Umberto Demoner Ramos

Antimicrobial Photodynamic Therapy as an alternative to Systemic Antibiotics: Results from a Double‐Blind, Randomized, Placebo‐Controlled, Clinical Study on type 2 Diabetics

AIM This double-blind, placebo-controlled clinical study compared multiple applications of the antimicrobial photodynamic therapy (aPDT) treatment protocol, to systemic doxycycline as adjuvant to scaling and root planing (SRP) on type 2 diabetic patients on clinical, systemic and immune-inflammatory outcomes. MATERIALS AND METHODS Thirty patients with Hba1c >7% were allocated in two groups, SRP + Doxy (n = 15) using systemic doxycycline 100 mg/day (14 days) and SRP + aPDT (n = 15) with multiple applications (0, 3, 7 and 14 days). Primary outcome was glycated haemoglobin levels (HbA1c). Clinical parameters: plaque score (PS), bleeding on probe, probing depth, suppuration, gingival recession, and clinical attachment level, percentage of pockets with desired clinical endpoint were measured at baseline and 3 months after therapy. Cytokine profile was assessed at 0, 1 and 3 month to measure IL1-β, TNF-α and TGF-β on gingival crevicular fluid. RESULTS No significant difference was detected on HbA1c, between treatments. The SRP + aPDT group showed advantage on reducing moderate pockets in single-rooted teeth at 3 months. SRP + aPDT presented better results at 3 months on IL1-β levels. There were no significant differences between TNF-α and TGF-β. CONCLUSIONS Both treatments improved clinical and systemic outcomes (Hba1c). SRP + aPDT performed better in moderate probing pocket depth on single-rooted teeth, reduced favourably inflammation in short term, and may be an alternative to systemic antibiotics. (Clinicaltrials.org ID NCT01595594).

A Randomized comparative clinical study of two surgical procedures to improve root coverage with the acellular dermal matrix graft

AIM This randomized, controlled, clinical study compared two surgical techniques for root coverage with the acellular dermal matrix graft (ADMG) to evaluate which procedure could provide better root coverage and greater amounts of keratinized tissue. MATERIALS AND METHODS Fifteen pairs of bilateral Miller Class I or II gingival recessions were treated and assigned randomly to the test group, and the contra-lateral recessions were assigned to the control group. The ADMG was used in both groups. In the control group, the graft and flap were positioned at the level of the cemento-enamel junction (CEJ), and in the test group, the graft was positioned 1 mm apical to the CEJ and the flap 1 mm coronal to the CEJ. The clinical parameters were taken before the surgeries and after 6 months. The gingival recession area, a new parameter, was measured in standardized photographs through a special device and software. RESULTS There were statistically significant differences favouring the proposed technique for all parameters except for the amount of keratinized tissue at 6 months. CONCLUSIONS The proposed test technique is more suitable for root coverage procedures with ADMG, and the new parameter evaluated appears valuable for root coverage analysis. (Clinicaltrials.gov Identifier: NCT01175720).

A Modified Surgical Technique for Root Coverage With an Allograft: A 12-Month Randomized Clinical Trial

BACKGROUND The aim of this randomized controlled clinical study is to investigate whether a modified surgical technique could provide better results for root coverage and greater amounts of keratinized tissue (KT) with the acellular dermal matrix graft (ADMG). METHODS Fifteen bilateral Miller Class I or II gingival recessions (GRs) were selected. The recessions were treated and assigned randomly to the test group (TG), and the contralateral recessions were assigned to the control group (CG). The ADMG was used in both groups with differences in the graft positioning between them. The following clinical parameters were measured before the surgeries and after 12 months: 1) probing depth; 2) relative clinical attachment level; 3) GR; 4) thickness of KT (TKT); and 5) KT width. A new parameter, the GR area (GRA), was measured in standardized photographs using a special device and software. RESULTS There was no significant difference between groups in KT width and TKT parameters at the 12-month postoperative period. However, there was a significant difference between the gains in GR (ΔGR) and GRA (ΔGRA), favoring the TG after 12 months. The TG presented ΔGR = 3.04 ± 0.29 mm and ΔGRA= 38,919 ± 9,238 pixel square values (pix(2)), and the CG presented ΔGR= 2.61 ± 0.41 mm and ΔGRA= 22,245 ± 9,334 pix(2) (P <0.05 and <0.001, respectively). CONCLUSIONS Both techniques were successful. The TG treatment was more effective in reducing GR and GRA. The flap and graft position may be of importance in root coverage procedures outcome.

Esthetical Clinical Crown Lengthening, Lip Repositioning, and Gingival Depigmentation

For many people, the smile is considered the “business card” because it may reflect a part of the individual behavior and feeling of each one of us. Healthy, harmonious, and pleasant smiles are associated to four elements:

Periodontal Anatomy and Its Role on the Treatment Planning of Aesthetic Areas

The periodontium can be defined as “the tissues that invest and support the teeth including the gingiva, alveolar mucosa, cementum, periodontal ligament, and alveolar and supporting bone” [1] (Fig. 2.1).

Complications, Adverse Effects, and Patient-Centered Outcomes of Soft Tissue Augmentation Procedures and the Use of Gingival Soft Tissue Substitutes

The base of systematic reviews available for gingival recession treatment the use of CAF alone or in association with allogeneic, xenogeneic, or alloplastic biomaterials (e.g., matrix grafts or enamel matrix derivative) has been described as being less painful and more comfortable, due to the need of only one surgical site [1–7]. Conversely, it has been demonstrated that use of SCTG, FGG, and nonabsorbable membranes has been associated with increased morbidity and some complications, such as postoperative pain, bleeding and swelling during the early phase of healing (Fig. 4.1a–c), and membrane exposure/contamination [1–7].

Multidisciplinary Decision-Making: The “Real-World” Clinical Scenarios

Case I – 1 (a–h). Treatment planning: nonsurgical periodontal therapy (supra- and subgingival scaling) and conventional gingivectomy at the anterior sextant of the mandible via external beveled incision. Baseline (a). After basic procedures (b). Identification of the remaining pseudo-pockets (c, d). Pseudo-pockets surgically removed (e). One-week follow-up (f). Four-month follow-up (g). Achievement of a normal probing depth (h)