Giovan Paolo Pini Prato

Root Coverage Esthetic Score : A System to Evaluate the Esthetic Outcome of the Treatment of Gingival Recession Through Evaluation of Clinical Cases

BACKGROUND Generally, esthetic outcomes following root-coverage procedures are not assessed. This article proposes a score for evaluating the esthetic outcome following root-coverage surgery. METHODS Thirty-one patients with Miller Class I and II recession defects treated with root-coverage procedures were evaluated. Esthetic outcomes were assessed using the root coverage esthetic score (RES) 6 months after surgery. This score evaluates five variables: level of the gingival margin, marginal tissue contour, soft tissue texture, mucogingival junction alignment, and gingival color. Because complete root coverage was the primary treatment goal, and the other variables were considered secondary, the value assigned for root coverage was 60% of the total score, whereas 40% was assigned to the other four variables. With regard to assessment of the final position of the gingival margin, 3 points were given for partial root coverage, and 6 points were given for complete root coverage; 0 points were assigned when the final position of the gingival margin was equal or apical to the previous recession. One point was assigned for each of the other four variables. Thus, 10 points was a perfect score. RESULTS Of the 31 treated recession defects, 24 (77%) exhibited complete root coverage at 6 months. The mean amount of root coverage was 89.4% (range, 0% to 100%). The mean RES was 7.8. Five of 24 cases of complete root coverage achieved a perfect score (RES = 10). In one case, RES = 0. CONCLUSION The RES system may be a useful tool to assess the esthetic outcome following root-coverage procedures.

Orthodontic and Periodontal Outcomes of Treated Impacted Maxillary Canines

OBJECTIVE To evaluate the influence of pretreatment radiographic features (alpha-angle, d-distance, and s-sector) on (1) the duration of active orthodontic traction and (2) the posttreatment periodontal status (pocket depth [PD] and keratinized tissue width [KT]) of impacted maxillary canines treated by a combined surgical (flap approach) and orthodontic (direct traction to the center of the ridge) treatment. MATERIAL AND METHODS A study population of 168 patients (168 canines) was evaluated. Multiple regression analysis was used. RESULTS Pretreatment radiographic variables were associated significantly with the duration of orthodontic traction. Age, sex, and site of impaction did not significantly affect the duration of traction. No significant differences in PD and KT were present at the end of surgical-orthodontic treatment with respect to any of the variables considered. The analysis of PD and KT variables after orthodontic treatment revealed a healthy periodontium. CONCLUSIONS alpha-angle, d-distance, and s-sector are valid indicators for the duration of orthodontic traction. They are not prognostic indicators of final periodontal status of orthodontically-repositioned canines.

Factors affecting the clinical approach to impacted maxillary canines: A Bayesian network analysis

INTRODUCTION The aim of this study was to apply Bayesian networks to evaluate the relative role and possible causal relationships among various factors affecting the diagnosis and final treatment outcome of impacted maxillary canines. METHODS A total of 168 patients with infraosseous impacted maxillary canines had a combined surgical-orthodontic approach aimed to guide the impacted tooth to the center of the alveolar ridge. Demographic, orthodontic, and periodontal variables were recorded and analyzed by means of Bayesian network analysis. RESULTS All 168 impacted canines were successfully moved and aligned in the dental arches with healthy periodontiums. According to the Bayesian network analysis, bilateral impaction was associated with palatal impaction and longer treatment; the pretreatment alpha-angle was a determinant for the duration of orthodontic traction, also because of the associations between greater angulation of impacted canines with more severe tooth displacement and with greater distance of the impacted canine from the occlusal plane; the posttreatment periodontal outcome was not related to the pretreatment radiographic variables. CONCLUSIONS Bayesian network analysis was useful to identify possible relationships among the variables considered for diagnosis and treatment of impacted canines.

Periodontal Plastic Surgery to Improve Aesthetics in Patients with Altered Passive Eruption/Gummy Smile: A Case Series Study

Altered passive eruption/gummy smile is a common challenge in patients requiring aesthetic treatment. A specific surgical protocol was designed and tested in patients with altered passive eruption. Standardized preoperative X-rays were used to assess crown length at baseline and to place submarginal incisions. Osseous respective therapy was performed to achieve biological width. Clinical outcomes were recorded 6 months after surgery. Eleven patients with a total of 58 teeth were treated with flap surgery and osseous resective therapy at upper anterior natural teeth. At the last followup, a significant and stable improvement of crown length was obtained when compared to the baseline (P < 0.0001). All patients rated as satisfactory in the final outcomes (final VAS value = 86.6). In conclusion, this study showed that periodontal plastic surgery including osseous resection leads to predictable outcomes in the treatment of altered passive eruption/gummy smile: A careful preoperative planning avoids unpleasant complications and enhances postsurgical stability of the gingival margin.