Diagnostic accuracy of on-scan assessments compared to clinical assessments using a periodontal probe for detecting gingival recession: A cross-sectional study.

Objectives: The aim of the current research was to assess the prevalence of gingival recession and to investigate possible associations among this condition, periodontal and epidemiological variables in a sample of young Greek adults in a general dental practice.Material and Methods: A total of 1,430 young adults was examined clinically and interviewed regarding several periodontal and epidemiological variables. Collected data included demographic variables, oral hygiene habits and smoking status. Clinical examination included the recording of dental plaque, supragingival calculus presence, gingival status and buccal gingival recession. Multivariate logistic regression analysis model was performed to access the possible association between gingival recession and several periodontal and epidemiological variables as potential risk factors.Results: The overall prevalence of gingival recession was 63.9%. The statistical analysis indicated that higher educational level [OR= 2.12, 95% CI= 0.53-8.51], cigarette smoking [OR= 1.97, 95% CI= 1.48-7.91], frequent tooth brushing [OR= 0.98, 95% CI= 0.56-1.96], presence of oral piercing [OR= 0.92, 95% CI= 0.38-1.58], presence of gingival inflammation [OR= 4.54, 95% CI= 1.68-7.16], presence of dental plaque [OR= 1.67, 95% CI= 0.68-2.83] and presence of supragingival calculus [OR=1.34, 95% CI= 0.59-1.88], were the most important associated factors of gingival recession.Conclusions: The observations of the current research supported the results from previous authors that several periodontal factors, educational level and smoking were significantly associated with the presence of gingival recession, while presence of oral piercing was a new factor that was found to be associated with gingival recession. Key words:Gingival recession, prevalence, risk factors, young adults.

Comparative analysis of surgical methods for treating generalized gingival recession with jaw bone deficiency. A clinical and radiological examination and treatment of 16 patients (aged 25-45) with generalized gingival recession (Miller Class I-II, K06.00) following orthodontic treatment with bracket systems was conducted. Patients were divided into 2 groups: group 1 (n=9) and group 2 (n=7). Treatment involved surgical correction of gingival recession using a connective tissue graft. In group 1, the guided bone regeneration (GBR) technique with soft tissue plastic surgery was applied. In group 2, a modified coronally advanced flap (CAF) was used. Assessment methods included periodontal probing, intraoral scanning (TRIOS 3Shape), cone-beam computed tomography (CBCT), and photography. In group 1, the mean percentage of gingival recession coverage was 95%, compared to 87% in group 2. Alveolar bone gain in group 1 patients was 96%, whereas group 2 exhibited bone atrophy of 12%. The guided bone regeneration procedure combined with a connective tissue graft enables stable and predictable outcomes in patients with gingival recession and bone atrophy following orthodontic treatment.

The aim of this study was to evaluate root coverage of gingival recessions and to compare graft vascularization in smokers and non-smokers. Thirty subjects, 15 smokers and 15 non-smokers, were selected. Each subject had one Miller Class I or II recession in a non-molar tooth. Clinical measurements of probing depth (PD), relative clinical attachment level (CAL), gingival recession (GR), and width of keratinized tissue (KT) were determined at baseline and 3 and 6 months after surgery. The recessions were treated surgically with a coronally positioned flap associated with a subepithelial connective tissue graft. A small portion of this graft was prepared for immunohistochemistry. Blood vessels were identified and counted by expression of factor VIII-related antigen-stained endothelial cells. Intragroup analysis showed that after 6 months there a was gain in CAL, a decrease in GR, and an increase in KT for both groups (P <0.05), whereas changes in PD were not statistically significant. Smokers had less root coverage than non-smokers (58.02% +/- 19.75% versus 83.35% +/- 18.53%; P <0.05). Furthermore, the smokers had more GR (1.48 +/- 0.79 mm versus 0.52 +/- 0.60 mm) than the non-smokers (P <0.05). Histomorphometry of the donor tissue revealed a blood vessel density of 49.01 +/- 11.91 vessels/200x field for non-smokers and 36.53 +/- 10.23 vessels/200x field for smokers (P <0.05). Root coverage with subepithelial connective tissue graft was negatively affected by smoking, which limited and jeopardized treatment results.

Accuracy of intraoral scanners for static virtual articulation: A systematic review and meta-analysis of multiple outcomes

Background The purpose of this clinical trial was to compare the outcome of gingival recession technique using the coronally advanced flap (CAF) with platelet-rich fibrin (PRF) and amniotic membrane. Materials and methods About 15 patients with bilateral Miller class I buccal gingival recessions (4–5 mm) in maxillary and mandibular canines were selected. The recessions were randomly assigned to receive either the CAF with PRF or the CAF with amniotic membrane. Recession height (RH), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), probing depth (PD), and clinical attachment level (CAL) were measured at baseline as well as 6 months postsurgery. Patient satisfaction with esthetics, root sensitivity, and postoperative pain was also evaluated. Results The average percentages of root coverage for CAF with PRF and CAF with amniotic membrane were 92.95% and 97.40% (p &lt; 0.05) respectively, and the complete root coverage observed was 56.94% and 76.47% respectively. The CAF with amniotic membrane showed a statistically significant increase in TKT (p &lt; 0.05). There were no significant differences between the two groups with regard to RH, RW, WKT, PD, and CAL. The esthetic condition after both treatments was considered satisfactory by the patients. Conclusion The outcome of this study reflects that CAF with PRF and amniotic membrane can be successfully used to treat class I gingival recession. How to cite this article Gautam A. Comparative Evaluation of Coronally Advanced Flap with Platelet-rich Fibrin vs Amniotic Membrane for the Treatment of Gingival Recession. J Health Sci Res 2017;8(1):31-37.

Prevalence and risk indicators of buccal gingival recessions in a Moroccan periodontitis patients: A retrospective study

Background: Periodontitis is inflammation of the gingiva accompanied by alveolar bone loss, which causes loss of attachment. Local factors that can exacerbate periodontitis are gingival recession, a condition where the gingival margin is pulled away from the cemento-enamel junction (CEJ), resulting in the opening of the root surface that was initially closed. Objective: This study aimed to determine the distribution of gingival recession features in chronic periodontitis patients at the Universitas Trisakti Dental Hospital, Indonesia. Material and Methods: This type of research is an observational descriptive with a cross-sectional research design with periodic medical record samples from January 2013 to December 2017. Data obtained from medical records were recorded and grouped in tables and then analyzed manually. Results: Of the 583 periodontal patients, there were 311 patients with gingival recession consisting of 11 maxillary gingival recession patients, 21 mandibular gingival recession patients with the majority of mild classification of gingival recession (3.0 mm from the exposed root surface) and 279 patients suffering from in both jaws with the majority classification of severe gingival recession ( 4.0 mm exposed root surface). Conclusion: Gingival recession in patients with chronic periodontitis is more common in the mandible than the maxilla. Patients with chronic periodontitis mostly experience gingival recession of more than 1 tooth in the upper and lower jaw with severe classification ( 4 mm).

Purpose: The aim of this study was to evaluate the buccal and lingual alveolar bone morphology and the periodontal clinical condition of impacted permanent maxillary central incisors at least 6 months after the orthodontic traction. Methods: This split mouth transversal study evaluated a sample of 11 patients a mean of 15.41 years after the orthodontic traction of unilateral impacted maxillary central incisor. The experimental group (TR) consisted of 11 impacted central incisors. The comparison group (NTR) consisted of 11 non-impacted contralateral teeth. High-resolution CBCT exams of central incisors were performed using Accuitomo (J. Morita, Kyoto, Japan). Cross section imagens passing through the center of maxillary central incisors were used to measure buccal and lingual alveolar bone level. Presence of fenestration, root dilacerations, root coverage, and position of the root apex were also assessed in the same images. Clinical parameters included the periodontal probing depth, attachment level, gingival bleeding index, plaque index, degree of gingival recession, amount of gingival mucosa and evaluation of interproximal papilla and black triangle. Digital model analysis included an assessment of clinical crown height and width. Intergroup comparisons were performed using paired t tests, McNemar and Wilcoxon tests (p&lt;0.05). Pearson correlation coefficient was calculated to determine the relationship between the clinical and CBCT findings. Results: TR group showed a significantly thinner buccal bone plate thickness at the middle and apical root level compared to NTR group. A decreased buccal alveolar crest level was observed in TR group in comparison to NTR group. The TR group showed a greater frequency of buccal bone dehicences and root dilacerations than antimeres. Experimental group showed more gingival recession, a decreased amount of gingival mucosa and an increased clinical attachment level at the buccal aspect than the NTR group. Moderate inverse correlation was found between buccal bone plate thickness of central incisors and attachment level and moderate positive correlation was found between buccal alveolar crest height and attachment level Conclusions: The periodontal conditions of maxillary central incisors long-term after orthodontic traction are different compared to its antimere. A decreased thickness and height of buccal alveolar bone and gingival recessions were observed in central incisors 15 years after orthodontic traction.

Aim:The main focus of the study is to determine the difference between the efficacy of xenogeneic collagen matrix (XCM) versus platelet-rich fibrin (PRF) adjunct to coronally advanced flap to treat the gingival recession.Background:Because of esthetic concerns or root hypersensitivity, typical necessity dictates for buccal gingival recession treatment. This study was planned to evaluate and compare the efficacy of XCM with PRF in the treatment of the recessed gingiva.Materials and Methods:Thirty-four sites with Cairo's RT1 and RT2 gingival recessions were taken, out of which 17 sites received XCM (test) and 17 sites received PRF (control). A periodontal treatment was performed first, followed by a re-evaluation. All clinical measurements, including recession height (RH), recession width (RW), clinical attachment level (CAL), keratinized tissue width, and keratinized tissue thickness, were taken before surgery (baseline) and at a 6-month interval following periodontal surgery. Landry's healing index was also measured at the 1st and 2nd weeks after surgery.Results:None of the acquired data implies a significant difference statistically for CAL, RW, RH, thickness, and width of keratinized tissue (WKT) at 6-month interval between both the groups. Comparison of healing at the 1st and 2nd week intervals among both the groups showed no statistical significance. No significant difference among both Groups A and B was seen according to the intergroup analysis in terms of periodontal parameters such as CAL (P = 0.374), RW (P = 0.542), RH (P = 0.890), WKT (P = 0.877) and thickness of keratinized tissue (P = 0.547), and Landry's healing index (P = 0.429).Conclusion:In consideration of the patient's comfort and the method's simplicity, it can be concluded that PRF or XCM can be employed as an alternative.

During the last decade, there have been great strides in the treatment of gingival recession defects, especially with subepithelial connective tissue graft and guided tissue regeneration (GTR) procedures. Gingival recession represents a significant concern for patients. It is necessary to choose the most appropriate procedure in order to obtain more root coverage while avoiding clinical disadvantages. The purpose of this randomized clinical trial was to evaluate the use of a bioabsorbable bilayer collagen membrane with GTR compared to a connective tissue graft in the treatment of gingival recession defects. Twenty patients each contributing a pair of Miller Class I or II buccal gingival recessions were treated. In each pair, one recession was randomly assigned for treatment with GTR using a bioabsorbable bilayer collagen membrane and the other treated with subepithelial connective tissue graft (CTG). Clinical measurements taken at baseline (D0) and 3 and 6 months post-treatment included recession depth (RD), recession width (RW), probing depth (PD), and clinical attachment level (CAL). Data were analyzed using the non-parametric Wilcoxon matched pair test. All results were statistically significant. Both treatments resulted in a significant gain of root coverage (P<0.0001), amounting to an average of 2.80 mm at 3 months in the GTR group and 3.34 mm in the CTG group. At 6 months, the decrease of the mean RD remained statistically significant: 2.70 mm (74.59% root coverage) in the GTR group and 3.19 mm (84.84% root coverage) in the CTG group. The mean RW also decreased from 4.48 mm at D0 to 2.42 mm at 6 months in the GTR group, and from 4.38 mm at D0 to 1.35 mm at 6 months in the CTG group, representing a percentage of coverage of 45.98% and 69.18%, respectively. Mean CAL gain obtained between D0 and 6 months with the GTR procedure and CTG was 3.31 mm and 3.09 mm, respectively, and was significant within groups. At 3 and 6 months, the differences in the results for RD, CAL, and RW were not statistically significant between the 2 groups. However, the difference was significant for PD at 3 and 6 months. The results suggest that a bioabsorbable bilayer collagen membrane can be used in the GTR treatment of human buccal recession defects, with no statistically significant differences between this procedure and connective tissue grafts.

Labial and buccal gingival recession is a common finding in the adult population that occurs due to various etiologies. When present, it can lead to unaesthetic appearance and also cause hypersensitivity. However, very limited literature is available quoting the incidence of palatal gingival recessions and, sometimes, it can go unnoticed during routine clinical examinations. These too can cause sensitivity and also pose a technical challenge in surgical correction due to poor accessibility and visibility when present. Herein, we report a case of palatal gingival recession treated successfully by connective tissue graft.

Esthetics forms an integral part of today’s world. In this article we will delve into the predicament of treating the receded gingiva by soft tissue engineering using acellular dermal matrix (ADM) allograft. A young female of 37 years visited our private periodontal office with Miller’s Class II gingival recession of 4mm in the mandibular left central incisor. A mucogingival surgery with ADM using a tunneling technique for root coverage was employed. The clinical parameters measured were the clinical gingival recession, the clinical attachment level and the probing depth. At 6 months postoperative assessment, 50% reduction in probing depth, 83.33% of attachment gain and 100% of clinical recession root coverage were recorded which were found to be maintained at 2 year postoperative follow-up too with the exception of probing depth which was found to be increased. In view of the encouraging results obtained in this case study, while being mindful of the potential limitations and differences, root coverage with ADM in conjunction with tunneling technique is found to be a predictable alternative to conventional procedures.

The most commonly used technique for covering gingival recessions is the coronally advanced flap (CAF) technique due to its high success rate. In clinical situations where there is less keratinized tissue apical to the defect due to unfavorable anatomical conditions, a more advantageous technique for this situation should be considered, specifically the laterally positioned flap (LPF). The aim of this study was to compare the gingival thickness after gingival recession coverage using the laterally positioned flap supported by an augmented and non-augmented connective tissue graft (CTG). Thirty-four patients with 105 gingival recessions of Miller’s class I and/or II were enrolled in this study. The method of choice was the laterally positioned flap. The test group was treated with previously augmented CTG harvested from the palatal mucosa while the control group was treated with a non-augmented CTG. Clinical measurements were recorded at baseline, 6, 12 and 24 months after intervention. Clinical results showed a statistically more significant percentage of average and complete gingival recession coverage in the test group. The LPF in combination with an augmented CTG proves to be an effective alternative to the CAF. Greater improvement in gingival thickness was observed in the LPF with augmented CTG than in non-augmented CTG.

Increased muscle stiffness in the upper trapezius has been suggested to be associated with cervical myofascial pain and myofascial trigger points (MTrP). Recently, efforts have been made to objectively detect MTrP using ultrasound shear wave elastography (SWE). However, there is no consensus on the relationship between muscle stiffness assessed by SWE and MTrP. This may be due to the possibility that muscle stiffness is not uniform even in the asymptomatic trapezius. The present study aimed to characterize passive muscle stiffness at the proximal, central, and distal sites of the anterior and posterior parts of the upper trapezius. Seventeen healthy young males without neck pain participated in the study. The upper trapezius was divided into anterior and posterior parts based on anatomical landmarks: the line between C6 and the lateral end of the clavicle was defined as the anterior part, while the line between C7 and the acromion angle was defined as the posterior part. Shear wave speed (SWS; an index of stiffness) was measured using ultrasound SWE at six sites in the anterior and posterior parts of the upper trapezius, at 25% (proximal), 50% (central), and 75% (distal) of the muscle belly length. SWS in the anterior part was significantly higher at the proximal (p < 0.001) and distal (p < 0.001) sites than at the central site. In the posterior part, there was no significant difference in SWS between the proximal, central, and distal sites. Comparisons between the anterior and posterior parts showed no significant differences in SWS at the proximal (p = 0.147), central (p = 0.339), and distal sites (p = 0.051). The characteristics of passive stiffness distribution in the anterior and posterior parts of the upper trapezius have important implications with respect to the optimal location of the control point during MTrP detection. In particular, it may be preferable to set the control point for detecting MTrP in the transverse direction rather than in the fascicle direction, that is, to compare passive muscle stiffness at the same levels between the anterior and posterior parts.

Objective: To assess the prevalence of dentine hypersensitivity (DH) among adult patient’s attending public dental clinics in Dar-es-salaam, Tanzania. Material and methods: This hospital based cross-sectional study assessed adults aged 18 years and above who attended public dental clinics in Dar-es-salaam, Tanzania. Prevalence of DH was clinically assessed in relation to age, sex, tooth type, presence of tooth wear (TW) and gingival recession (GR). Analysis of data used the SPSS program with level of statistical significance set at p<0.05. Result: The 323 participant’s age ranged between 18 and 72 years. Majority of participants were in age group 18 to 30 years (33.7%) and females (52.9%). The prevalence of clinically diagnosed DH was 46.4% (n=150) which had a similar prevalence to tooth wear (46.4%) and gingival recession (45.5%). DH statistically significantly increased with age, presence of tooth wear and presence of gingival recession (p<0.05). Teeth most diagnosed with DH were the first molars in the lower jaw (63.5%). Participants without tooth wear (OR=0.137; 95% CI 0.07 - 0.24) or gingival recession (OR=0.161; 95% CI 0.09 - 0.28) are less likely to have clinically diagnosed DH. Conclusion: This study demonstrates that prevalence of clinically diagnosed DH among subjects was common (46.4%) with first molars in lower jaw being most affected (63.5%). DH had a statistically significant increase with age, tooth wear and gingival recession however, logistic regression indicated that those without tooth wear or gingival recession were less likely to have DH.