Search Results (18)

Background: Patient-reported outcome measures (PROMs) are essential for assessing postoperative morbidity and patient-centered treatment value after periodontal plastic surgery. This study evaluated PROMs following the modified coronally advanced tunnel (MCAT) combined with subepithelial connective tissue graft (SCTG) and different adjunctive biomaterials. Methods: This retrospective pooled secondary analysis included 64 patients treated for 275 gingival recessions using MCAT + SCTG with physiological saline (control), 24% EDTA, enamel matrix derivative (EMD), or cross-linked hyaluronic acid (HA). PROMs were the primary outcomes and included postoperative pain and swelling assessed using a 0–100 mm visual analogue scale (VAS), together with binary symptom measures recorded on days 1, 2, 4, 7, and 14. Patient satisfaction, esthetic perception, and willingness to recommend treatment were also assessed. Clinical and esthetic outcomes at 12 months served as reference parameters. Results: Early postoperative pain differed significantly between groups on days 1, 2, and 7 (p = 0.016, 0.024, and 0.033, respectively). Edema also varied significantly on days 2, 4, and 14 (p = 0.011, 0.001, and 0.001, respectively). The HA group showed lower pain scores on days 2 and 4, whereas EDTA was associated with greater early discomfort. Despite these differences, long-term satisfaction, esthetic perception, willingness to recommend treatment, and root coverage outcomes were high and comparable among groups (p > 0.05). Conclusions: MCAT + SCTG provides predictable and stable outcomes for multiple gingival recessions, regardless of adjunctive biomaterial. However, PROMs revealed differences in early postoperative morbidity, supporting their integration into clinical decision-making alongside clinician-reported outcomes. Full article

Background and Clinical Significance: Severe skeletal Class II malocclusion associated with periodontal compromise and posterior edentulism requires a carefully sequenced interdisciplinary treatment approach integrating orthodontic, surgical, periodontal, and prosthetic rehabilitation. Case Presentation: This case report describes the comprehensive interdisciplinary management of a 21-year-old female patient presenting with skeletal Class II malocclusion, severe mandibular retrognathia, vertical maxillary excess, labial incompetence, temporomandibular joint (TMJ) dysfunction and periodontal deficiencies. The treatment sequence involved occlusal splint therapy, pre-surgical orthodontic decompensation, bimaxillary orthognathic surgery using a segmental Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO), postoperative orthodontic refinement with aligners, periodontal plastic surgery using the Zucchelli technique and guided bone regeneration (GBR) with implant placement in the posterior mandible. At the four-year follow-up, the patient demonstrated complete root coverage, stable skeletal correction, and satisfactory implant integration, with maintenance of functional and aesthetic outcomes over time. Conclusions: This report highlights the importance of precise preoperative planning and the synergy between orthodontics, orthognathic surgery and periodontics in achieving optimal functional and aesthetic results. Full article

This single-center, split-mouth, single-blind pilot randomized trial compared patient morbidity, healing and root coverage between the subepithelial connective tissue graft (SCTG) and the de-epithelialized free gingival graft (D-FGG) when combined with the modified coronally advanced tunnel (MCAT) technique in multiple adjacent gingival recessions. Sixteen systemically healthy patients with bilateral Miller Class I/II (Cairo RT1) recessions were enrolled, and contralateral sides were randomly allocated to MCAT + SCTG (control) or MCAT + D-FGG (test) by means of sequentially numbered, opaque, sealed envelopes (SNOSE). Patient-reported outcomes (pain, chewing discomfort, bleeding) and the Landry Healing Index were assessed at 1 and 2 weeks; recession depth, mean root coverage (mRC) and Root Coverage Esthetic Score (RES) were evaluated at 6 months. Both techniques achieved high mRC (test: 94.22% ± 10.28%; control: 94.60% ± 9.99%) and RES (test: 8.02 ± 0.63; control: 8.14 ± 0.77), with no statistically significant intergroup differences. Donor-site pain was significantly lower in the D-FGG group, whereas early chewing discomfort and bleeding were higher. Because the trial was not powered for equivalence or non-inferiority, these preliminary findings are hypothesis-generating and require confirmation in adequately powered trials. Full article

Background: Gingival recession (GR) is defined as the exposure of the root surface due to the gingival margin shifting apically from the cemento-enamel junction. Current effective management of defects related to GR relies on root coverage periodontal plastic surgery (RCPPS), using the Modified Coronally Advanced Flap (mCAF) with an envelope design. Recent literature also reported the association of different biomaterials to the mCAF procedure. In light of these considerations, a systematic review (SR) was conducted to determine and compare the efficacy of all mCAF adjunctive techniques for the treatment of multiple adjacent GR-type (MAGR) defects. Methods: An electronic search was conducted in 2025 on studies published between 2013 and 2025, using PubMed, Scopus, Web of Science, and Cinahl Complete, to address the focused question: “which is the efficacy of different mCAF adjunctive techniques for the treatment of multiple adjacent GR-type defects, in terms of root coverage (RC), esthetic outcomes, and keratinized tissue (KT) augmentation?”. Randomized controlled trials with a minimum follow-up of 6 months with ≥ 5 patients treated for coverage of MAGR were included. Risk of bias was assessed with RoB 2 Tool. A meta-analysis was performed using RevMan5.4 software and the level of evidence of included studies was analyzed with GRADEPro GDT. Results: A total of 17 studies were included in the SR, 9 of which evaluating mCAF + sCTG (subepithelial connective tissue graft) vs. mCAF adjunctive techniques [Collagen Matrix (CM), xenogeneic acellular dermal matrix (XADM), Platelet-Rich Fibrin (PRF), Enamel Matrix Derivatives (EMD), sCTG harvested double blade scalpel] were then included in the meta-analysis. The primary outcomes of complete root coverage (CRC) and keratinized tissue width variation (ΔKTW) were statistically significant ([CRC: Odds Ratio (OR) 1.70; 95% CI (confidence interval) 1.18, 2.44; p = 0.004]; [ΔKTW: SMD (standardized mean difference) 0.37; 95% CI 0.11, 0.63; p = 0.005]) in favor of mCAF + CTG. Meanwhile, no statistically significant difference was observed in terms of RES. The certainty assessment highlighted relevant results: despite the lack of evidence in the long-term, a high level of evidence showed that sCTG was more effective than XADM in terms of CRC (p = 0.002) and ΔKTW (p = 0.0001). A low level of evidence revealed that sCTG achieved a greater ΔKTW compared to CM (p = 0.0006). Although no significant differences were observed, a low level of evidence suggested that mCAF + EMD and mCAF + sCTG (DBS) may provide good results. To date, only one RCT showed long-term stable results of CTG in terms of RC. Conclusions: The association of sCTG to mCAF demonstrated better results in terms of RC and KTW augmentation in short- and medium-term follow-ups. Long-term studies are needed to confirm the efficacy of the other mCAF adjunctive techniques, considering limitations due to heterogeneity in follow-ups, distribution of techniques analyzed, and different study designs. Registration in PROSPERO (International prospective register of systematic reviews) was performed with ID CRD420251085823. Full article

Background: The aim of this bibliometric study was to evaluate publication trends in the most frequently cited clinical trials on the treatment of gingival recession, taking into account the augmentation materials used. Methods: A Web of Science search was performed among articles published by 30 September 2024. Two independent reviewers evaluated year of publication, journal, authorship country of authors, collaborative relationship, keywords, and the main domains. Results: The top one hundred most-cited clinical trials were published in the span of 26 years from 1993 to 2019, and the total citation counts varied from 44 to 284 (83.69 citations per paper). There was correlation between the time of publication and the number of citations. The articles were authored by 333 researchers representing twenty-two countries. Italy contributed the highest number of articles (n = 36), followed by the USA (n = 28) and Brazil (n = 17). International collaborations were predominantly observed between Italy, the USA, and Switzerland. The type of graft was the most cited field of research (34), followed by guided tissue regeneration (17) and enamel matrix derivative (13). Conclusions: The country that produced the highest number publications among the 100 most-cited clinical trials on gingival recession treatment was Italy. The use of connective tissue graft (CTG) and coronally advanced flap (CAF) was the most prominent trend. Future work should combine bibliometric mapping with critical quality appraisal and explore whether citation trends align with best available evidence. Full article

Objectives: Periapical periodontitis, which is a periodontal dysfunction, is a current clinical problem. Due to the frequency of occurrence and the adverse effects they cause, they are considered a social disease. They require detailed diagnostics to implement appropriate treatment. Mathematical calculations based on data obtained from radiological images used in routine clinical practice may help differentiate the forms of periodontitis. This study aimed to evaluate the areas affected by periodontitis in comparison to the healthy tissues of the periapical area. Methods: The study analyzed texture components using the gray-level co-occurrence matrix (GLCM) and the gray-level run-length matrix (GRLM) on an orthopantomogram (OPG) from 50 patients with clinically confirmed periodontitis treated at the Department of Maxillofacial and Plastic Surgery, University of Bialystok. Texture analysis was performed on defined regions of interest (ROIs) to distinguish diseased from healthy tissues. We employed four classification algorithms to assess model performance. Results: The data set included 50 patients, with 76 cases of periodontitis and 50 healthy ROIs. The reference standard was clinical diagnosis confirmed by two specialist doctors. The best-performing algorithm achieved an AUC of 98%. Conclusions: The obtained results showed significant statistical differences in the inflamed regions compared to the control, which may aid in diagnosing and selecting the treatment method for periodontitis. Full article

Gingival recession is a common problem, particularly affecting oral health and esthetics, and its treatment involves surgical root coverage procedures. The aim of this narrative review is to evaluate the role of systemic antibiotic therapy in mucogingival surgery for recession treatment. The available literature does not support routine antibiotic use in systemically healthy patients undergoing recession coverage surgery. Indications for prophylactic antibiotics are restricted to individuals at high risk of infective endocarditis and immunocompromised patients with elevated susceptibility to surgical site infections. Although mucogingival surgeries are performed in a non-sterile environment, the risk of infection remains low when proper aseptic techniques and good preoperative tissue preparation are applied. The review emphasizes the importance of making clinical decisions that consider the patient’s health status and are aligned with current recommendations. It also emphasizes the necessity for prospective studies to evaluate antibiotics’ effect on recession coverage procedures outcome. To bridge the gap between contemporary evidence and clinical practice and to foster responsible use of antibiotics in periodontal plastic surgery, the authors of this review integrate current evidence and clinical guidelines into a practical tool designed to assist clinicians in making reasoned, evidence-based decisions. Full article

The mucosa height has always been of interest in modern implant dentistry to obtain biomimetic results. Papilla height, mucosa scalloping, and free mucosal margin level are crucial to achieve “pink aesthetics”. The aim of this study was to investigate the vertical increase in the peri-implant soft tissues with a porcine cross-linked collagen matrix (Geistlich Fibro-Gide^®). Methods: A total of 60 patients were divided into the following three groups: Group 1—patients who received porcine cross-linked collagen matrix for vertical soft tissue augmentation and a cover screw combined with a coronally advanced flap (CAF); Group 2—patients who received the collagen matrix combined with a healing abutment and CAF; Group 3 (control group)—patients who received a traditional surgical approach based on crestal incision and no collagen matrix as well as no CAF. Results: The average horizontal tissue thickness growth after 3 months was more effective for Group 1 (1.35 ± 1.23 mm) compared to Group 2 (0.85 ± 0.67 mm) and the control group (0.20 ± 0.41 mm). The average tissue height growth was 1.05 ± 1.39 mm for Group 1, 0.32 ± 1.28 mm for Group 2, and −0.05 ± 0.39 mm for the control group. Finally, the average increase in the band of keratinized mucosa was 0.60 ± 1.23 mm for Group 1, −0.60 ± 0.94 mm for Group 2, and 0.45 ± 0.60 mm for the control group. Conclusions: The combination of the CAF, porcine cross-linked collagen matrix, and cover screw resulted in better clinical results compared to Group 2 and 3. Full article

This study aims to evaluate the influence of the additional use of enamel matrix derivate (EMD) in the treatment of gingival recession defects using a coronally advanced flap (CAF) and a xenogeneic dermal matrix (XDM) by means of digital and clinical assessment methods. In this prospective randomized controlled study, recession height and area, width and thickness of keratinized gingiva, pocket probing depth, and clinical attachment levels were measured at the baseline and followed up for one year. Fifteen patients (n = 15) with 24 gingival recession defects were treated between 2019 and 2021. On average, the digitally assessed root coverage of the control group (CAF + XDM) was not significantly different compared to the test group (CAF + XDM + EMD), with 69 ± 28% and 36 ± 32%, respectively (p = 0.094). One year postoperatively, there were no differences found regarding keratinized tissue width (KTW) between the control group and test group (p = 0.690). However, the control group showed superior results in the thickness of keratinized gingiva (p = 0.044). The present study showed that there were no statistically significant differences in the root coverage results in the CAF + XDM + EMD group compared to the CAF + XDM group. The adjunctive use of EMD to a CAF and XDM in the treatment of gingival recession defects does not appear to have any clinical benefit. Full article

The use of free gingival graft (FGG) and connective tissue graft (CTG) from the palate are among the most predictable periodontal and peri-implant plastic surgery procedures. However, palatal harvesting causes severe discomfort in the palatal area in patients undergoing harvesting. The aim of this umbrella review is to evaluate which products or techniques can result in fewer side effects and less morbidity in patients. Systematic reviews, with meta-analysis or not, about postoperative pain and wound healing in patients undergoing surgery to remove a free gingival graft or connective tissue graft from the palatal region, published only in the English language, were electronically searched for on BioMed Central, Scopus, MEDLINE/PubMed, the Cochrane library databases, and PROSPERO register. Of 1153 titles, only 7 articles were included in this review. The reviews included suggest that the more effective interventions for patient-reported outcomes, particularly for pain management, are cyanoacrylate adhesives, platelet-rich fibrin, hyaluronic acid, and the use of palatal stents. Low-level laser therapy also demonstrated good results in palatal wound healing speed after FGG procedures. Also, topical agents were also described. Future studies and more high-quality randomized clinical trials are needed to provide clear descriptions and standardized procedures of interventions to obtain clear results. Full article

The goal of plastic periodontal surgery is to obtain complete root coverage, increasing gingival thickness (GT), a positive prognostic factor for gingival margin stability over time. The aim of this study was to compare the effectiveness of the Coronally Advanced Flap (CAF) in RT1 (GR; gingival recession with no loss of interproximal attachment) when associated with a connective tissue graft from the maxillary tuberosity (tCTG) or with leukocyte and platelet-rich fibrin (L-PRF) membranes in obtaining root coverage and increasing the thickness and width of the keratinized tissue, along with aesthetic improvement, taking into account a number of patient-related outcomes. Thirty patients with two adjacent RT1 GRs (GRs with no loss of interproximal attachment) were each treated using CAF associated with tCTG (15 patients) or L-PRF. The main outcome was a GT increase; secondary outcomes were keratinized tissue width (KT), gingival recession (GR), probing depth (PD), clinical attachment level (CAL), root coverage percentage (RC%), complete root coverage (CRC), and root coverage esthetic score (RES). Patient-reported outcomes were discomfort (D), dentine hypersensitivity (DH), patient-related esthetic score (PRES), and overall treatment satisfaction (OTS). After 12 months, clinical and patient-reported parameters did not show significant differences between groups, with the only exception being a GT gain, which was significantly greater in the CAF + tCTG group. Our results showed that both techniques were effective in treating RT1 GRs, with comparable patient-related outcomes. However, the use of tCTG produces significantly thicker tissue, covering the exposed root surface. Full article

Background and Objectives: Dental implants are recognized as an effective treatment in the management of edentulous patients; controversies surround the connection between the sufficiency of keratinized gingiva (KG) and peri-implant health. Maintaining an ample amount of peri-implant KG is crucial for minimizing gingival inflammation, highlighting the need for regular consideration of soft-tissue augmentation. Among the diverse periodontal plastic surgical procedures, the apically positioned flap (APF) is notable for its ability to enhance the width of keratinized tissue while minimizing patient morbidity. The aim of this study was to evaluate the effects of L-PRF on palatal wound healing and patient discomfort after surgery. Materials and Methods: Twenty patients with two adjacent submerged fixtures in the maxilla and buccal keratinized gingiva widths < 2 mm were treated with APF and L-PRF. Clinical evaluations were performed at 1, 2, 3, and 4 weeks post-surgery, focusing on parameters such as complete wound epithelialization (CWE), postoperative discomfort (D), changes in feeding habits (CFH), alteration of sensitivity (AS) around the wound area, and the consumption of analgesics. Results: Our data revealed CWE in 5 patients by the end of the second week, with the remaining 15 achieving CWE by the end of the third week. For D and CHF, a statistically significant improvement was recorded for all cases between the first and second weeks, as well as AS, although less substantial, by the third week. No significant changes were noted for AS over the initial two weeks. Conclusions: These findings suggest that L-PRF may enhance wound healing and decrease patient discomfort following APF for fixture uncovering. Full article

The aesthetic constancy and functional stability of periodontium largely depend on the presence of healthy mucogingival tissue. Soft tissue management is crucial to the success of periodontal surgery. Recently, synthetic substitute materials have been proposed to be used for soft tissue augmentation, but the tissue compatibility of these materials needs to be further investigated. This study aims to assess the in vitro responses of human gingival mesenchymal stromal cells (hG-MSCs) cultured on a Gelatin/Polycaprolactone prototype (GPP) and volume-stable collagen matrix (VSCM). hG-MSCs were cultured onto the GPP, VSCM, or plastic for 3, 7, and 14 days. The proliferation and/or viability were measured by cell counting kit-8 assay and resazurin-based toxicity assay. Cell morphology and adhesion were evaluated by microscopy. The gene expression of collagen type I, alpha1 (COL1A1), α-smooth muscle actin (α-SMA), fibroblast growth factor (FGF-2), vascular endothelial growth factor A (VEGF-A), transforming growth factor beta-1 (TGF-β1), focal adhesion kinase (FAK), integrin beta-1 (ITG-β1), and interleukin 8 (IL-8) was investigated by RT-qPCR. The levels of VEGF-A, TGF-β1, and IL-8 proteins in conditioned media were tested by ELISA. GPP improved both cell proliferation and viability compared to VSCM. The cells grown on GPP exhibited a distinct morphology and attachment performance. COL1A1, α-SMA, VEGF-A, FGF-2, and FAK were positively modulated in hG-MSCs on GPP at different investigation times. GPP increased the gene expression of TGF-β1 but had no effect on protein production. The level of ITG-β1 had no significant changes in cells seeded on GPP at 7 days. At 3 days, notable differences in VEGF-A, TGF-β1, and α-SMA expression levels were observed between cells seeded on GPP and those on VSCM. Meanwhile, GPP showed higher COL1A1 expression compared to VSCM after 14 days, whereas VSCM demonstrated a more significant upregulation in the production of IL-8. Taken together, our data suggest that GPP electrospun nanofibers have great potential as substitutes for soft tissue regeneration in successful periodontal surgery. Full article

An esthetically pleasing smile is a valuable aspect of physical appearance and plays a significant role in social interaction. Achieving the perfect balance between extraoral and intraoral tissues is essential for a harmonious and attractive smile. However, certain intraoral deficiencies, such as non-carious cervical lesions and gingival recession, can severely compromise the overall aesthetics, particularly in the anterior zone. Addressing such conditions requires careful planning and meticulous execution of both surgical and restorative procedures. This interdisciplinary clinical report presents a complex case of a patient with esthetic complaints related to asymmetric anterior gingival architecture and severely discolored and eroded maxillary anterior teeth. The patient was treated using a combination of minimally invasive ceramic veneers and plastic mucogingival surgery, resulting in a successful outcome. The report emphasizes the potential of this approach in achieving optimal esthetic results in challenging cases, highlighting the importance of an interdisciplinary team approach in achieving a harmonious balance between dental and soft tissue aesthetics. Full article

Background and Objectives: The report describes a technique using a diagnostic mock-up as a crown-lengthening surgical guide to improve the gingival architecture. Materials and Methods: The patient’s primary concern was improving her smile due to her “gummy smile” and short clinical crowns. After clinical evaluation, surgical crown lengthening accompanied by maxillary central full-coverage single-unit prostheses and lateral incisor veneers was recommended. The diagnostic mock-up was placed in the patient’s maxillary anterior region and used as a soft tissue reduction guide for the gingivectomy. Once the planned gingival architecture was achieved, a flap was reflected to proceed with ostectomy in order to obtain an appropriate alveolar bone crest level using the overlay. After six months, all-ceramic crowns and porcelain veneers were provided as permanent restorations. Results: A diagnostic mock-up fabricated with a putty guide directly from the diagnostic wax-up can be an adequate surgical guide for crown-lengthening procedures. The diagnostic wax-up was used to fabricate the diagnostic mock-up. These results suggested that it can be used as a crown-lengthening surgical guide to modify the gingival architecture. Several advantages of the overlay used in the aesthetic complex case include: (1) providing a preview of potential restorative outcomes, (2) allowing for the appropriate positioning of gingival margins and the desired alveolar bone crest level for the crown-lengthening procedure, and (3) serving as a provisional restoration after surgery. Conclusions: The use of a diagnostic mock-up, which was based on a diagnostic wax-up, as the surgical guide resulted in successful crown lengthening and provisional restorations. Thus, a diagnostic overlay can be a viable option as a surgical guide for crown lengthening. Full article