This manuscript aims to review periodontal plastic surgery for root coverage at single and multiple gingival recessions. Techniques are assessed based on biological principles, surgical procedures, ...prognosticative factors and expected clinical and esthetic outcomes. The use of coronally advanced flap, laterally sliding flap, free gingival graft, the tunnel grafting technique, barrier membranes, enamel matrix derivative, collagen matrix and acellular dermal matrix are evaluated. The clinical scenario and practical implications are analyzed according to a modern evidence‐based approach.
Background
The aim of this Systematic Review (SR) was to assess the clinical efficacy of periodontal plastic surgery procedures in the treatment of localized gingival recessions (Rec) with or without ...inter‐dental clinical attachment loss (iCAL).
Material and Methods
Electronic and hand searches were performed to identify randomized clinical trials (RCTs) on treatment of single gingival recessions with at least 6 months of follow‐up. Primary outcome variable was complete root coverage (CRC). Secondary outcome variables were recession reduction (RecRed) and keratinized tissue (KT) gain. To evaluate treatment effect, Odds Ratios were combined for dichotomous data and mean differences in continuous data using a random‐effect model.
Results
Fifty‐one RCTs (53 articles) with a total of 1574 treated patients (1744 recessions) were included in this SR. Finally, 30 groups of comparisons were identified and a total of 80 meta‐analyses were performed. Coronally Advanced Flap (CAF) was associated with higher probability of CRC and higher amount of RecRed than Semilunar Coronal Positioned Flap (SCPF). The combination CAF plus Connective Tissue Graft (CAF+CTG) or CAF plus Enamel Matrix Derivative (CAF+EMD) was more effective than CAF alone in terms of CRC and RecRed. The combination CAF plus Collagen Matrix (CAF+CM) achieved higher RecRed than CAF alone. In addition, CAF+CTG achieved CRC more frequently than CAF+EMD, SCPF, Free Gingival Graft (FGG) and Laterally Positioned Flap (LPS). CAF+CTG was also associated with higher RecRed than Barrier Membranes (CAF+GTR), CAF+EMD and CAF+CM. GTR was not able to improve the clinical efficacy of CAF. Studies adding Acellular Dermal Matrix (ADM) under CAF showed a large heterogeneity and not significant benefits compared with CAF alone. Multiple combinations, using more than a single graft/biomaterial under the flap, usually provide similar or less benefits than simpler, control procedures in term of root coverage outcomes.
Conclusions
CAF procedures alone or with CTG, EMD are supported by large evidence in modern periodontal plastic surgery. CAF+CTG achieved the best clinical outcomes in single gingival recessions with or without iCAL.
Background
The aim of this systematic review was to compare clinical, radiographic and patient‐reported outcomes (PROMs) in intra‐bony defects treated with regenerative surgery or access flap.
...Materials and Methods
A systematic review protocol was written following the PRISMA checklist. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) on regenerative treatment of deep intra‐bony defects (≥3 mm) with a follow‐up of at least 12 months. Primary outcome variables were probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain and tooth loss. Secondary outcome variables were Rec, radiographic bone gain, pocket “closure,” PROMs and adverse events. Meta‐analysis was carried out when possible. To evaluate treatment effect, odds ratios were combined for dichotomous data and mean differences for continuous data using a random‐effect model.
Results
A total of 79 RCTs (88 articles) published from 1990 to 2019 and accounting for 3,042 patients and 3,612 intra‐bony defects were included in this systematic review. Only 10 of included studies were rated at low risk of bias. A total of 13 meta‐analyses were performed. All regenerative procedures provided adjunctive benefit in terms of CAL gain (1.34 mm; 0.95–1.73) compared with open flap debridement alone. Both enamel matrix derivative (EMD) and guided tissue regeneration (GTR) were superior to OFD alone in improving CAL (1.27 mm; 0.79–1.74 mm and 1.43 mm; 0.76–2.22, respectively), although with moderate–high heterogeneity. Among biomaterials, the addition of deproteinized bovine bone mineral (DBBM) improved the clinical outcomes of both GTR with resorbable barriers and EMD. Papillary preservation flaps enhanced the clinical outcomes. The strength of evidence was low to moderate.
Conclusion
EMD or GTR in combination with papillary preservation flaps should be considered the treatment of choice for residual pockets with deep (≥3 mm) intra‐bony defects.
Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability ...study. J Clin Periodontol 2011; doi: 10.1111/j.1600‐051X.2011.01732.x.
Background: The aims of this study were (i) to test the reliability of a new classification system of gingival recessions using the level of interproximal clinical attachment as an identification criterion and (ii) to explore the predictive value of the resulting classification system on the final root coverage outcomes.
Material and methods: Patients showing at least one buccal gingival recession were recruited by one operator. Three recession types (RT) were identified. While class RT1 included gingival recession with no loss of interproximal attachment, class RT2 recession was associated with interproximal attachment loss less than or equal to the buccal site and class RT3 showed higher interproximal attachment loss than the buccal site. The classification was tested by two examiners blinded to the data collected by the other examiner. Intra‐rater and inter‐rater agreement was assessed. Furthermore, the 6‐month root coverage outcomes of consecutively treated gingival recessions were retrospectively evaluated in order to explore the predictive value of the proposed classification on the final recession reduction (Rec Red).
Results: The new classification system of gingival recessions was tested in a total of 116 gingival recessions (mean 3.2±1.2 mm) in 25 patients. The intra‐class correlation coefficient (ICC) for inter‐rater agreement was 0.86, showing an almost perfect agreement between the examiners. The RT classification was predictive of the final Rec Red (p<0.0001) at the 6‐month follow‐up in 109 treated gingival recessions.
Conclusions: The evaluation of interproximal clinical attachment level may be used to classify gingival recession defects and to predict the final root coverage outcomes.
Objectives
Aims of this SR were to assess the association of Periodontitis (PD) with Chronic Kidney Disease (CKD) and with different CKD stages.
Materials and methods
MEDLINE, Cochrane Central ...Register of Trials and EMBASE, up to April 4, 2021 were searched. RCTs, prospective and retrospective cohort studies, case–control studies and cross‐sectional studies were considered. JBI’s Critical Appraisal Tool for risk of bias assessment was used. The risk of PD was calculated using the Mantel–Haenszel odds ratios (MH‐OR); weighted mean difference for clinical attachment level (CAL) and periodontal probing depth (PPD) were also evaluated.
Results
Out of 1949 titles screened, 142 full texts were evaluated and 17 studies were included. CKD was associated to higher risk of PD (MH‐OR = 2.36, 95% C.I. 1.25, 4.44; p = 0.008), higher mean CAL (WMD = 0.41 mm 95% C.I. 0.22, 0.60; p < 0.0001) and mean PPD (WMD = 0.25 mm 95% C.I. 0.03, 0.47; p = 0.02) compared to healthy individuals. Severe CKD (stages 4–5 vs 2–3) resulted at higher risk of PD (MH‐OR = 2.21, 95% C.I. 1.07, 4.54; p = 0.03). Heterogeneity and risk of bias were high.
Conclusions
An association between PD and CKD was found. It could be appropriate to consider PD a frequent CKD comorbidity.
Aerosol–cloud interactions play a crucial role in shaping Earth’s climate and hydrological cycle. Observing these interactions with high precision and accuracy is of the utmost importance for ...improving climate models and predicting Earth’s climate. Over the past few decades, lidar techniques have emerged as powerful tools for investigating aerosol–cloud interactions due to their ability to provide detailed vertical profiles of aerosol particles and clouds with high spatial and temporal resolutions. This review paper provides an overview of recent advancements in the study of ACI using lidar techniques. The paper begins with a description of the different cloud microphysical processes that are affected by the presence of aerosol, and with an outline of lidar remote sensing application in characterizing aerosol particles and clouds. The subsequent sections delve into the key findings and insights gained from lidar-based studies of aerosol–cloud interactions. This includes investigations into the role of aerosol particles in cloud formation, evolution, and microphysical properties. Finally, the review concludes with an outlook on future research. By reporting the latest findings and methodologies, this review aims to provide valuable insights for researchers engaged in climate science and atmospheric research.
Polar stratospheric clouds (PSCs) form in polar regions, typically between 15 and 25 km above mean sea level, when the local temperature is sufficiently low. PSCs play an important role in the ozone ...chemistry and the dehydration and denitrification of the stratosphere. Lidars with a depolarization channel may be used to detect and classify different classes of PSCs. The main PSC classes are water ice, nitric acid trihydrate (NAT), and supercooled ternary solutions (STSs), the latter being liquid droplets consisting of water, nitric acid, and sulfuric acid. PSCs have been observed at the lidar observatory at Concordia Station from 2014 onward. The harsh environmental conditions at Concordia during winter render successful lidar operation difficult. To facilitate the operation of the observatory, several measures have been put in place to achieve an almost complete remote control of the system. PSC occurrence is strongly correlated with local temperatures and is affected by dynamics, as the PSC coverage during the observation season shows. PSC observations in 2021 are shown as an example of the capability and functionality of the lidar observatory. A comparison of the observations with the satellite-borne CALIOP (Cloud-Aerosol Lidar with Orthogonal Polarization) lidar has been made to demonstrate the quality of the data and their representativeness for the Antarctic Plateau.
Aim
To evaluate the non‐inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent ...recessions and compare superiority in patient‐reported outcomes (PROM).
Material and methods
One hundred and eighty‐seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient‐reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates.
Results
Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six‐month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non‐inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8–8.8).
Conclusion
Replacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.
Aim
The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system.
Methods
Thirty participants (10 periodontal experts, 10 ...general dentists and 10 undergraduate students) and a gold‐standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy.
Results
Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pairwise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy.
Conclusions
Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.
Generally, esthetic outcomes following root-coverage procedures are not assessed. This article proposes a score for evaluating the esthetic outcome following root-coverage surgery.
Thirty-one ...patients with Miller Class I and II recession defects treated with root-coverage procedures were evaluated. Esthetic outcomes were assessed using the root coverage esthetic score (RES) 6 months after surgery. This score evaluates five variables: level of the gingival margin, marginal tissue contour, soft tissue texture, mucogingival junction alignment, and gingival color. Because complete root coverage was the primary treatment goal, and the other variables were considered secondary, the value assigned for root coverage was 60% of the total score, whereas 40% was assigned to the other four variables. With regard to assessment of the final position of the gingival margin, 3 points were given for partial root coverage, and 6 points were given for complete root coverage; 0 points were assigned when the final position of the gingival margin was equal or apical to the previous recession. One point was assigned for each of the other four variables. Thus, 10 points was a perfect score.
Of the 31 treated recession defects, 24 (77%) exhibited complete root coverage at 6 months. The mean amount of root coverage was 89.4% (range, 0% to 100%). The mean RES was 7.8. Five of 24 cases of complete root coverage achieved a perfect score (RES = 10). In one case, RES = 0.
The RES system may be a useful tool to assess the esthetic outcome following root-coverage procedures.
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