Roberto Rotundo

Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? A multi‐centre, randomized, double‐blind, clinical trial

AIMS This parallel-group, multi-centre, double-blind, randomized-controlled clinical trial was undertaken to compare the clinical outcomes and patient morbidity of coronally advanced flap (CAF) alone or in combination with a connective tissue graft (CAF+CTG) in single Miller Class I and II gingival recessions. MATERIAL AND METHODS Three centres enrolled 85 patients with one recession each. Surgery was performed elevating a pedicle flap; 42 sites randomly received a graft under the flap. Measurements were taken by blind and calibrated examiners. Outcome measures included recession reduction, complete root coverage (CRC), intra-operative and post-operative morbidity, dentine sensitivity, and side effects. RESULTS No differences were noted in the intra-operative and post-operative patient-related variables between the two groups. Surgical time was significantly shorter in the CAF group. Recession reduction was not statistically different between the two groups, even though a model showed a tendency towards improved outcomes in sites treated with CAF+CTG (adjusted difference 0.33 mm, 95% CI=-0.06 to 0.72, p=0.1002). Significantly greater probability of CRC was observed after CAF+CTG (adjusted OR=5.09, 95% CI=1.69-17.57, p=0.0033). Dentine hypersensitivity improved in both the groups. CONCLUSIONS Both treatments were effective in providing a significant reduction of the baseline recession and dentine hypersensitivity, with only limited intra-operative and post-operative morbidity and side effects. Adjunctive application of a CTG under a CAF increased the probability of achieving CRC in maxillary Miller Class I and II defects.

Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split‐mouth study with a 5‐year follow‐up

AIM The aim of this long-term study was to compare the clinical outcomes of coronally advanced flap (CAF) alone versus coronally advanced flap plus connective tissue graft (CAF+CTG) in the treatment of multiple gingival recessions using a split-mouth design over 5 years of follow-up. MATERIALS AND METHODS A total of 13 patients (mean age 31.4 years) showing multiple bilateral gingival recessions were treated. On one side, CAF+CTG was used, while in the contra-lateral side, a CAF alone was applied. Clinical outcomes were evaluated at the 6-month, 1-year and 5-year follow-ups. RESULTS A total of 93 Miller class I, II and III gingival recessions were treated. In the CAF+CTG-treated sites, the baseline gingival recession was 3.6 +/- 1.3 mm, while in the CAF-treated sites, it was 2.9 +/- 1.3 mm (p=0.0034). No difference in terms of the number of sites with complete root coverage (CRC) was reported (OR=0.49, p=0.1772) at the 6-month follow-up. At the 5-year follow-up, CAF+CTG-treated sites showed a higher percentage of sites with CRC (52%) than CAF-treated sites (35%) (OR=3.94; p=0.0239). An apical relapse of the gingival margin in CAF-treated sites was observed while a coronal improvement of the margin was noted in CAF+CTG-treated sites between the 6-month and the 5-year follow-ups. CONCLUSIONS CAF+CTG provided better CRC than CAF alone in the treatment of multiple gingival recessions at the 5-year follow-up.

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.

Retrospective Evaluation of the Influence the Interleukin-1 Genotype on Radiographic Bone Levels in Treated Periodontal Patients Over 10 Years

BACKGROUND A difference in genetic susceptibility to plaque accumulation has been advocated to explain different responses to periodontal therapy. The purpose of this study is to assess the role of the interleukin-1(IL-1) polymorphism on the rate of bone and tooth loss in non-smoking periodontally treated patients during maintenance. METHODS Sixty consecutive non-smoking patients (mean age 46.8 ± 5.0) with moderate to severe periodontitis, treated and maintained for over 10 years were selected. At baseline (T0), radiographic evaluation (cementoenamel junction [CEJ]-root apex, CEJ-bottom of defect mesial and distal, CEJ-bone crest mesial and distal, crown-root ratio) was performed. All patients received scaling and root planing; 36 patients then underwent surgical therapy. Subsequently, all patients were enrolled in a periodontal maintenance program with recall visits every 3.4 ± 1.0 months for at least 10 years. At the latest recall visit (T2) the same radiographic measurements evaluated at baseline were taken and a DNA sample for IL-1 genetic susceptibility testing was collected and sent for analysis. RESULTS Twenty-three of the 60 patients (38.3%) were IL-1 genotype positive. A total of 52 teeth (3.3%) out of 1,566 were lost due to periodontitis between T0 and T2; 28 of 957 (2.9%) in the IL-1 genotype negative group and 24 of 609 (3.9%) in IL-1 genotype positive group. The mean variation in bone defect level (ΔBD) averaged -0.04 mm in IL-1 genotype negative patients and 0.01 mm in IL-1 genotype positive patients. The mean variation in bone crest level (ΔBC) averaged -0.24 mm in IL-1 genotype negative patients and -0.28 mm in IL-1 genotype positive patients. However, a few patients showed significant differences in response to therapy based on initial bone levels and genotype. IL-1 negative patients who showed minimal initial bone loss responded to the therapy better than the IL-1 positive patients. IL-1 positive patients with severe initial bone loss showed a better response to the therapy than IL-1 negative patients. CONCLUSIONS On average, there were no significant differences related to IL-1 genotype in tooth loss after 10 years in a non-smoking, well-maintained periodontal population. On an individual patient basis, the IL-1 genotype, in combination with the initial bone level, seems useful at the beginning of therapy for predicting bone level variation. J Periodontol 2001;72:767-773.

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.

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.

Fourteen-year outcomes of coronally advanced flap for root coverage: follow-up from a randomized trial

TRIAL DESIGN This long-term 14-year-randomized split-mouth study aimed at evaluating (1) the outcomes of two different methods of root surface modifications (root surface polishing versus root planing) used in combination with a coronally advanced flap (CAF) and (2) the long-term results of CAF performed for the treatment of single gingival recessions. METHODS Ten patients with similar bilateral recessions ≥2 mm were selected for a split-mouth randomized design study. Exposed root surfaces were assigned to receive polishing (test sites) or root planing (control sites). A multilevel model was used to analyse data at 3 months, 1, 5 and 14 years. RESULTS One patient dropped out after 1 year. At 14 years, recession depth (Rec) was 0.9 (1.2) mm for the test sites and 0.9 (0.9) mm for the control sites. The interaction between treatment and keratinized tissue was significant (p=0.0035). Rec increased slightly over time (p=0.0006) in both the groups. CONCLUSIONS This study shows that during a long-term follow-up, gingival recession recurred in 39% of the treated sites following the CAF procedure.

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.

Aesthetic perception after root coverage procedure.

AIM To investigate the aesthetic perception of the clinical outcomes of a simulated root coverage procedure in three different groups: patients, dentists, and periodontists. MATERIAL AND METHODS 100 patients, 107 general dentists affiliated with the Dental Association of Prato, Italy, and 81 active members of the Italian Society of Periodontology were recruited for this study. The following variables: age, gender, level of education, place of residence, and years of practice (only for dentists and periodontists) were recorded by means of a questionnaire administered to each subject within the three different groups. In addition, the participants in the study were requested to assign scores to images of eight simulated clinical cases of gingival recessions: a pre- and post-treatment image for each case. RESULTS Statistically significant differences between groups were not detected in most of the scores. Gender and residence were not significantly associated with the scores, while age was correlated for two clinical cases (p=0.0014 and 0.0017). All the cases of complete root coverage showed the highest scores among all the participants. CONCLUSIONS These results showed that complete root coverage following root coverage procedure is perceived as the most successful outcome by patients, dentists, and periodontists.

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.