of moderate to severe periodontitis: A 12‐month, randomized prospective, multicenter study

BACKGROUND Treatment of periodontitis aims to halt progressive bone and attachment loss and regenerate periodontal structures. In this study, the effect of using an enamel matrix derivative (EMD) as an adjunct to non-surgical periodontal therapy (test) versus non-surgical therapy alone (control) was evaluated. METHODS A prospective, split-mouth, multicenter study evaluated scaling and root planing (SRP) with and without EMD in 51 patients presenting with moderate to severe periodontitis (PPD = 5 to 8 mm) in at least 2 pockets per contralateral quadrants within the same arch. The primary outcome variable was change in clinical attachment level (CAL) after 12 months. Secondary variables inclu…

Efficacy of electrical neuromuscular stimulation in the treatment of chronic periodontitis

Purpose: The purpose of the present randomized controlled clinical study was to evaluate the short-term outcomes of microcurrent electrical neuromuscular stimulation (MENS) as an adjunct method to nonsurgical periodontal therapy. Methods: Twenty patients with moderate to severe chronic periodontitis were recruited into the study and randomly treated with either nonsurgical periodontal therapy followed by 5 MENS treatments with a microcurrent device or by nonsurgical periodontal therapy alone. Periodontal parameters were measured at baseline and 6 weeks following therapy, and included the plaque index, bleeding on probing, probing depth, and clinical attachment level (CAL). Results: All meas…