Comparative evaluation of effect of injectable platelet-rich fibrin with collagen membrane compared with collagen membrane alone for gingival recession coverage

BACKGROUND Collagen membrane and platelet-rich fibrin(PRF)have emerged as vital biomaterials in the field of periodontal regeneration.Minimally invasive techniques are being preferred by most periodontists,as it is patient compliant with fewer post-surgical complications as compared to conventional surgical techniques.Thus,in this study we have evaluated the effect of injectable PRF(i-PRF)with collagen membrane compared with collagen membrane alone using vestibular incision subperiosteal tunnel access(VISTA)technique for gingival recession coverage.AIM To compare the efficacy of VISTA using collagen membrane with collagen membrane soaked in injectable PRF for gingival recession coverage.METHODS A split mouth randomized controlled clinical trial was designed;13 subjects having at least 2 teeth indicated for recession coverage were enrolled in this study.The sites were randomly assigned to control group(VISTA using collagen membrane alone)and the test group(VISTA using collagen membrane with i-PRF).The clinical parameters assessed were pocket depth,recession depth(RD),recession width(RW),relative attachment level,keratinised tissue width(KTW),keratinised tissue thickness(KTT),and percentage root coverage.RESULTS RD showed a statistically significant difference between the test group at 3 mo(0.5±0.513)and 6 mo(0.9±0.641)and the control group at 3 mo(0.95±0.51)and 6 mo(1.5±0.571),with P values of 0.008 and 0.04,respectively.RW also showed a statistically significant difference between the test group at 3 mo(1±1.026)and 6 mo(1.65±1.04)and the control group at 3 mo(1.85±0.875)and 6 mo(2.25±0.759),with P values of 0.008 and 0.001,respectively.Results for KTW showed statistically significant results between the test group at 1 mo(2.85±0.489),3 mo(3.5±0.513),and 6 mo(3.4±0.598)and the control group at 1 mo(2.45±0.605),3 mo(2.9±0.447),and 6 mo(2.75±0.444),with P values of 0.04,0.004,and 0.003,respectively.Results for KTT also showed statistically significant results between test group at 1 mo(2.69±0.233),3 mo(2.53±0.212),and 6 mo(2.46±0.252)and the control group at 1 mo(2.12±0.193),3 mo(2.02±0.18),and 6 mo(1.91±0.166),with P values of 0.001,0.001,and 0.001,respectively.The test group showed 91.6%,81.6%,and 67%root coverage at 1 mo,3 mo,and 6 mo,while the control group showed 82.3%,66.4%,and 53.95%of root coverage at 1 mo,3 mo,and 6 mo,respectively.CONCLUSION The use of minimally invasive VISTA technique along with collagen membrane and injectable form of platelet-rich fibrin can be successfully used as a treatment method for multiple or isolated gingival recessions of Miller’s class-I and class-II defects.

Gingival unit transfer using in the Miller Ⅲ recession defect treatment

The most significant factor for the success in soft tissue grafts is the synergistic relation between vascular configuration and involved tissues. In the soft tissue graft procedures, site specific donor tissue is assumed to have improved potential for function and aesthetic survive at recipient sites. On a clinical level, using site specific gingival unit graft that placed on traditionally prepared recipient site, results in predictable root coverage. In this case report the clinical effectiveness of gingival unit transfer(GUT) technique performed on Miller Ⅲ recession was presented and a similar recession case treated with free gingival graft(FGG) technique for comparison. Probing depth, recession depth, keratinized tissue width and clinical attachment level clinical parameters were measured at baseline and postoperative 8 mo. Percentage of defect coverage was evaluated at postoperative 8 mo. Creeping attachment was assessed at postoperative 1, 3, 6 and 8 mo. The GUT revealed better defect coverage and creeping attachment results than the FGG in the treatment of Miller Ⅲ defects.

In Vitro Evaluation of Two Tissue Substitutes for Gingival Augmentation

Three-dimensional collagen matrices of porcine origin are being used as substitutes for soft tissue grafts in periodontal plastic surgery in search of aesthetic and natural results. This in vitro study aimed to compare Fibro-Gide® (GeistlichBiomaterials) and Mucoderm® (BotissBiomaterials) matrices during the initial phase of soft tissue formation. For this purpose, samples of 5 × 5 mm were obtained, and then human fibroblasts were plated on them. After 24, 48 and 72 h, cell viability was assessed using an MTT assay, and the secretion of type I collagen, MMP-2, TIMP-1 and TIMP-2 was analyzed by ELISA immunoassay. The control group (C) consisted of cells plated on polystyrene without the matrices. The morphology of the surfaces was also examined using scanning electron microscopy (SEM), as was the average roughness (Ra) of the samples by a profilometer. Topographic analysis revealed that roughness was significantly higher on Mucoderm® than on Fibro-Gide® (p 0.05). The synthesis of type I collagen, MMP-2 and TIMP-1 were significantly higher from cells plated on Fibro-Gide® than on Mucoderm®, in all time points (p ® than on Mucoderm® (p ® induced an increase in type I collagen, MMP-2 and TIMP-1 and TIMP-2.

Multi-disciplinary treatment of maxillofacial skeletal deformities by orthognathic surgery combined with periodontal phenotype modification:A case report

BACKGROUND Maxillofacial deformities are skeletal discrepancies that cause occlusal,functional,and esthetic problems,and are managed by multi-disciplinary treatment,including careful orthodontic,surgical,and periodontal evaluations.However,thin periodontal phenotype is often overlooked although it affects the therapeutic outcome.Gingival augmentation and periodontal accelerated osteogenic orthodontics(PAOO)can effectively modify the periodontal phenotype and improve treatment outcome.We describe the multi-disciplinary approaches used to manage a case of skeletal ClassⅢmalocclusion and facial asymmetry,with thin periodontal phenotype limiting the correction of deformity.CASE SUMMARY A patient with facial asymmetry and weakness in chewing had been treated with orthodontic camouflage,but the treatment outcome was not satisfactory.After examination,gingiva augmentation and PAOO were performed to increase the volume of both the gingiva and the alveolar bone to allow further tooth movement.After orthodontic decompensation,double-jaw surgery was performed to reposition the maxilla-mandibular complex.Finally,implant placement and chin molding were performed to restore the dentition and to improve the skeletal profile.The appearance and function were significantly improved,and the periodontal tissue remained healthy and stable.CONCLUSION In patients with dentofacial deformities and a thin periodontal phenotype,multi-disciplinary treatment that includes PAOO could be effective,and could improve both the quality and safety of orthodontic-orthognathic therapy.