This paper aims to create a "bridge" between research and practice by developing a practical, extensive, and clinically relevant study that translates evidence-based findings on soft tissue root ...coverage (RC) of recession-type defects to daily clinical practice.
This review is prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused questions. A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE and EMBASE databases up to and including June 2013. Systematic reviews (SRs), randomized clinical trials, controlled clinical trials, case series, and case reports evaluating recession areas that were treated by means of RC procedures were considered eligible for inclusion through the three parts of the study (part I, an overview of the base of SRs; part II, an alternative random-effects meta-analyses on mean percentage of RC and sites exhibiting complete RC; and part III, an SR of non-randomized trials exploring other conditions not extensively evaluated by previous SRs). Data on Class I, II, III, and IV recessions, type of histologic attachment achieved with treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions, tooth type and location, long-term effectiveness outcomes, unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes were assessed as well.
Of the 2,456 potentially eligible trials, 234 were included. Data on Class I, II, III, and IV gingival recessions, histologic attachment achieved after treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions/biomodification, tooth type and location, long-term effectiveness outcomes and unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes (i.e., esthetic, visual analog scale, complications, hypersensitivity, patients perceptions) were assessed. Subepithelial connective tissue (CT)-based procedures and coronally advanced flap plus acellular dermal matrix grafts, enamel matrix derivative, or collagen matrix led to the best improvements of recession depth, clinical attachment level (CAL) gain, and keratinized tissue (KT). Some conditions, such as smoking and use of magnification, may affect RC outcomes.
All RC procedures can provide significant reduction in recession depth and CAL gain for Miller Class I and II recession-type defects. Subepithelial CT graft-based procedures provided the best outcomes for clinical practice because of their superior percentages of mean and complete RC, as well as significant increase of KT.
This review aims to: 1) assess the long-term outcomes of untreated buccal gingival recession (GR) defects and the associated reported esthetic and functional alterations; and 2) evaluate which ...factors influence the progression/worsening of dental and periodontal tissue conditions of untreated GR defects.
Interventional and observational studies with duration of ≥24 months reporting outcomes from adult patients with localized or multiple GR defects not treated by root coverage or gingival augmentation procedures were considered eligible for inclusion. MEDLINE and EMBASE databases were searched for articles published through July 2015. Random-effects meta-analyses were performed comparing baseline versus most recent follow-up outcomes (i.e., number of patients with ≥1 GR and number of sites with GR).
Of 378 potentially eligible articles, eight (reporting six studies) met inclusion criteria. Of 1,647 GR defects with baseline and follow-up information, 78.1% experienced GR depth increase during the follow-up period, whereas the remaining experienced decrease or no change. Moreover, there was a 79.3% increase in the number of GR defects among the patients followed (i.e., new GR defects). Pooled estimates (data from four studies) showed significantly increased odds of recession development long term, regarding either number of patients (odds ratio 2.43; P = 0.03) or number of sites with GR (odds ratio 2.16; P = 0.0005).
Untreated recession defects in individuals with good oral hygiene have a high probability of progressing during long-term follow-up.
Objective
Clinical gingival inflammation is a well‐defined site‐specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently ...indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a “gingivitis site”) is completely different from defining and grading a “gingivitis case” (GC) (i.e. a patient affected by gingivitis), and that a “gingivitis site” does not necessarily mean a “GC”. The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque‐induced gingivitis and to propose a set of criteria to define GC.
Importance
A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance.
Findings
Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%)
Conclusions
A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.
Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. ...Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non‐periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored.
Two broad categories of gingival diseases include non‐dental plaque biofilm–induced gingival diseases and dental plaque‐induced gingivitis. Non‐dental plaque biofilm‐induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque‐induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque‐induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non‐periodontitis patient or in a currently stable “periodontitis patient” i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis.
Precision dental medicine defines a patient‐centered approach to care, and therefore, creates differences in the way in which a “case” of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.
Oral rehabilitation through implant supported dental restorations often requires a ridge augmentation procedure (RAP) prior to implant fixture placement since tooth extraction/loss results in ...alveolar ridge deficiencies. Although RAP‐related surgical techniques and biomaterials have been in practice for several decades, outcomes are not always predictable. Post‐surgical complications experienced during the early or late wound healing phases may jeopardize the targeted ideal ridge dimensions, required for implant fixture placement, and may have other consequences, such as negatively impacting the patient's quality of life. This review describes reported post‐surgical complications following RAP under the following subtitles: complications by tissue type, complications in function and aesthetics, complications by healing time, complications by biomaterial type, and complications by surgical protocol modalities. Specifically, RAP performed by using particulate bone graft substitutes and related complications are explored. Modalities developed to prevent/manage these complications are also discussed.
A common etiology of excessive gingival display is hypermobile upper lip, which can be managed by non-surgical and surgical approaches. Among the surgical options, lip repositioning surgery is a ...relatively simple procedure with minimal complications. Since the original description of the technique almost 50 years ago, several minor and major modifications have been introduced. The available evidence indicates that, when applied to properly diagnosed cases, the technique is effective in reducing gingival display and results in improved smile esthetics and high patient satisfaction. This article reviews the various techniques and modifications and summarizes the reported outcomes of the procedure.
Background
Pre‐restorative crown lengthening surgery (CLS) is a common periodontal procedure, for which systematic reviews are lacking. This systematic review aimed to assess outcomes of CLS ...performed for restorative reasons.
Methods
Databases (MEDLINE, Scopus, OpenGrey) were searched up to January 2016 for clinical/animal trials on CLS for restorative reasons with ≥6‐month follow‐up. Primary outcomes investigated were: free gingival margin position, probing depth, clinical attachment level, and plaque/inflammation indices.
Results
Four non‐randomized and one randomized controlled clinical trial and one controlled animal trial were included. Heterogeneity and high risk of bias were identified. CLS resulted in increased crown length (6‐month average: 1.4–3.3 mm). Between immediate postsurgery and follow‐up, gingival margin may rebound, largely during the first three postoperative months. Technical (flap positioning, osseous resection, root preparation) and anatomical (periodontal biotype) factors influence outcomes. The literature lacks studies on tooth mobility, crown–root ratio, patient‐ and referring dentist‐reported outcomes, surgical technique comparisons, and restorative treatment timing.
Conclusions
Within the available data limitations, it is concluded that CLS results in increased crown length and possible gingival margin rebound. Technical aspects (primarily) and anatomical factors (secondarily) influence outcomes. Future research is needed to fill significant voids in our knowledge on several procedural aspects.
Human gingiva transcriptome during wound healing Wang, Yun; Tatakis, Dimitris N.
Journal of clinical periodontology,
April 2017, 2017-Apr, 2017-04-00, 20170401, Volume:
44, Issue:
4
Journal Article
Peer reviewed
Objectives
To investigate the gene expression profile of human gingiva following surgical wounding.
Methods
Ten volunteers had one side of the palate wounded. Five days later, biopsies were harvested ...from both wounded (healing gingiva) and contra‐lateral site (normal gingiva). Tissue samples were processed for gene expression (RNA‐Seq, real‐time PCR) and immunohistochemistry. Gene set enrichment/pathway analysis was also performed.
Results
Seven hundred genes were significantly differentially expressed in healing gingiva. Among genes with >twofold change (FC) in expression, 399 genes were up‐regulated and 88 down‐regulated, several not previously reported expressed in gingiva. Most increased in expression (≥30‐FC) were MMP1, CCL18, SPP1, MUC21, CTHRC1, MMP10, and SERPINE1; most decreased (≥7‐FC) were COCH, SIAH3, MT4, IGFL3, KY, and SYT16. Real‐time PCR confirmed significantly changed mRNA levels for selective genes tested. Gene set enrichment analysis revealed several significantly enriched biological pathways. Immunohistochemistry confirmed protein expression of MUC21, CTHRC1, CTGF, and SYT16 in normal and healing gingiva.
Conclusions
This first comprehensive analysis of the human gingival transcriptome during surgical wound healing offers novel insights into the participating molecular and biological mechanisms. The present results could serve as basis for future investigations into gingival wound healing following surgical, traumatic, or other type of injury.
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