Objective: The introduction of a new collagen substitute, that potentially will reduce the invasiveness of the two techniques, by avoiding the need for a second surgical site, i.e., the donor site, need to be evaluated in relation with the surgical procedure that could benefit the most by the utilization of such a matrix. The aim of this study was to compare the clinical outcomes following treatment of RT 1 multiple adjacent gingival recessions (MAGRs) using the modified coronally advanced tunnel technique (MCAT) or the multiple coronally advanced flap (MCAF) in conjunction with a new volume stable xenogeneic collagen matrix (VXCM). Secondarily, the study evaluated whether patients report a preference in terms of discomfort between the two surgical techniques. Methods: Twenty patients requiring treatment of MAGRs were randomly assigned to one of the two treatment groups (group A: MCAF+VCMX; group B: MCAT+VCMX). The following measurements were recorded at baseline (i.e. prior to surgery), at 6 and 12 months: gingival recession depth (REC), probing pocket depth (PPD), keratinized tissue width (KTW) and gingival thickness (GT). Post-operative pain and discomfort were recorded using a visual analogue scale (VAS) at 1 week. The primary outcome variable was mean root coverage (mRC), secondary outcomes were complete root coverage (CRC), change in KTW and GT, patient discomfort and satisfaction, and duration of surgery. Results: Healing was uneventful in both groups. At 12 months, both treatments resulted in statistically significant improvements of REC and GT compared with baseline (p < 0.05). The mRC measured 79.95 ± 29.92% at MCAF group, whereas 64.74 ± 40.5% MCAT group (p = 0.124). CRC was found at 65.6% of MCAF-treated sites and at 52% of MCAT-treated sites (p=0.181). Conclusions: Similar clinical results should be expected when MAGRs are treated with MCAF or MCAT, with the adjunct of VCMX.

The aim of the present case series was to evaluate the outcomes of the modified coronally advanced tunnel technique (MCAT) using the width of keratinized tissue (KTW) as an indicator to apply the connective tissue graft (CTG) specifically. Seven patients requiring treatment for the presence of multiple gingival RT1 recession defects in the maxilla were enrolled in the study. A total of 36 recessions were treated with MCAT, and the CTG was applied in 16 sites presenting < 2 mm of KTW at baseline. The mean root coverage from baseline to 1 year postsurgery was 90% for the sites treated with MCAT alone and 93.7% for those treated with MCAT+CTG. The increase of KTW was higher in the sites treated with CTG than in the sites treated without it. Within the limitations of the present case series, it can be concluded that the proposed surgical technique is extremely effective in gaining root coverage and reducing the amount of connective tissue harvested from the donor site.

The aim of this present prospective study was to evaluate the outcomes of the multiple coronally advanced flap (MCAF) with a site-specific application of connective tissue graft (CTG) for the treatment of multiple gingival recession defects with or without the presence of noncarious cervical lesions (NCCLs). Analysis of periodontal conditions was performed in order to determine if the cementoenamel junction (CEJ) restorations could affect adequate plaque control as well as maintenance over time. A total of 93 gingival recessions were treated, 61% of which presented a NCCL restored with composite resin positioned 1 mm apical to the position of the anatomical CEJ. The surgical treatment involved MCAF+CTG for 54 sites and MCAF alone for 39 sites. At 12 months, complete root coverage (CRC) and periodontal parameters of restored and nonrestored teeth were assessed, and the differences between the two groups were not significant. It can be concluded that the proposed treatment modality does not produce a negative effect on periodontal condition and amount of CRC, thus resulting in a satisfactory esthetic result.

This report describes the long-term outcomes of nonsurgical periodontal therapy and supportive periodontal treatment (SPT) of a 21-year-old patient affected by generalized aggressive periodontitis at multiple teeth with a compromised prognosis. After 25 years of SPT, no teeth had been extracted and no periodontal pockets associated with bleeding on probing were present. Radiographic analysis showed an improvement in infrabony defects, demonstrating longterm improvement is possible with nonsurgical periodontal treatment provided that smoking is not present and the patient is included in a strict SPT.

The aim of this study was to evaluate the short- (1 year) and longer-term (3 years) effectiveness of a surgical procedure combining coronally advanced flap (CAF) with site-specific application of connective tissue graft (CTG) in the treatment of multiple gingival recessions (MGR). A total of 60 periodontally healthy subjects with esthetic complaints due to excessive tooth length presenting multiple (at least three) Miller Class I and II gingival recession defects (≥ 1 mm) affecting adjacent teeth in the maxilla and mandible were enrolled in the study. All recessions were treated with CAF. The CTG was applied in gingival defects with a baseline keratinized tissue height (KTH) < 1 mm or with KTH between 1 and 2 mm and gingival thickness < 1 mm. Complete root coverage (CRC) was obtained in 98.5% (263 of 267 recessions) and in 94.7% (256 of 267 recessions) of the sites at the 1- and 3-year follow-up visits, respectively. No statistically significant differences were found at 1 and 3 years in terms of CRC between sites with or without CTG and between sites belonging to the maxilla or mandible. A greater increase in KTH at 3 years was demonstrated in sites treated with CTG. This was ascribed to the tendency of the mucogingival line to regain its genetically determined position and not to graft exposure. The present study demonstrated that the proposed surgical technique combining CAF with site-specific application of CTG was an effective treatment modality for the management of MGR, obtaining 93% CRC in the CAF-treated sites and 100% CRC in the sites treated with CAF + CTG at 3 years.

The purpose of the present study was to compare two different surgical procedures, connective tissue graft and guided bone regeneration, when applied in conjunction with implant placement. Probing pocket depth and the recession depth were recorded at the implant site after crown placement (T1) and at the 1-year follow-up (T2), while the keratinized tissue height and the buccal mucosa thickness were recorded at three different time points: at the time of implant surgery (T0), after crown placement, and at the 1-year followup. No statistically significant differences in peri-implant mucosa thickness, recession, or other periodontal parameters were recorded at adjacent teeth.

The aim of this study was to test whether zirconia abutments exhibit the same clinical and esthetic outcomes as titanium abutments in single-tooth implant restorations in the esthetic area. The 24 treated patients were randomly assigned to a test (zirconia abutment) or control (titanium abutment) group. Objective evaluations were carried out using the Implant Crown Aesthetic Index (ICAI) and the Papilla Index (PI) at the 1-month and 12-month follow-up examinations after crown cementation. No significant differences, either in ICAI or in other periodontal or radiographic measurements, were observed. At 1 year, zirconia and titanium abutments exhibited the same esthetic outcomes.

Purpose: To evaluate, through a systematic review of the literature, the efficacy of different surgical techniques in maintaining residual bone in the alveolar process following tooth extractions. Materials and Methods: MEDLINE/PubMed was searched through January 2010 and papers were selected according to the CONSORT statement and an independent three-stage screening process. The selected outcome variables were clinical width and height changes of the socket, and means and standard deviations were calculated from the included studies. For those studies that were randomized controlled trials, six meta-analyses were performed by dividing studies into three groups with regard to the use of barriers and grafting (barriers alone, graft alone, or both). Results: Thirteen papers met the eligibility criteria and were included in the analyses. Statistically significant ridge preservation was found for studies that used barriers alone; the pooled weighted mean was 0.909 mm (95% confidence interval, 0.497554 to 1.320732 mm) for bone height, while the mean for bone width was 2.966 mm (95% confidence interval, 2.334770 to 3.598300 mm). Conclusions: Socket preservation procedures are effective in limiting horizontal and vertical ridge alterations in postextraction sites. The meta-analysis indicates that the use of barrier membranes alone might improve normal wound healing in extraction sites. Keywords: alveolar socket preservation, ridge preservation, systematic review

Over the last few decades, many authors have investigated the effect of periodontal disease and treatment on pulpal status with controversial results. This study was conducted to verify whether periodontal disease in a deep intrabony defect and complex therapy, including aggressive root planing such as in periodontal regeneration, have an influence on tooth vitality. One hundred thirty-seven patients who fulfilled the requirements were included. The collected data did not support the need for "preventive" root canal treatment in severely compromised teeth that are planned to undergo periodontal regenerative surgery.

Hintergrund: Wenn die Weichgewebsbedingungen im Bereich eines Rezessionsdefekts ungünstig sind, kann der Einsatz eines gestielten Lappens (verschoben oder rotiert) als Methode zur Deckung der Wurzel und als Abdeckung eines Gewebetransplantats unmöglich sein. Ein freies Schleimhauttransplantat kann nicht empfohlen werden, da es eine schlechte Vorhersagbarkeit zur Deckung der Wurzel hat und ästhetisch nicht ideal ist. Das Ziel des vorliegenden Fallberichts ist es, eine Modifikation einer zweizeitigen chirurgischen Technik vorzustellen, die eine bessere Deckung der Wurzel, ein ästhetischeres Ergebnis und eine reduzierte Morbidität für den Patienten bringt. Methoden: Im ersten Fallbericht wurde eine Miller-Klasse-II-Rezession mit einer bukkal großen Sondierungstiefe am zentralen Unterkieferschneidezahn behandelt. Im ersten chirurgischen Schritt wurde ein epithelisiertes Transplantat mit der gleichen apikokoronalen Dimension wie die Höhe der keratinisierten Gewebe der Nachbarzähne apikal der Knochendehiszenz angenäht. Vier Monate später wurde ein koronaler Verschiebelappen zur Deckung der freiliegenden Wurzel durchgeführt. Im zweiten Fallbericht wurde eine Miller-Klasse-III-Rezession behandelt, bei der die mesiale Wurzel des unteren ersten Molaren bukkal eine große Sondierungstiefe aufwies. Im ersten chirurgischen Schritt wurde ein freies Schleimhauttransplantat mesial der freiliegenden Wurzel positioniert, um so lateral der Rezession keratinisiertes Gewebe zu gewinnen. Dies genügte, um den lateralen und koronalen Verschiebelappen zur Deckung der Wurzel in einem zweiten Eingriff durchzuführen. Ergebnisse: Im ersten Fallbericht konnten ein Jahr nach dem Eingriff eine vollständige Deckung der Wurzel, ein Anstieg (4 mm) der Höhe der keratinisierten Gewebe und eine Anpassung der Mukogingivallinie beobachtet werden. Die reduzierte Dimension des Transplantats minimierte die Beschwerden für die Patientin und bewirkte ein gutes ästhetisches Ergebnis der mukogingivalen Gewebe. Dieses befriedigende Ergebnis konnte über fünf Jahre erhalten werden. Im zweiten Fallbericht wurden ein Jahr nach dem Eingriff eine erfolgreiche Deckung der Wurzel, ein Anstieg (3 mm) der Höhe der keratinisierten Gewebe und eine gute Harmonie der mukogingivalen Gewebe erzielt. Diese Ergebnisse wurden über fünf Jahre nach der Behandlung erhalten. Schlussfolgerungen: Die Modifikationen eines zweizeitigen Vorgehens - Reduktion der Transplantatgröße und standardisierte chirurgische Technik - ermöglichen die erfolgreiche Vesorgung gingivaler Rezessionen, bei denen durch die kompromittierte Ausgangssituation ein einzeitiges Vorgehen ausgeschlossen ist.