Effect of Root Surface Biomodification on Multiple Recession Coverage with Modified Coronally Advanced Tunnel Technique and Subepithelial Connective Tissue Graft: A Retrospective Analysis

To improve treatment efficacy of gingival recessions (GR), chemical preparation of the exposed root surface was advocated. The aim of this study was to compare the additional influence of root biomodifications with 24% ethylenediaminetetraacetic acid (EDTA) alone or with enamel matrix derivative (EMD) on the 12 month outcomes of modified coronally advanced tunnel (MCAT) with subepithelial connective tissue graft in the treatment of multiple GR. Average root coverage (ARC), complete root coverage (CRC), reduction in GR, reduction in recession width (RW), gain in clinical attachment level (CAL), increase in gingival thickness (GT), increase in keratinized tissue width (KTW) and changes in root coverage esthetic score (RES) were evaluated. A total of 60 patients with 215 GR were enrolled. In 70, GR root surfaces were treated with EDTA + EMD, in other 72, with EDTA, while in the remaining 73 saline solution was applied. ARC was 94%, 89%, and 91% in the EDTA + EMD, the EDTA and the saline groups, respectively (p = 0.8871). Gains in clinical attachment level (CAL; 2.1 ± 1.1 mm) and RES values (9.6 ± 0.9) were significantly higher in the EDTA + EMD group, when compared with two other groups. The differences between other preoperative and postoperative parameters showed statistical significance only within but not between groups. MCAT outcomes may benefit from adjunctive use of EDTA + EMD regarding 12 month CAL gain and professionally assessed esthetics using RES following treatment of GR.

Clinical and Biochemical Assessment of Lycopene Gel Combined With Nanohydroxyapatite Graft in Treatment of Grade II Furcation Defects: A Randomized Controlled Clinical Study

Background: This study aimed to evaluate the effects of lycopene gel, as a natural antioxidant, mixed with a nanohydroxyapatite graft (NHG) covered by an occlusive resorbable collagen membrane (CM) in the surgical treatment of grade II furcation defects and on the gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG), as a marker of oxidative injury. Methods: In this randomized controlled clinical study a total of 24 patients with grade II furcation defects were randomly assigned into three equal groups. Furcation defects in group I were managed with lycopene gel mixed with NHG and CM, group II with NHG and CM, and group III with open flap debridement only. Site-specific changes in clinical parameters including probing depth (PD), vertical clinical attachment level (VCAL), horizontal clinical attachment level (HCAL), radiographic maximum vertical depth (MAX V), and maximum horizontal depth (MAX H) were measured at baseline and six months postoperatively. Gingival crevicular fluid levels of 8-OHdG were analyzed using enzyme-linked immunosorbent assay (ELISA) at baseline, one week, and three months. Results: Surgical management of grade II furcation defects resulted in a significant reduction in PD and 8-OHdG levels and a gain in CAL, MAX V, and MAX H in all groups. The differences between lycopene treated sites compared to NHG and CM alone were not significant at six months but demonstrated significantly superior clinical parameters compared to open flap debridement alone. Conclusion: Lycopene does not confer a benefit when combined with NHG in the surgical treatment of grade II furcation defects.

Parodontális vertikális csontdefektusok gyógyulásának hosszú távú kiértékelése PRG- vagy EMD-vel történt kezelést követően

A retrospektív esetsorozat célja intraosszeális csontdefektusok gyógyulásának hosszú távú klinikai értékelése autológ vérlemezkében gazdag készítménnyel (Platelet-Rich Gel, PRG) vagy zománc-mátrix derivátummal (Enamel Matrix Derivatives, EMD) történt kezelést követően.A vizsgálatban 24 intraosszeális defektussal rendelkező, nem dohányzó, krónikus parodontitisben szenvedő páciens vett részt. A négy bemutatott eset ezen kontrollált klinikai vizsgálat résztvevője, akiknél 1, 3, illetve 7 évvel a műtétet követően történt kiértékelés a következő paraméterek rögzítésével: szondázási mélység (PD – probing depth), illetve klinikai tapadási szint (CAL – clinical attachment level). Teljes vastagságú lebenyek képzését követően a defektus kürettálása, illetve gyökérsimítás történt. Vérlemezkében gazdag plazma (PRP) preparálása után, Ca-glükonát és friss vénás vér hozzáadásával vérlemezkében gazdag plazma gél (PRG) készült. A parodontális vertikális defektusok ellátását PRG(n = 2) vagy EMD (n = 2) applikációját követően sebzárás követte.Egy évvel a műtét után mindkét kezelési módszer szignifikáns szondázási mélység (PD) csökkenést és klinikai tapadási nívó (CAL) növekedést eredményezett, és ezek az eredmények 3, illetve 7 év után is kedvezőek maradtak. Bemutatott eseteinknél, úgy a PRG-, mint az EMD-kezelés megbízható hosszú távú klinikai eredményeket mutatott.

A Generative Adversarial Inpainting Network to Enhance Prediction of Periodontal Clinical Attachment Level

Deep learning algorithms has recently been used to determine clinical attachment levels (CAL) which aid in the diagnosis of periodontal disease. However, the limited field-of-view of dental bitewing x-rays poses a challenge for convolutional neural networks (CNN) because out-of-view anatomy cannot be directly considered. This study presents an inpainting algorithm using generative adversarial networks (GANs) coupled with partial convolutions to predict out-of-view anatomy to enhance CAL prediction accuracy. 80,326 images were used for training, 12,901 images were used for validation and 10,687 images were used to compare non-inpainted methods to inpainted methods for CAL predictions. Statistical analyses were conducted using mean bias error (MBE), mean absolute error (MAE) and Dunn’s pairwise test comparing CAL at p=0.05. Comparator p-values demonstrated statistically significant improvement in CAL prediction accuracy between corresponding inpainted and non-inpainted methods with a MAE of 1.04mm and 1.50mm respectively. The Dunn’s pairwise test indicated a statistically significant improvement in CAL prediction accuracy between both inpainted methods compared to their non-inpainted counterparts, with the best performing methods achieving a Dunn’s pairwise value of -63.89. This study demonstrates the superiority of using a generative adversarial inpainting network with partial convolutions to predict CAL from bitewing images.

Long-Term Assessment of Periodontal Tissues after Corticotomy-Assisted Orthodontic Arch Expansion

Objectives: The aim of the study was the long-term assessment of the condition of periodontal tissues after corticotomy-assisted orthodontic expansion in patients with transverse maxillary deficiency. Materials and Methods: The study included a group of 18 adults (9 women, 9 men) aged between 24 and 40 years who were at least 5 years post treatment. The following parameters were assessed: the full mouth plaque index (FMPI), full mouth bleeding on probing (FMBOP), probing depth (PD), clinical attachment level (CAL), gingival recession height (GR), recession width (RW), papilla height (PH), papilla width (PW), bone sounding (BS), phenotype, and KT. Results: During examination performed at least 5 years after the completion of orthodontic treatment, the values of PD and CAL were found to be considerably decreased compared to the examination one year post treatment (PD: −0.23; 95% Cl: −0.29, −0.16) (CAL: −0.04; 95% Cl: −0.17, 0.10). The other parameters—FMPI, FMBOP, GR, RW, PH, PW, BS, phenotype, and KT—did not change significantly. Conclusions: Corticotomy-assisted orthodontic arch expansion does not have a negative effect on the periodontium in long-term observations. Clinical Relevance: Orthodontic arch expansion can lead to bone dehiscence and gingival recession. Long-term observations revealed that corticotomy-assisted orthodontic expansion of the upper arch is not followed by negative changes in periodontal status.

Treatment of Intrabony Defects with a Combination of Hyaluronic Acid and Deproteinized Porcine Bone Mineral

Background: this study evaluates the clinical outcomes of a novel approach in treating deep intrabony defects utilizing papilla preservation techniques with a combination of hyaluronic acid (HA) and deproteinized porcine bone mineral. Methods: 23 patients with 27 intrabony defects were treated with a combination of HA and deproteinized porcine bone mineral. Clinical attachment level (CAL), pocket probing depth (PPD), gingival recession (REC) were recorded at baseline and 6 months after the surgery. Results: At 6 months, there was a significant CAL gain of 3.65 ± 1.67 mm (p < 0.001) with a PPD reduction of 4.54 ± 1.65 mm (p < 0.001), which was associated with an increase in gingival recession (0.89 ± 0.59 mm, p < 0.001). The percentage of pocket resolution based on a PPD ≤4 mm was 92.6% and the failure rate based on a PPD of 5 mm was 7.4%. Conclusions: the present findings indicate that applying a combined HA and xenograft approach in deep intrabony defects provides clinically relevant CAL gains and PPD reductions compared to baseline values and is a valid new approach in treating intrabony defects.

High-resolution ultrasonography of gingival biomarkers for periodontal diagnosis in healthy and diseased subjects

Periodontal disease affects nearly 50% of Americans but diagnostic methods have remained the same for decades. Periodontal examination via physical probing provides critical metrics such as pocket depth, clinical attachment level, and gingival recession; however, this practice is time consuming, variable, and often painful. In this study, we investigated high-frequency ultrasound (40 MHz) for the image-based measurement of periodontal metrics. Imaging was performed at midbuccal sites for a set of periodontally healthy (n = 10) and diseased (n = 6) subjects and image-based measurements were compared to gold-standard physical probing measurements. Human operators identified relevant markers (e.g., cementoenamel junction, gingival margin, alveolar bone crest) in B-mode ultrasound images from 66 teeth to calculate gingival height and alveolar bone level. These metrics were correlated to clinical measurements of probing pocket depth and clinical attachment level for disease staging (1.57-mm bias and 0.25-mm bias, respectively). Interoperator bias was negligible (<0.1 mm) for gingival height measurements and 0.45 mm for alveolar bone level measurements. The ultrasonographic measurements of gingival height and alveolar bone level served as effective diagnostic surrogates for clinical probing measurements while offering more detailed anatomical information and painless operation.

Management of an endo-perio lesion: A multidisciplinary approach

The presence of pulpal pathosis and inflammatory periodontal disease concomitantly can complicate diagnosis and treatment planning of any tooth. It requires a combined treatment approach involving endodontic, periodontic and prosthodontic intervention. Often, the periodontal and prosthodontic aspects are neglected by the clinicians after successful endodontic treatment resulting in failure. The present case report describes a multidisciplinary approach for the treatment of a tooth that presented with an endo-perio lesion; using non-surgical root canal treatment and periodontal regenerative surgery (non-incised papillae surgical approach, {NIPSA} long with GTR membrane and an alloplastic bone graft) which were then followed by the placement of a conservative tooth coverage restoration (endocrown). A significant gain in clinical attachment level was seen 6 months postoperatively. Radiographically also a significant amount of bone fill was observed.

Can Fixed Space Maintainers Have Adverse Effect on the Teeth and Periodontium?

BACKGROUND Space maintenance after premature loss of primary teeth is of importance in preventing space loss and potential crowding in future. Fixed space maintainers are used to prevent space loss but the presence of such fixed appliances near the tooth and its supporting structures may have some adverse effects. The purpose of this study was to evaluate the potential adverse effects of fixed space maintainers on the teeth and periodontium. METHODS Twenty young children in mixed dentition period (between 8 – 11y 7m years old) who were considered for space maintainer treatment were selected. Each patient had bilateral first molars that went under the band for fixed space maintainer. The patients were examined for decayed, missed and filled teeth (DMFT), bleeding on probing, clinical attachment level, gingival index and periodontal pocket depth at the beginning (T0), one month (T1), three months (T2) and six months (T3) later. Repeated measures ANOVA then Post - hoc LSD (Friedman test for gingival index) tests were used to interpret the data. RESULTS As compared to the beginning of the study, at the end of the 6 months follow-up period DMFT of the involved first molars did not change significantly (P = 0.163). But bleeding on probing, clinical attachment level, gingival index and periodontal pocket depths changed significantly at the same time frame (P < 0.001). CONCLUSIONS The fixed space maintainers might have some adverse effects on the periodontal structures of the banded teeth, so the clinicians should insist more on oral hygiene instructions and the patients must be under intense oral hygiene control. KEY WORDS Space Maintainers, DMFT, Bleeding on Probing, Clinical Attachment Level, Periodontal Pocket Depth