Clinical applications of mucogingival therapies utilizing adjunctive autologous blood products.

Background: Mucogingival deformities are prevalent oral conditions and can result in esthetic compromise, dentinal hypersensitivity, and an increase in radicular caries rates. Mucogingival treatments address thin periodontal phenotype and/or gingival recession defects. Although many of these grafting procedures are predictable in improving soft-tissue quality and quantity around teeth and dental implants, patients often complain of discomfort at both the donor and recipient sites.

The effect of bone particle size on the histomorphometric and clinical outcomes following lateral ridge augmentation procedures: A randomized double-blinded controlled trial.

Background: The aim of this randomized clinical trial was to clinically and histologically compare the amount and quality of bone gained after lateral ridge augmentation (LRA) procedures performed using small-particle (SP)-size (250-1000 μm) versus large-particle (LP)-size (1000-2000 μm) size corticocancellous bone allografts at 6 months following surgical intervention.

Methods: Twenty-two patients, each presenting with ridge width <5 mm were enrolled. Patients were randomly allocated to SP- and LP-size graft.

A Prospective, Randomized Controlled Pilot Trial to Compare Vestibular Incision Subperiosteal Access and Sulcular Tunnel Access Root Coverage Procedures to Treat Gingival Recession.

The aim of this randomized prospective study was to compare clinical and patient-centered outcomes of Miller Class I and II gingival recession defects treated with acellular dermal matrix (ADM) grafts and either vestibular incision subperiosteal tunneling access (VISTA) or sulcular tunnel access (STA) techniques. A total of 29 gingival recession defects in nine patients were assessed to determine clinical outcomes, including probing depth (PD), gingival recession (GR), width of keratinized tissue (KT), width of attached tissue (AT), tissue thickness at the gingival margin (TT1), and tissue thickness 4 mm apical to the gingival margin (TT2). Visual analog scale (VAS) assessment of patient-perceived pain, bleeding, swelling, and changes in activity were assessed postoperatively at 7 and 30 days, and professional assessment of postoperative esthetics using the Pink Esthetic Score (PES) was performed at 6 months.

Patient-reported outcomes of palatal donor site healing using four different wound dressing modalities following free epithelialized mucosal grafts: A four-arm randomized controlled clinical trial.

Background: The aim of this study was to compare the effects of four different commonly used wound dressings in improving patient reported outcomes (PROMS) after free epithelialized mucosal grafts (FEGs) harvesting.

Methods: Following 72 FEGs harvesting from 72 patients, patients were assigned into four groups.

Control: collagen plug + sutures (CPS); test: collagen plug with cyano-acrylate (CPC), platelet rich fibrin (PRF) + sutures, or palatal stent only (PS).

The Impact of Orthodontic Retainers on Gingival Recession: A Best-Evidence Review.

Retention is a critical phase of orthodontic therapy and aims to maintain occlusal stability and avoid crowding relapse. This best-evidence article reviews the effects of the different types of orthodontic retention appliances, fixed and removable, on the development and progression of gingival recession at the mandibular anterior teeth. Searched databases included PubMed, Scopus, Cochrane Library, Embase, and Dentistry and Oral Sciences.

Association between lateral wall thickness and sinus membrane perforation during lateral sinus elevation: A retrospective study.

Purpose: This study aimed to investigate the influence of the thickness of the sinus lateral wall on the incidence of sinus membrane perforation.

Materials And Methods: A retrospective study was conducted by reviewing dental records of patients who received lateral wall sinus elevation in two educational institutes. The wall thickness 4 mm and 6 mm coronal to the sinus floor was measured with CBCT.

The new periodontal disease classification: Level of agreement on diagnoses and treatment planning at various dental education levels.

Purpose/objectives: Using the periodontal diseases classification published in 2018, this study evaluated the level of agreement among predoctoral and postgraduate students of different education levels and specialties in the diagnosis and treatment planning of periodontal conditions.

Methods: Second-year (D2) and fourth-year (D4) dental students, postgraduate orthodontic students (OS), and periodontology students (PS) were presented with an anonymous survey of 10 cases, each with five choices of diagnosis and seven therapeutic approaches. The cases included a patient summary, photographs, radiographs, periodontal charting, and ranged from health to periodontitis.

A 5-Year Retrospective Analysis of Biologic and Prosthetic Complications Associated With Single-Tooth Endosseous Dental Implants: Practical Applications.

Focused Clinical Question: What are the key considerations of the incidence and timing for single-tooth implant complications, including early failure, biological complications, and prosthetic complications?

Summary: Single-tooth dental implants have been shown to have a high overall survival rate, but implant complications affect patient satisfaction and may lead to costly and/or time-consuming repair and revision. Assessing the incidence and types of biologic and prosthetic complications and the timing of such complications is helpful so that the underlying causes can be addressed during the treatment planning process. Furthermore, identification of patient demographics, patient-, implant-, and site-specific factors associated with such complications may allow for more comprehensive risk assessment during treatment planning.

The impact of anatomic, patient and surgical factors on membrane perforation during lateral wall sinus floor elevation.

Objectives: This retrospective study aimed to evaluate the influence of anatomical, patient and surgical factors on the occurrence of membrane perforation (MP) during lateral window sinus floor elevation (LWSFE).

Material And Methods: A review of LWSFE patient records between 2014 and 2019 accounted for MP occurrence, window surface area (WSA), intravenous sedation use, osteotomy instrument type and clinician experience. Preoperative cone beam computed tomography (CBCT) scans were analyzed for lateral wall thickness (LWT), LFM and LAM angles formed between lateral and medial walls at the floor and anterior wall, respectively, sinus width at 5-, 10- and 15-mm (LM-5, LM-10 and LM-15) from the floor, residual bone height (RBH), sinus pathologies, septa and arterial anastomoses.

Clinical Decision Making for Primary Peri-Implantitis Prevention: Practical Applications.

Focused Clinical Question: When planning dental implant therapy, what risk-reduction strategies allow practitioners to select patients, sites, and restorative plans that decrease the incidence of peri-implant disease?

Summary: With a marked increase in the number of patients receiving dental implants to treat partial or complete edentulism, it follows that the prevalence of peri-implant mucositis and peri-implantitis have increased. Risks associated with implant therapies may vary based upon underlying local, environmental, surgical, patient, prosthetic, and fixture-related factors. Furthermore, an emphasis on preventative measures and maintenance should be undertaken to avoid development and progression of peri-implant diseases.

Management of a Large Artery During Maxillary Sinus Bone Grafting: A Case Report.

Introduction: Branches of the posterior superior artery (PSA) are often found within the lateral wall of the maxillary sinus. Most vessels are small and laceration of the blood vessel during sinus augmentation is not uncommon. Such lacerations can result in intra-surgical bleeding complicating the augmentation procedure, otherwise they are typically non-life threatening.

Students' Evaluations of Simulations in Dentistry: A Multiple Cohort Study at a U.S. Dental School.

Simulation may help translate didactic learning to patient care in areas such as communication skills and medical emergency management. The aims of this study were to investigate how multiple cohorts of dental students evaluated simulations utilizing standardized patients and manikins and to explore evaluations of a simulation that combined social determinants of health with oral health education. All approximately 600 second- and fourth-year dental students at one U.

Changes in Keratinized Tissue Width Following Connective Tissue Grafts and Diode Laser- vs Blade-Gingivoplasty.

The objectives of this study were to clinically and histologically assess the capacity of bilaminar subepithelial connective tissue grafts (SCTGs) alone or in combination with gingivoplasty (Gv) to increase the keratinized gingiva width (KGW) in contralateral mandibular sites lacking KG (10 patients, 42 sites). The effects of Gv timing (1 vs 2 months) and technique (blade vs laser) were also evaluated. SCTGs alone resulted in mean KGW increase of 0.

The Effect of Dental Implant Collar Design on Crestal Bone Loss at 1 Year After Implant Placement.

The aim of this randomized, prospective study was to compare clinical and radiographic outcomes of microtextured implants with two different collar designs at 1 year postplacement. A total of 69 implants were assessed in 58 patients for site, patient-specific, and clinician-experience variables. Overall implant survival was 94.

Glycemic control among patients with physician-managed type 2 diabetes.

Outcomes for treatment, overall oral health status, and periodontal disease progression in patients with type 2 diabetes mellitus (T2DM) have been associated with glycemic control as measured by hemoglobin A1c (HbA1c) levels. Due to the high prevalence of T2DM among patient populations in the United States, this study sought to assess baseline levels of glycemic control for patients with a known diagnosis of T2DM who were under the care of a physician and to identify management solutions for these patients. All patients included in this study were prescreened to ensure that they were dentate, had been diagnosed with T2DM at least 3 months previously, were under the care of a physician for diabetes management, and had no changes to their diabetes-related medications for 3 months or more (N = 822).

Creation of a Zone of Immobile Connective Tissue with Acellular Dermal Matrix Allografts.

Acellular dermal matrix allografts (ADMs) have been hypothesized to create a zone of immobile connective tissue (ICT) extending apical to the mucogingival junction (MGJ). This 12-month prospective randomized trial investigated the presence of ICT after the use of two commercially available ADMs with coronally advanced flaps in the treatment of Miller Class I and II recession defects. This study demonstrated that the use of either type of ADM resulted in predictable root coverage and a zone of ICT extending apical to the MGJ by 1.

Decision Making in the Treatment of Patients With Rheumatoid Arthritis and Periodontitis: Scientific Evidence and Clinical Experience.

Focused Clinical Question: What are the key considerations for coordination of care for a patient with rheumatoid arthritis (RA) and chronic periodontitis (CP), and what are the clinical implications of RA on periodontal health? Summary: Both RA and CP involve hyper-immune response and osseous destruction. However, despite emerging evidence that RA and CP may have common etiologies and patients with RA have increased risk of CP, periodontal evaluation and treatment remain largely similar for patients with and without RA. More fully assessing inflammatory burden in patients with RA and CP may allow practitioners to more accurately assess the risk profile of a patient for RA and periodontal disease progression and to better evaluate adequate end points to periodontal therapy.

Clinical and Patient-Centered Outcomes Following Treatment of Multiple Gingival Recessions Using Acellular Dermal Matrix Allografts.

The aim of this case series was to evaluate clinical and patient-centered outcomes when treating multiple recessions (Miller Class I, II, and III) affecting five or more teeth in a single procedure using acellular dermal matrix in 18 eligible participants (mean of 7.4 ± 1.7 recessions/patient).

Enhancement of the Regenerative Potential of Anorganic Bovine Bone Graft Utilizing a Polyglutamate-Modified BMP2 Peptide with Improved Binding to Calcium-Containing Materials.

Autogenous bone is the gold standard material for bone grafting in craniofacial and orthopedic regenerative medicine. However, due to complications associated with harvesting donor bone, clinicians often use commercial graft materials that may lose their osteoinductivity due to processing. This study was aimed to functionalize one of these materials, anorganic bovine bone (ABB), with osteoinductive peptides to enhance regenerative capacity.

Healing Time for Final Restorative Therapy After Surgical Crown Lengthening Procedures: A Review of Related Evidence.

Focused Clinical Question In healthy patients who receive surgical crown lengthening, how much healing time should be allowed for the positional changes of the gingival margin before final restoration? Clinical Scenario A 59-year-old woman presented to the University of Alabama at Birmingham School of Dentistry in August 2011 for replacement of her existing porcelain-fused-to-metal crowns on the maxillary anterior teeth for esthetic reasons. Clinical examination revealed a diagnosis of developmental mucogingival deformity manifested by gingival excess in the maxillary anterior sextant. An esthetic evaluation was performed and identified excessive gingival display attributable to short clinical crowns and excluded vertical maxillary excess and short or hypermobile upper lip as etiologic factors.