Karin Jepsen

Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial

AIM To evaluate the clinical outcomes of the use of a xenogeneic collagen matrix (CM) in combination with the coronally advanced flap (CAF) in the treatment of localized recession defects. MATERIAL & METHODS In a multicentre single-blinded, randomized, controlled, split-mouth trial, 90 recessions (Miller I, II) in 45 patients received either CAF + CM or CAF alone. RESULTS At 6 months, root coverage (primary outcome) was 75.29% for test and 72.66% for control defects (p = 0.169), with 36% of test and 31% of control defects exhibiting complete coverage. The increase in mean width of keratinized tissue (KT) was higher in test (from 1.97 to 2.90 mm) than in control defects (from 2.00 to 2.57 mm) (p = 0.036). Likewise, test sites had more gain in gingival thickness (GT) (0.59 mm) than control sites (0.34 mm) (p = 0.003). Larger (≥3 mm) recessions (n = 35 patients) treated with CM showed higher root coverage (72.03% versus 66.16%, p = 0.043), as well as more gain in KT and GT. CONCLUSIONS CAF + CM was not superior with regard to root coverage, but enhanced gingival thickness and width of keratinized tissue when compared with CAF alone. For the coverage of larger defects, CAF + CM was more effective.

Clinical concepts for regenerative therapy in furcations

Furcation involvements present one of the greatest challenges in periodontal therapy because furcation-involved molar teeth respond less favorably to conventional periodontal therapy compared with noninvolved molar or nonmolar teeth. Various regenerative procedures have been proposed and applied with the aim of eliminating the furcation defect or reducing the furcation depth. An abundance of studies and several systematic reviews have established the effectiveness of membrane therapy (guided tissue regeneration) for buccal Class II furcation involvement of mandibular and maxillary molars compared with open flap surgery. Bone grafts/substitutes may enhance the results of guided tissue regeneration. However, complete furcation closure is not a predictable outcome. Limited data and no meta-analyses are available on the effects of enamel matrix proteins for furcation regeneration. Enamel matrix protein therapy has demonstrated clinical improvements in the treatment of buccal Class II furcation defects in mandibular molars; however, complete closure of the furcation lesion is achieved only in a minority of cases. Neither guided tissue regeneration nor enamel matrix protein therapy have demonstrated predictable results for approximal Class II and for Class III furcations. Promising preclinical data from furcation regeneration studies in experimental animals is available for growth factor- and differentiation factor-based technologies, but very limited data are available from human clinical studies. Although cell-based therapies have received considerable attention in regenerative medicine, their experimental evaluation in the treatment of periodontal furcation lesions is at a very early stage of development. In summary, the indications and the limitations for currently available treatment modalities for furcation defects are well established. New regenerative treatments are clearly needed to improve the predictability of a complete resolution of furcation defects.

EFP Delphi study on the trends in Periodontology and Periodontics in Europe for the year 2025

AIM The aim was to assess the potential trends in Periodontology and Periodontics in Europe that might be anticipated by the year 2025, using the Delphi method. MATERIAL AND METHODS The expert opinion of 120 experts was sought through the use of an open-ended questionnaire, developed by an advisory group, containing 40 questions concerning the various trends in periodontology. RESULTS The experts (113 responders) expect a stabilization of the prevalence of periodontitis, both for the chronic as well as the aggressive cases, but an increase in implant-related diseases up to the year 2025. Concurrently, the importance of implants is seen to be increasing. They foresee an increased demand for postgraduate periodontology and implantology training. This is mirrored in an increase in publications for implant dentistry and increase in demand and need for training. Concerning the patients, better-informed individuals seeking more routine check-ups are expected. CONCLUSION A continued need for specialized periodontists, but also well trained dental practitioners is foreseen for next decade in Europe. Apart from periodontology they will be increasingly exposed to and trained in implant dentistry.

Long-Term Stability of Root Coverage by Coronally Advanced Flap Procedures

BACKGROUND This study compared 6-month and 3-year outcomes for root coverage (RC) by coronally advanced flap (CAF) procedures in localized gingival recessions. METHODS Two centers, that had participated in a 6-month multinational multicenter randomized clinical trial (RCT), followed up 18 patients with 36 Miller Class I and II defects that had been treated in a split-mouth design with CAF procedures or CAF + xenogeneic collagen matrix (CMX). Percentage of RC, complete root coverage (CRC), width, and thickness of keratinized tissue were assessed by the same masked examiners as after the 6-month RCT. RESULTS There was a high correlation between 6-month and 3-year RC outcomes for both CAF procedures. Mean RC after CAF + CMX amounted to 89.9% after 6 months and 91.7% after 3 years (Pearsons correlation: 0.91). Corresponding values for CAF were 83.7% versus 82.8% (Pearsons correlation: 0.94). Likewise, CRC was stable with 61%/61% for CAF + CMX and 39%/39% for CAF after 6 months/3 years, respectively. CONCLUSIONS In this 3-year follow-up of a subgroup of patients from a previous 6-month RCT, there was a high correlation between the results for RC after 6 months and 3 years, indicating their stability. These data suggest that 6-month outcomes may be useful to predict long-term outcomes in CAF procedures with or without additional use of CMX.

Esthetic and functional rehabilitation of a severely compromised central incisor: an interdisciplinary approach.

This case report of a patient with a central incisor with rapid destruction of periodontal tissues associated with pathologic tooth migration illustrates the esthetic and functional reconstruction of a severely compromised tooth. An interdisciplinary approach, including resolution of the infection and regenerative periodontal surgery followed by orthodontic tooth movement, transformed a hopeless tooth with high mobility, attachment loss approaching the apex, and a Miller Class IV recession into a clinically healthy tooth. Treatment planning for periodontally involved anterior teeth with pathologic migration should consider a multidisciplinary approach for preservation of the natural dentition.

Management of a Central Incisor with Horizontal Root Fracture for Esthetic and Functional Rehabilitation.

Severely traumatized incisors in young adults are a very common problem, and one that is difficult to treat because healing of these teeth is not always predictable and implant placement has to be delayed until adulthood. This case report of a horizontal root fracture in an avulsed central incisor illustrates the ability to maintain crucial tooth structure. A lateral socket augmentation procedure after extraction of a root fragment combined with an endodontic and regenerative periodontal treatment approach could preserve natural esthetics and function, which are directly related to quality of life. The preservation of alveolar bone volume following partial root removal will eventually facilitate later placement of a dental implant with an improved esthetic and functional prosthodontic result in a patient with a high-risk esthetic profile.