Giovanpaolo Pini-Prato

Lack of adjunctive benefit of Er:YAG laser in non-surgical periodontal treatment: a randomized split-mouth clinical trial

AIM This split-mouth, randomized, clinical trial aimed to evaluate the efficacy of erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser application in non-surgical periodontal treatment. MATERIALS AND METHODS A total of 27 patients underwent four modalities of non-surgical therapy: supragingival debridement; scaling and root planing (SRP)+Er:YAG laser; Er:YAG laser; and SRP. Each strategy was randomly assigned and performed in one of the four quadrants. Clinical outcomes were evaluated at 3 and 6 months. Subjective benefits of patients have been evaluated by means of questionnaires. RESULTS Six months after therapy, Er:YAG laser showed no statistical difference in clinical attachment gain with respect to supragingival scaling [0.15 mm (95% CI -0.16; 0.46)], while SRP showed a greater attachment gain than the supragingival scaling [0.37 mm (95% CI 0.05; 0.68)]. No difference resulted between Er:YAG laser+SRP and SRP alone [0.05 mm (95% CI -0.25; 0.36)]. CONCLUSIONS The adjunctive use of Er:YAG laser to conventional SRP did not reveal a more effective result than SRP alone. Furthermore, the sites treated with Er:YAG laser showed similar results of the sites treated with supragingival scaling.

Coronally advanced flap with and without connective tissue graft for the treatment of single maxillary gingival recession with loss of inter-dental attachment. A randomized controlled clinical trial

BACKGROUND The aim of this randomized clinical trial (RCT) was to evaluate the adjunctive benefit of Connective Tissue Graft (CTG) to Coronally Advanced Flap (CAF) for the treatment of gingival recession associated with inter-dental clinical attachment loss equal or smaller to the buccal attachment loss (RT2). MATERIAL AND METHODS A total of 29 patients with one recession were enrolled; 15 patients were randomly assigned to CAF+CTG while 14 to CAF alone. Measurements were performed by a blind and calibrated examiner. Outcome measures included complete root coverage (CRC), recession reduction (RecRed), Root coverage Esthetic Score (RES), intra-operative and post-operative morbidity, and root sensitivity. RESULTS After 6 months, CAF+CTG resulted in better outcomes in terms of CRC (adjusted OR = 15.51, p = 0.0325) than CAF alone. CRC was observed in >80% of the cases treated with CAF+CTG when the baseline amount of inter-dental CAL was ≤ 3 mm. No difference was detected in term of RecRed. CAF+CTG was associated with longer surgical-time (p < 0.0001), higher number of days with post-operative morbidity (p = 0.0222) and the need for a greater number of analgesics (p = 0.0178) than CAF alone. No difference for final RES score was detected (p = 0.1612). CONCLUSION Both treatments can provide CRC in single gingival recession with inter-dental CAL loss. The application of CTG under CAF resulted in predictable CRC when inter-dental CAL was ≤ 3 mm.

Classification of dental surface defects in areas of gingival recession.

BACKGROUND A clinical classification of surface defects in gingival recession area is proposed. METHODS Two factors were evaluated to set up a classification system: presence (A) or absence (B) of cemento-enamel junction (CEJ) and presence (+) or absence (-) of dental surface discrepancy caused by abrasion (step). Four classes (A+, A-, B+, and B-) were identified on the basis of these variables. To validate the classification three different calibrated examiners applied the proposed classification system to 46 gingival recessions and kappa statistics were performed. The classification was used on 1,010 gingival recessions from 353 patients to examine the distribution of the four classes. RESULTS The kappa statistics for intrarater agreement ranged from 0.74 to 0.95 (almost perfect agreement), whereas interrater agreement ranged from 0.26 to 0.59 (moderate agreement). Out of 1,010 exposed root surfaces associated with gingival recession, 144 showed an identifiable CEJ associated with a root surface defect (Class A+, 14%); 469 an identifiable CEJ without any associated step (Class A-, 46%); 244 an unidentifiable CEJ with a step (Class B+, 24%); and 153 an unidentifiable CEJ without any associated step (Class B-, 15%). CONCLUSION The proposed classification describes the dental surface defects that are of paramount importance in diagnosing gingival recession areas.

The Miller classification of gingival recession: limits and drawbacks.

Pini-Prato G. The Miller classification of gingival recession: limits and drawbacks. J Clin Periodontol 2011; 38: 243–245. 38: 243–245. doi: 10.1111/j.1600-051X.2010.01655.x.

Long-Term 8-Year Outcomes of Coronally Advanced Flap for Root Coverage

BACKGROUND This long-term 8-year case series study aims at evaluating the results of the outcomes of coronally advanced flap (CAF) procedures performed for the treatment of single gingival recessions (GRs). METHODS Sixty patients with single maxillary GRs ≥ 2 mm, without loss of interproximal soft and hard tissue, treated with the CAF procedure and evaluated at 6 months in a previously published article, were followed for 8 years. Complete root coverage, recession reduction, and amount of keratinized tissue (KT) were analyzed using descriptive statistics, the paired t test, McNemar test, and a general linear model. RESULTS Three patients dropped out during the course of 8 years. Recession reduction from baseline to 8 years was 2.3 ± 1.1 mm; P <0.0001, whereas GRs increased in 53% of the sites from 6 months to 8 years (0.5 ± 0.7 mm; P <0.0001). The percentage of sites with complete root coverage decreased from 55% at 6 months to 35% at 8 years (P = 0.0047). The amount of KT tended to decrease from baseline to 8 years (0.6 ± 0.8 mm; P <0.0001). The general linear model shows that recession reduction is associated with both baseline recession depth and with the amount of initial KT. Sex, age, and smoking are not associated with recession reduction at 8 years. CONCLUSIONS The CAF procedure is effective in the treatment of GRs However, recession relapse and reduction of KT occurred during the follow-up period. The baseline width of KT is a predictive factor for recession reduction when using the CAF technique.

Influence of inter‐dental tissues and root surface condition on complete root coverage following treatment of gingival recessions: a 1‐year retrospective study

AIM To explore the influence of inter-dental tissues and root surface condition on complete root coverage following surgical treatment of gingival recessions. METHODS Three hundred and eighty-six single recessions treated over 28 years were assessed. Patient-level and periodontal variables, presence/loss of inter-dental tissues, and presence/absence of non-carious cervical lesions (NCCLs) were recorded. Root coverage was assessed 1-year post-surgery. Multilevel analysis was performed to identify predictors of CRC. RESULTS Based on type of root coverage procedure four patient groups were created: free gingival graft (FGG) (n = 116), coronally advanced flap (CAF) (n = 107), CAF+connective tissue graft (CTG) (n = 131), and guided tissue regeneration (GTR) (n = 32). Percentages of complete root coverage (CRC) were 18.1% for FGG, 35.5% for CAF, 35.1% for CAF+CTG, and 18.8% for GTR. There was an OR = 0.26 (p < 0.0001) of achieving CRC in cases with loss of inter-dental tissue compared with cases with no inter-dental tissue loss. Similarly, cases with presence of NCCL showed an OR = 0.28 (p < 0.0001) of achieving CRC compared with cases without a NCCL. FGG achieved less CRC then CAF+CTG (p = 0.0012; OR = 0.32). CONCLUSIONS NCCLs, just like inter-dental tissue loss, are significant negative prognostic factors in achieving CRC following root coverage procedures.

Treatment of Acute Periodontal Abscesses Using the Biofilm Decontamination Approach: A Case Report Study.

The aim of this preliminary study was to show the treatment effect of the biofilm decontamination approach on acute periodontal abscesses. Clinical cases showing acute periodontitis were treated using an oral tissue decontaminant material that contains a concentrated aqueous mixture of hydroxybenzenesulfonic and hydroxymethoxybenzene acids and sulfuric acid. The material was positioned into the pocket on the root surface and left in the site for 30 seconds. No instrumentation was performed before the treatment. No systemic or local antibiotics were used in any of the cases. A questionnaire was used for each patient to record the pain/discomfort felt when the material was administered. All of the treated cases healed well and very rapidly. The infections were quickly resolved without complications, and the pockets associated with marginal tissue recession were also reduced. The momentary pain upon introduction of the material was generally well tolerated in the nonsurgically treated cases, and it completely disappeared after a few seconds. The biofilm decontamination approach seems to be a very promising technique for the treatment of acute periodontal abscess. The local application of this material avoids the use of systemic or local antibiotics.

Critical Evaluation of Complete Root Coverage as a Successful Endpoint of Treatment for Gingival Recessions

Two differing evaluation criteria for complete root coverage (CRC) were used to compare incidence of CRC after root coverage procedures. Clinical records of 363 patients (386 single recessions) treated between 1984 and 2012 were screened. CRC was assessed 1 year after surgery using two separate evaluation criteria: CRC1, in which the gingival margin was at or above the cementoenamel junction (CEJ), measured using a periodontal probe directly on patients by a single examiner; and CRC2, in which the gingival margin was above the CEJ, rendering it completely invisible based on a visual assessment of high-magnification digitalized images by two calibrated examiners. Descriptive and inferential statistics were performed. The k statistic was also calculated to test the agreement between the two examiners. Four treatment groups were identified: free gingival graft (FGG; n = 116), coronally advanced flap (CAF; n = 107), CAF + connective tissue graft (CTG; n = 131) and guided tissue regeneration (GTR; n = 32). The overall difference between the proportion of CRC1 and CRC2 was statistically significant (P < .0001), as were the intragroup differences for FGG (P = .0002), CAF (P = .0009), and CTG (P = .0002). Treatment of gingival recessions should only be deemed completely successful when root coverage is associated with a gingival margin and a crevice probing depth that is coronal to the CEJ. When root coverage is regarded as complete with gingival margin located at the level of CEJ, it does not represent complete treatment success.

Nonsurgical Treatment of Peri-implantitis Using the Biofilm Decontamination Approach: A Case Report Study.

The aim of this preliminary study is to show the effect of the biofilm decontamination approach on peri-implantitis treatment. Clinical cases showing peri-implantitis were treated using an oral tissue decontaminant material that contains a concentrated aqueous mixture of hydroxybenzenesulfonic and hydroxymethoxybenzenesulfonic acids and sulfuric acid. The material was positioned in the pocket around the implant without anesthesia in nonsurgically treated cases. No instrumentation and no systemic or local antibiotics were used in any of the cases. A questionnaire was used for each patient to record the pain/discomfort felt when the material was administered. All of the treated cases healed well and rapidly. The infections were quickly resolved without complications. The momentary pain on introduction of the material was generally well tolerated and completely disappeared after a few seconds. The biofilm decontamination approach seems to be a very promising technique for the treatment of peri-implantitis. The local application of this material avoids the use of systemic or local antibiotics.

Authors' Response: Re: Finkelman RD. Letter to the Editor: Re: “Clinical Guidelines of the Italian Society of Periodontology for the Reconstructive Surgical Treatment of Angular Bony Defects in Periodontal Patients”

We appreciate the interest and the comments by Dr. Richard D. Finkelman1 about our article titled ‘‘Clinical guidelines of the Italian Society of Periodontology for the reconstructive surgical treatment of angular bony defects in periodontal patients.’’2 He suggested that the randomized clinical trial by Reddy et al.3 on standard regenerative surgery in infrabony defects using a combined treatment (placement of a freeze-dried demineralized bone allograft, coverage with a bioabsorbable guided tissue regeneration membrane, and adjunctive use of systemic antibiotics) should be included in the guidelines. Even if this study is interesting, the guidelines considered only single treatments of angular bony defects as reported in the Materials and Methods, ‘‘Results concerning combinations of . . . treatments (e.g., bone graft beneath a membrane) were not taken into consideration because . . . it would be difficult to determine the contributions of the single techniques to the overall results.’’2 Therefore, the quoted article3 (as well as other papers) was excluded from the clinical guidelines.