The efficacy of enamel matrix derivative (Emdogain) for the treatment of deep infrabony periodontal defects: a placebo-controlled randomised clinical trial. Tunnel technique versus coronally advanced flap with acellular dermal matrix graft in the treatment of multiple gingival recessions. Root coverage in molar teeth: a comparative controlled randomized clinical trial. Topical and systemic antimicrobial therapy in guided tissue regeneration. Clinical evaluation of periodontal surgical treatment with an Er:YAG laser: 5-year results. Immediate placement and restoration of implants in the aesthetic zone with a trimodal approach: soft tissue alterations and its relation to gingival biotype. Does the dimension of the graft influence patient morbidity and root coverage outcomes? A randomized controlled clinical trial. Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 10- to 27-year long-term study. Do gingival soft tissues benefit from the application of a papilla preservation flap technique in endodontic surgery? Efficacy and safety of acupuncture for hypertension: An overview of systematic reviews. Clinical and Microbiological Effects of Photodynamic Therapy Associated with Non-surgical Treatment in Aggressive Periodontitis Effects of pretreatment clinical parameters on bioactive glass implantation in intrabony periodontal defects. Photodynamic therapy as adjunct to non-surgical periodontal treatment in patients on periodontal maintenance: a randomized controlled clinical trial A comparison of methods of aesthetic assessment in root coverage procedures.
PURPOSE To evaluate the efficacy of Emdogain versus placebo ( its carrier ) for the treatment of deep infrabony defects . MATERIAL S AND METHODS Thirty patients with an infrabony defect of at least 4 mm deep and at least 2 mm wide were r and omly allocated for treatment with either Emdogain or placebo ( the Emdogain carrier ) . The treating clinician was completely blinded to the therapy provided and performed all evaluations blindly up to the third year of follow-up . Outcome measures were tooth loss , complications , post-operative healing , patient 's satisfaction with treatment and aesthetics , changes in probing attachment levels ( PAL ) , probing pocket depths ( PPD ) , gingival recessions ( REC ) and radiographic bone levels ( RAD ) . RESULTS One year after treatment , both therapies had significantly improved clinical outcome measures : placebo group PAL gain = 3.3 mm , PPD reduction = 3.9 mm , and RAD gain = 2.5 mm ; Emdogain group PAL gain = 3.4 mm , PPD reduction = 4.2 mm , and RAD gain = 2.5 mm . Both therapies induced statistically significant gingival recession ( 0.6 mm in the placebo and 0.8 mm in the Emdogain group ) . There were no statistically significant differences between groups for any of the outcomes tested . No teeth had to be extracted up to 3 years after treatment . CONCLUSIONS There does not appear to be any clinical advantage when using Emdogain over its carrier ( placebo ) in the treatment of deep and wide infrabony defects AIM The aim of this r and omized controlled clinical study was to evaluate the outcomes of acellular dermal matrix ( ADM ) graft in combination with tunnel technique ( TUN ) on root coverage , aesthetics , and patient satisfaction and to compare with coronally advanced flap (CAF)+ADM in the treatment of multiple gingival recessions . MATERIAL AND METHODS A total of 20 patients with 58 Miller Class I multiple recessions ≥3 mm were included and divided into TUN+ADM and CAF+ADM groups . At baseline and 12 months , probing depth ( PD ) , clinical attachment level ( CAL ) , recession height ( RH ) and width ( RW ) , keratinized tissue height ( KT ) , gingival thickness , and complete and mean root coverage ( CRC , MRC ) were evaluated . Patient satisfaction and root coverage aesthetic scores ( RES ) were also assessed . RESULTS Mean root coverage was 75.72 % in TUN+ADM and 93.81 % in CAF+ADM . Intragroup comparisons revealed significant differences at 12 months for all parameters in both groups ( p < 0.05 ) . Intergroup differences were found to be statistically significant for RH and RW reduction , KT increase , CAL gain , MRC , CRC , and RES in favour of CAF+ADM group ( p < 0.05 ) . CONCLUSION Both techniques were effective in root coverage of multiple recessions ; however , better clinical results were achieved with CAF and ADM combination AIM To compare the clinical outcomes of laterally moved , coronally advanced flap ( LMCAF ) versus Bilaminar technique ( BT ) in the treatment of single gingival recession on molar teeth . MATERIAL AND METHODS Fifty patients showing Miller I and II gingival recessions at first molar teeth were treated : 25 were r and omly assigned to the BT group and 25 belonged to the LMCAF group .  Patient 's post-operative morbidity was assessed 1 week after the surgery , while aesthetic evaluation and the clinical evaluation were made 1 year later . RESULTS No statistically significant difference was demonstrated in terms of recession and PPD reduction . Statistically greater probability of complete root coverage ( CRC , Odds Ratio 22.1 ) and greater increase in gingival thickness were observed in the BT group . Greater increase in keratinized tissue was obtained in the LMCAF .  Patient satisfaction with aesthetics was very high in both treatment groups . Better post-operative course was observed in the LMCAF , while better post-operative sensitivity and root coverage evaluation were demonstrated in patients treated with BT . CONCLUSIONS Gingival recession at first molar teeth can be successfully treated with LMCAF and BT . Better CRC was achieved with BT , while more comfortable post-operative course was associated with the LMCAF BACKGROUND Bacterial contamination of membrane material negatively affects healing after guided tissue regeneration ( GTR ) procedures ; conversely , flap connective tissue integration on barrier material improves the clinical outcomes . The objective of this study was to evaluate the effect of topical application of antibiotics on : 1 ) clinical outcomes of  GTR surgical procedures using titanium reinforced exp and ed polytetrafluoroethylene ( ePTFE ) periodontal membrane ; 2 ) bacterial colonization of membrane material ; and 3 ) flap connective tissue-membrane integration . METHODS Fifty-six deep interproximal bony defects were treated with  GTR surgical procedures  using titanium reinforced ePTFE periodontal membranes . Patients were r and omly assigned to 1 of the 2 antimicrobial treatment groups : the test group received weekly topical application of 25 % metronidazole gel and the control group received systemic antibiotics ( amoxicillin plus clavulanic acid 1 g/day for 14 days ) . Clinical outcomes were assessed at 1 year ; the amount of bacterial contamination and connective tissue integration on membrane material was evaluated at time of membrane removal by means of a morphological ( SEM ) method . RESULTS No statistically significant difference was found between test and control groups in terms of clinical attachment ( CAL ) gain ( baseline CAL - 12 months CAL ; P = 0.2 ) and probing depth ( PD ) reduction ( baseline PD - 12 months PD ; P = 0.6 ) . A greater increase in gingival recession ( REC ) ( 12 months REC - baseline REC ) was found in the test group compared to the control group ( P = 0.003 ) . The SEM analysis revealed no statistically significant ( t test ) difference between test and control groups in the number of fields positive to integrated connective tissue ( P = 0.82 ) , while the number of fields positive to bacteria was statistically higher ( P < 0.001 ) in the control group . CONCLUSIONS Local antibiotic administration is more effective than systemic use in preventing membrane contamination , but it does not improve clinical outcomes due to an interference of the vehicle ( gel ) with gingival tissues which may reduce the potential benefits derived from better control of the bacterial load BACKGROUND The aim of the present study was to evaluate and compare the long-term clinical outcomes of erbium-doped : yttrium , aluminum , and garnet ( Er : YAG ) laser-assisted periodontal flap surgery versus conventional treatment with the modified Widman flap procedure . METHODS A total of 146 single-rooted periodontally involved teeth from 25 patients were included in this study . In each patient , left or right maxillary single-rooted teeth were assigned r and omly to one of two groups : group A ( Er : YAG laser ) and group B ( modified Widman flap surgery ) . Er : YAG laser was used to debride the bone pockets , scale the root surface , and trim the periodontal flap . Recession , probing depth ( PD ) , clinical attachment level ( CAL ) , plaque index ( PI ) , gingival index ( GI ) , and bleeding on probing ( BOP ) scores were recorded at baseline and at 3 , 6 , 12 , 24 , 36 , 48 , and 60 months . RESULTS Both treatments result ed in decreases in PD , PI , GI , and BOP , increases in gingival recession , and gains in CAL . PD reduction in group A versus group B was statistically significant at 6 , 12 , 24 , and 36 months ( P < 0.05 ) . Gains in CAL were significantly greater in group A versus group B at 6 , 12 , 24 , and 36 months . BOP scores were significantly lower in group A versus group B at 3 and 6 months ( P < 0.05 ) . All other differences between treatment groups were not statistically significant . CONCLUSIONS Surgical treatment of single-rooted teeth with chronic periodontitis using the Er : YAG laser yields greater PD reduction and gains in CAL for up to 3 years compared to conventional Widman flap surgery . The short-term results obtained with both treatments can be maintained over 5 years PURPOSE The aim of this prospect i ve study was to evaluate the soft tissue changes around  implants  in the aesthetic zone , placed under a trimodal approach ( immediate post- extraction placement , flapless , and immediate provisional restoration ) and its relationship to gingival/periodontal biotype of the patient . MATERIAL S AND METHODS The sample consisted of 14 patients from two private practice s that were in need of a tooth extraction in the anterior maxillary region ( cuspid to cuspid ) and were c and i date s to a replacement with a dental implant .  An initial measurement ( baseline ) of the position or the mesial and distal papillae and gingival zenith was made at this time , with a rigid dental-supported stent and an electronic precision caliper , able to the second tenth of a millimeter ; after careful tooth extraction , the periodontal thickness , at a point 5 mm apical to de gingival buccal margin , with an analogical thickness gauge , able to one tenth of a millimeter . Once the implant was inserted an immediate provisional restoration was delivered . To evaluate the soft tissue changes measurements were repeated at 3 , 6 , and 12 months . A statistical analysis was performed to evaluate the changes in the gingival margin around the implant restorations and to identify a possible correlation to patient 's periodontal thickness . RESULTS All 14 patients received Straumann ( ® ) implants ( 9 Tissue Level [ TL ] Regular Neck [ RN ] , 2 TL Narrow Neck [ NN ] , 2 Bone Level [ BL ] Narrow Crossfit [ NC ] , and 1 BL Regular Crossfit [ RC ] ) . All implants integrated and none had any biological complications . Three provisional restorations presented screw loosening and retightened once and one loss retention and was recemented once . In one patient , with a severe bruxing habit , the final restoration suffered screw loosening and was retightened . Of the final restorations , 12 were screw-retained and 2 cemented on custom-made Zirconia abutments . A mean recession of the buccal margin of 0.45 mm was recorded at 12 months ( ± 0.25 mm ) . An acceptable papilla level was present in all cases at 1 year , with mean changes of 0.38 mm ( ± 0.60 ) for the mesial and 0.80 mm ( ± 0.90 ) of the distal papilla , respectively . No correlation could be established between the soft tissue changes and the periodontal biotype of the patient . CONCLUSIONS Within the limitations of this study , the good aesthetic outcome and minimal complications seem to vali date the trimodal approach protocol as a reliable and simple protocol to place and restore immediate implants in the aesthetic zone . No correlation between the patient 's gingival biotype and the soft tissue alterations could be established . Additional studies are needed to verify long-term aesthetic results with this approach and to better define and quantify biotypes AIM Primary aim of this study was to evaluate if patient morbidity was improved by diminishing graft thickness and height ; secondary objective was to evaluate if such graft modifications influence root coverage and aesthetic outcomes . METHODS 60 Miller class I and II gingival recessions ( GR ) ( ≥ 3 mm in depth ) were treated with the coronally advanced flap plus extraoral de-epithelialized free gingival graft ( FGG ) . In 30 r and omly selected control GRs ( " big graft group " ) , the FGG thickness was ≥ 2 mm and the height was equal to bone dehiscence ( BD ) ; in the other 30 test defects ( " small graft group " ) , the thickness of the FGG was < 2 mm and the height was 4 mm . The post-operative patient morbidity was assessed 1 week after the surgery . The clinical and aesthetic evaluations were performed 1 year after the surgery . RESULTS Lower analgesic assumption , better post-operative course evaluations , better patient colour match scores and better periodontist aesthetic assessment s were reported in the " small graft " group . No statistically significant differences were demonstrated between the two groups in terms of recession reduction , CRC and increase in KTH . Greater GT increase was obtained in the control-treated sites . CONCLUSIONS Coronally advanced flap plus CTG of reduced thickness and height was associated with less patient morbidity , better aesthetic evaluations with no difference in RC outcomes BACKGROUND The aim of this retrospective long-term split-mouth study was to compare the periodontal conditions of sites treated with gingival-augmentation procedures  to untreated homologous contralateral sites over a long period of time ( 10 to 27 years ) . METHODS Fifty-five subjects with 73 sites ( test group ) lacking attached gingiva associated with recessions were treated by means of submarginal free gingival grafts ( SMFGGs ) and marginal free gingival grafts ( MFGGs ) . The 73 contralateral homologous sites ( control group ) , with or without recession and with or without attached gingiva , were not treated . Patients were recalled every 4 months during the follow-up period ( 10 to 27 years ) . Clinical variables , including recession depth , amount of keratinized tissue ( KT ) , and probing depth ( PD ) , were measured in treated and untreated sites at baseline , at 1 year , and at the end of the follow-up period . RESULTS At the end of the follow-up period , recession was reduced in all treated sites ( 1.5 + /- 1.0 mm for SMFGG and 1.3 + /- 0.9 mm for MFGG ) , whereas it was increased in the untreated sites ( -0.7 + /- 0.7 mm for SMFGG and -1.0 + /- 0.5 mm for MFGG ) . In the treated sites , the increased KT remained quite stable during the follow-up period . PD remained stable ( 1 mm ) in the treated and untreated sites . CONCLUSIONS The sites treated with gingival-augmentation surgery showed a tendency for coronal displacement of the gingival margin with a reduction in recession . The contralateral untreated sites showed a tendency for apical displacement of the gingival margin with an increase in the existing recessions PURPOSE A healthy gingival condition after endodontic surgery  may depend on adequate soft tissue management . The aim of this study was to compare 2 incision techniques , papilla base incision ( PBI ) and intrasulcular flap ( IS ) , which are currently used in endodontic surgery . MATERIAL S AND METHODS In the present nonr and omized controlled clinical trial , patients requiring endodontic surgery on a single tooth were enrolled .  PBI was used in 1 group and IS was used in the other group . The primary outcomes were changes in periodontal probing depth , gingival recession , and height of the interproximal mesial and distal papillae . Outcome variables were assessed preoperatively and 6 months after surgery . Between-group differences were evaluated through appropriate statistical analysis , with significance set at a P value equal to .05 . RESULTS Each group was composed of 12 patients and the 2 groups were comparable at baseline . Two weeks after surgery , papilla height decreased significantly in the IS group ( 2.05 and 1.80 mm at the mesial and distal aspects , respectively ) , whereas no significant decrease in papilla height was observed in the PBI group ( 0.10 and 0.20 mm ) . No statistically significant difference between groups was observed after 6 months . No significant difference between groups was found for gingival recession or probing depth at any follow-up time . CONCLUSIONS Better soft tissue preservation in the early postoperative period was achieved using the PBI approach compared with the IS approach . The PBI can be recommended for endodontic surgical procedures involving esthetic regions BACKGROUND AND PURPOSE Acupuncture is widely used in the treatment of hypertension , yet its efficacy and safety for hypertension remain controversial . This overview aim ed to summarize the evidence on acupuncture for hypertension . METHODS Eight data bases were search ed . The Assessment of Multiple Systematic Review s ( AMSTAR ) tool and the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach were performed . RESULTS Fifteen systematic review s ( SRs ) were identified . Method ological quality and quality of evidence were unsatisfactory . Acupuncture combined with Western medicine ( WM ) was superior to WM in systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) , efficacy rate , and traditional Chinese medicine ( TCM ) syndrome .  Acupuncture was more effective in treating SBP and DBP than sham acupuncture plus WM . Evidence regarding the benefit of acupuncture alone for SBP and DBP , efficacy rate and TCM syndrome was inconsistent . No serious adverse effects were identified . CONCLUSION High- quality SRs and r and omized controlled trials ( RCTs ) are required Background and aims . The aim of this study was to compare the effectiveness of adjunctive photodynamic therapy ( PDT ) in the treatment of aggressive periodontitis . Material s and methods . A total of 24 patients with clinical diagnosis of aggressive periodontitis received scaling and root planing ( SRP ) for periodontal treatment . In a split-mouth design study , the teeth of one quadrant of each arch with ≥4 mm of probing depth were selected r and omly for additional treatment with PDT ( test group ) . PDT was performed with a diode laser beam with a wavelength of 670 - 690 nm and a power of 75 Mw . The control group consisted of selected teeth of the contralateral quadrant ( SRP only ) . Before any treatment , subgingival plaque sample s were collected by an endodontic paper cone for microbiological analysis by real-time polymerase chain reaction ( PCR ) for detection of Aggregatibacter actinomycetecommitans . Clinical parameters including clinical attachment loss ( CAL ) as primary outcome , plaque index ( PI ) , bleeding on probing ( BOP ) , probing depth ( PD ) and gingival recession ( REC ) were measured at baseline and after 90 days . Inter-group and intra-group statistical analyses were performed . Results . Treatment groups showed an improvement in all the clinical parameters and a significant reduction in the counts of A. actinomycetecommitans at 90 days compared to baseline ( P < 0.05 ) . None of the periodontal parameters exhibited significant differences between the two groups ( P > 0.05 ) . Conclusion . Within the limitations of this study , the results did not show additional benefits from PDT as an adjunctive treatment for patients with aggressive periodontitis BACKGROUND The various methods for regeneration of periodontal tissue that have been developed can be classified into guided tissue regeneration and bone implantation . Since the implantation material s have shown both deficiencies and merits , dentists have begun exploring the bioactive glass first used in plastic surgery . This paper examines the effectiveness of this new material on periodontal intrabony defects . METHODS Clinical effects of bioactive glass implantation in intrabony periodontal defects were evaluated 6 months after surgery in 38 intrabony defects from 38 patients with chronic periodontitis . Twenty-one experimental defects received bioactive glass implantation  ( test group ) , while 17 control defects were treated with a flap procedure only ( control group ) . The criteria for comparative observation were preoperative and postoperative probing depth ( PD ) , clinical attachment level ( CAL ) , bone probing depth ( BPD ) , and gingival recession . RESULTS Reductions in PD were observed in both groups ( P<0.01 ) . The reduction in PD was significantly greater in the test group when preoperative PD exceeded 7 mm ( P<0.01 ) . Improvements in CAL were also observed in both groups ( P<0.01 ) , with the test group showing significantly greater gains ( P<0.05 ) . In those cases where preoperative CAL was less than 7 mm , there was no statistically significant difference between the two groups . Reduction in BPD was observed in both groups , with the test group showing significantly greater reduction ( P < 0.01 ) . There was no significant difference in BPD change , however , when preoperative BPD was < or = 7 mm . Significantly greater reduction of BPD in the test group was observed when intrabony defect depth was > 4 mm ( P < 0.05 ) . Significant improvements in PD , CAL , and BPD were noted in the test group when the crestal involvement exceeded 100 degrees . Correlation test between various clinical parameters indicated that greater changes in PD and CAL in the test group were observed when preoperative CAL was large ( P<0.001 ) , and greater changes in PD ( P<0.05 ) , CAL ( P<0.01 ) , and BPD ( P<0.05 ) were noted when preoperative BPD was large . Correlation between crestal involvement and CAL change was noted only in the control group ( P<0.01 ) . High correlations were observed between PD changes and CAL changes and between CAL changes and BPD changes in both groups . CONCLUSIONS Use of a bone substitute in a flap operation result ed in significantly greater improvements in CAL and BPD over flap operation alone and seemed to have positive effects in postoperative PD , CAL , and BPD in those cases with more severe preoperative CAL and BPD Recent pre clinical and clinical data have suggested the potential benefit of photodynamic therapy ( PDT ) in the treatment of periodontitis . However , currently , there are very limited data from controlled clinical trials evaluating the effect of PDT in the treatment of periodontitis . The aim of the present study was to evaluate the clinical and microbiological effects of the adjunctive use of PDT in non-surgical periodontal treatment in patients receiving supportive periodontal therapy . Twenty-four patients receiving regularly supportive periodontal therapy were r and omly treated with either subgingival scaling and root planing followed by a single episode of PDT ( test ) or subgingival scaling and root planing alone ( control ) . The following parameters were evaluated at baseline and at 3 months and 6 months after therapy : full mouth plaque score ( FMPS ) , full mouth bleeding score ( FMBS ) , bleeding on probing ( BOP ) at experimental sites , probing pocket depth ( PPD ) , gingival recession ( REC ) , and clinical attachment level ( CAL ) . Primary outcome variables were changes in PPD and CAL . Microbiological evaluation of Aggregatibacter actinomycetemcomitans ( A.a . ) , Porphyromonas gingivalis ( P.g . ) , Prevotella intermedia ( P.i . ) , Tannerella forsythensis ( T.f . ) , Treponema denticola ( T.d . ) , Peptostreptococcus micros ( P.m . ) , Fusobacterium nucleatum ( F.n . ) , Campylobacter rectus ( C.r . ) , Eubacterium nodatum ( E.n . ) , Eikenella corrodens ( E.c . ) , and Capnocytophaga species ( C.s . ) was also performed at baseline and at 3 months and 6 months after therapy , using a commercially available polymerase chain reaction test . No differences in any of the investigated parameters were observed at baseline between the two groups . At 3 months and 6 months after treatment , there were no statistically significant differences between the groups in terms of PPD , CAL and FMPS . At 3 months and 6 months , a statistically significantly higher improvement of BOP was found in the test group . At 3 months after therapy , the microbiological analysis showed a statistically significant reduction of F.n . and E.n . in the test group . At 6 months , statistically significantly higher numbers of E.c . and C.s . were detected in the test group . The additional application of a single episode of PDT to scaling and root planing failed to result in an additional improvement in terms of PPD reduction and CAL gain , but it result ed in significantly higher reduction of bleeding scores than following scaling and root planing alone AIM To evaluate the reliability of professional qualitative scoring methods used in evaluating aesthetic results after  root coverage therapy and to evaluate the relationship between subjective and objective measurements . MATERIAL AND METHODS A review panel of seven professional and non-professional , trained and untrained observers used photographic records to assess the overall cosmetic results of 162 root coverage surgical procedures in 133 patients ( mean follow-up 17.51+/-17.37 months ) . Two different methods were used . In the before-after panel scoring system , observers evaluated the difference between preoperative and postoperative views , whereas in the r and om panel scoring system , observers rated each photograph independently . RESULTS For both methods , intrarater agreement ranged from substantial to almost perfect for the periodontists . The best interrater agreement was found for trained periodontists using the five-point ordinal scale of the before-after panel scoring system ( kappa=0.68 ) . Neither root coverage percentage nor gingival augmentation was correlated to cosmetic assessment . CONCLUSIONS The before-after scoring system is an acceptable and reliable method for professional cosmetic assessment of root coverage therapy . The overall cosmetic evaluation does not appear to be related to the percentage of root coverage
Periodontal Plastic Surgery ( PPS ) techniques applying grafts underneath CAF with or without the adding of EMD are associated with improved aesthetics assessed by final patient perception and RES as professional evaluation system
BACKGROUND The aim of this study was to perform a systematic review ( SR ) of r and omized controlled trials ( RCTs ) to explore if periodontal plastic surgery procedures for the treatment of single and multiple gingival recessions ( Rec ) may improve aesthetics at patient and professional levels .