Huseyin Gencay Keceli

Use of platelet gel with connective tissue grafts for root coverage: a randomized-controlled trial.

BACKGROUND Platelet-rich plasma (PRP) was speculated to be a promoter of periodontal regeneration. There are only a few clinical comparative studies using PRP in the treatment of gingival recession. AIM The aim of the present study was to compare connective tissue graft (CTG)+PRP with CTG alone in the treatment of gingival recession. MATERIAL AND METHODS Forty patients with Miller I/II recessions were included. Each recession was randomly treated with either CTG+PRP or CTG. Clinical variables were recorded at baseline and at 6 weeks, 6 and 12 months. Root coverage (RC) and attachment gain (AG) were also calculated. RESULTS Probing depth, recession depth, clinical attachment level, keratinized tissue width and recession width (RW) were improved in both study groups. However, no difference was observed between groups, except RW. RW in the control group was statistically lower than the test group at all follow-up periods. CONCLUSION Treatment of recession with CTG or a CTG-PRP combination resulted in favourable clinical outcomes. However, no difference could be found between CTG and CTG+PRP. Whether much longer follow-up studies with higher statistical power may change these results remains questionable.

Vertical and horizontal dimensional evaluation of free gingival grafts in the anterior mandible: a case report series

The shrinkage of free gingival grafts (FGGs) is a well-known clinical phenomenon but there are limited studies demonstrating the dimensional changes during healing in FGGs. The aim of the study is to examine the shrinkage of FGG in both horizontal and vertical dimensions and calculate the changes in the surface area of the graft at early and delayed periods of healing. The FGG procedure was applied to 15 consecutive patients in their mandibular anterior area. The graft sizes and areas were measured and the shrinkage of the graft was calculated at baseline and days 10, 21 and 180. Hemorrhage, sense alteration and pain symptoms were also examined. Change in the horizontal direction was not statistically significant during the whole study period (p > 0.05). However, there was a statistically significant reduction in the vertical direction in all visits, except day 10 (p < 0.05). Calculated graft area was also significantly reduced during the study period at all time-points compared to the baseline (p < 0.001). At day 10, 4 (26.7%) recipient sites and 5 (33%) donor sites demonstrated paresthesia. Only one (0.07%) recipient site demonstrated paresthesia at day 21 where the donor site resulted with an uneventful healing. At day 10, 5 (33%) patients demonstrated bleeding at their donor regions and resulted with a complete cessation of bleeding at day 21. Pain symptom was found in 8 (53.3%) recipient sites where 3 (20%) donor regions presented pain symptom at day 10. Graft shrinkage in the vertical dimension seems to affect the clinical outcomes of the FGG procedure. However, the influence of horizontal graft shrinkage was minimal.

Evaluation of palatal donor site haemostasis and wound healing after free gingival graft surgery

AIM Evaluating effectiveness of a medicinal plant extract (MPE) in achieving haemostasis and early wound healing at free gingival graft (FGG) donor site in a randomized controlled fashion. METHODS Forty patients requiring FGG at lower anterior area were randomly assigned into two groups. FGG was performed to all patients and following graft procurement; wet gauze (WG) was applied alone (control: WG group) or with MPE (test: MPE + WG group) for haemostasis. Donor site working time, bleeding (BLE), colour match (CM), pain, epithelization (EP) and sensation loss (SL) were evaluated. RESULTS Thirty-three participants completed a 6-month period study. In the test group, primary BLE was shorter (p < 0.001) and fewer individuals showed secondary BLE during 3 days (p < 0.001). During the 6 days, pain scores were higher in WG patients (p < 0.05). Later on, no inter-group difference was observed. EP was relatively faster (p < 0.001) and CM was slightly better (p < 0.05) in MPE + WG group. CONCLUSION MPE provided faster and continuous haemostasis that made a positive contribution to the early soft tissue healing to some extent but due to limitations; further trials are needed to demonstrate the efficiency of this material.

The Adjunctive Effect of Platelet-Rich Fibrin to Connective Tissue Graft in the Treatment of Buccal Recession Defects: Results of a Randomized, Parallel-Group Controlled Trial.

BACKGROUND Platelet-rich fibrin (PRF) is an autologous preparation that has encouraging effects in healing and regeneration. The aim of this trial is to evaluate the effectiveness of coronally advanced flap (CAF) + connective tissue graft (CTG) + PRF in Miller Class I and II recession treatment compared to CAF + CTG. METHODS Forty patients were treated surgically with either CAF + CTG + PRF (test group) or CAF + CTG (control group). Clinical parameters of plaque index, gingival index, vertical recession (VR), probing depth, clinical attachment level (CAL), keratinized tissue width (KTW), horizontal recession (HR), mucogingival junction localization, and tissue thickness (TT) were recorded at baseline and 3 and 6 months after surgery. Root coverage (RC), complete RC (CRC), attachment gain (AG), and keratinized tissue change (KTC) were also calculated. RESULTS All individuals completed the entire study period. At baseline, mean VR, HR, CAL, KTW, and TT values were similar (P >0.05). In both groups, all parameters showed significant improvement after treatment (P <0.001), and except TT (P <0.05), no intergroup difference was observed at 6 months after surgery. The amount of RC and AG, but not KTC and CRC, was higher in the PRF-applied group (P <0.05). CONCLUSIONS According to the results, the addition of PRF did not further develop the outcomes of CAF + CTG treatment except increasing the TT. However, this single trial is not sufficient to advocate the true clinical effect of PRF on recession treatment with CAF + CTG, and additional trials are needed.

A genome-wide association study identifies nucleotide variants at SIGLEC5 and DEFA1A3 as risk loci for periodontitis.

Abstract Periodontitis is one of the most common inflammatory diseases, with a prevalence of 11% worldwide for the severe forms and an estimated heritability of 50%. The disease is characterized by destruction of the alveolar bone due to an aberrant host inflammatory response to a dysbiotic oral microbiome. Previous genome‐wide association studies (GWAS) have reported several suggestive susceptibility loci. Here, we conducted a GWAS using a German and Dutch case‐control sample of aggressive periodontitis (AgP, 896 cases, 7,104 controls), a rare but highly severe and early‐onset form of periodontitis, validated the associations in a German sample of severe forms of the more moderate phenotype chronic periodontitis (CP) (993 cases, 1,419 controls). Positive findings were replicated in a Turkish sample of AgP (223 cases, 564 controls). A locus at SIGLEC5 (sialic acid binding Ig‐like lectin 5) and a chromosomal region downstream of the DEFA1A3 locus (defensin alpha 1‐3) showed association with both disease phenotypes and were associated with periodontitis at a genome‐wide significance level in the pooled samples, with P = 1.09E‐08 (rs4284742,‐G; OR = 1.34, 95% CI = 1.21‐1.48) and P = 5.48E‐10 (rs2738058,‐T; OR = 1.28, 95% CI = 1.18‐1.38), respectively. SIGLEC5 is expressed in various myeloid immune cells and classified as an inhibitory receptor with the potential to mediate tyrosine phosphatases SHP‐1/‐2 dependent signaling. Alpha defensins are antimicrobial peptides with expression in neutrophils and mucosal surfaces and a role in phagocyte‐mediated host defense. This study identifies the first shared genetic risk loci of AgP and CP with genome‐wide significance and highlights the role of innate and adaptive immunity in the etiology of periodontitis.

Management of Limited Vertical Bone Height in the Posterior Mandible: Short Dental Implants Versus Nerve Lateralization With Standard Length Implants.

Abstract Inferior alveolar nerve lateralization (IANL) and short dental implants (SDI) are 2 viable implant-based treatment approaches in the presence of atrophied posterior mandible. Despite the risks of dysfunction, infection, and pathologic fractures in IANL, it becomes possible to place standard implants. The purpose of this study was to compare SDI and IANL approaches from clinical and radiographic aspects. Fifteen subjects having unilateral atrophic mandibles were allocated to SDI and IANL treatment groups. Following surgical procedures, early postoperative complications, implant survival, and periimplant clinical and radiographic parameters including probing pocket depth, attachment level, keratinized tissue amount, vertical tissue recession, and marginal bone loss were recorded at baseline and 1-year after prosthetic rehabilitation. In both groups, no implant was lost. Except usual postoperative complications, 2 patients had transient paraesthesia after IANL. According to time-dependent evaluation, both groups showed significant increase in probing pocket depth and attachment level at 1-year follow-up compared with baseline (P < 0.05). Except a slight but significant increase in mesial surface of SDI group (P < 0.05), no remarkable time-dependent change was identified in vertical tissue recession. Keratinized tissue amount did not exhibit any inter- or intragroup difference during whole study period. Marginal bone loss did not show any difference between IANL and SDI groups at follow-up. SDI placement or standard length implant placement with IANL can be considered promising alternatives in the treatment of atrophic mandibular posterior regions. However, SDI may be preferred in terms of lower complication risk.

Fifteen months follow-up of a hopeless tooth treated with two-step procedure involving intentional replantation and free gingival graft.

The aim of the report is to document 15-month results of mucogingival surgery applied following intentional replantation (IntR). A mandibular left lateral incisor with severe periodontitis and malposition was replanted and splinted following root canal treatment. Three months after IntR, a free gingival graft (FGG) was placed. Fifteen months follow-up of the case demonstrated significant improvement in periodontal healing parameters and significant bone fill was detected around the root apex. As a conclusion, IntR may be speculated as a convenient alternative to keep the periodontally hopeless teeth and supportive approaches such as FGGs may improve the outcomes following IntR.

Evaluation of Extraction Site Dimensions and Density Using Computed Tomography Treated With Different Graft Materials: A Preliminary Study

Purpose: The preliminary human study was designed to evaluate extraction site changes using CT after socket preservation (SP) with different materials. Materials and Methods: Fifty-two sockets from 17 Turkish individuals (8 women and 9 men; mean age 44.70 ± 9.99 years) localized at the maxillary anterior area were treated with demineralized bone matrix + collagen membrane (CM) (N = 14), hydroxyapatite bone substitute (HBS) + CM (N = 14), CM (N = 13), or left empty (N = 11). CT scans were taken 10 and 120 days after the procedure. Horizontal and vertical socket dimensions and Hounsfield unit (HU) values were evaluated. Results: First 3 groups showed a significant horizontal decrease from day 10 to 120. No significant change was detected in vertical socket dimension. For both horizontal and vertical, no intergroup difference was detected at days 10 and 120. At days 10 and 120, HU values in HBS + CM group were significantly higher compared with others. Apical and coronal HU values were not different at any period. Conclusion: Even if it did not provide better socket dimensions, HBS + CM treatment brought higher tissue density and thus, can be recommended to increase the bone quality and implant success after SP in upper anterior area.

Evaluation of single tooth loss to maxillary sinus and surrounding bone anatomy with cone-beam computed tomography: A multicenter study

Background: Posterior maxillary tooth loss may complicate the implant treatment due to the alterations in alveolar anatomy and maxillary sinus pneumatization. This study aimed to comprehensively examine the anatomical structure of this region from cone-beam computed tomography (CBCT) images. Materials and Methods: The posterior maxilla regions with single tooth loss were analyzed by dividing the variables into 3 subgroups from images of 597 patients chosen from 1160 CBCTs. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height (ABH) and width (RW), posterior superior alveolar artery (PSAA), and adjacent roots were evaluated. Results: The majority of the patients demonstrated 0 to 5 mm membrane thickness. Irregular SM thickening was lower for female patients. While females showed higher number of narrow sinus, males had higher RW than females. Sinus augmentation classification showed negative correlation with ABH, root-tip sinus floor and edentulous site classification. Posterior septa height was correlated with number of septa and ABH. PSAA diameter and location were also correlated between each other. Conclusion: The present results define formation of a sinus space with 11 mm coronal and 16 mm apical width after single tooth loss. A flat or semispherical thickening around 4 mm is usual in most cases with 51% possibility of anterior septum existence. A ridge anatomy, around 7.5 mm ABH and 7.2 to 9.3 RW from coronal to apical, complements this anatomy. Further studies are needed to clarify the reasons behind the SM and crestal anatomy variations between genders.

Tissue engineering applications and nanobiomaterials in periodontology and implant dentistry

Abstract The treatment of periodontal diseases with their associated anomalies and replacement of lost teeth by endosseous dental implants sometimes undertakes a stringent process with high variations in success rates and predictability of regeneration. An applied biomedical research area, tissue engineering, aims to develop biomaterials or procedures for replacing damaged tissues with new ones by adhering to the principles of developmental biology, biomaterials science and cell biology. Nanotechnology came out as a new scientific discipline in 1990s and with significant developments on techniques and materials, various treatment strategies have been defined and functional tissue regeneration have become a reality. Today, an elaborated oral health care achievement is now beyond the expectance by the utilization of tissue engineering modalities and nanobiomaterials. This chapter aims to highlight and discuss the role of nanobiomaterials and their diagnostic, therapeutic and preventive potential in periodontics and implants dentistry, with particular emphasis given to current challenges and future possibilities related with the strategies of tissue engineering in periodontology and implant dentistry.