Growth factor-mediated treatment of recession defects: a randomized controlled trial and histologic and microcomputed tomography examination. Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 10- to 27-year long-term study. Randomised controlled trials and publication trends in periodontal research during 1980-2000. Abstracts Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study Long-term evaluation of periodontal therapy: I. Response to 4 therapeutic modalities. Periodontal risk assessment model in a sample of regular and irregular compliers under maintenance therapy: a 3-year prospective study. Clinical application of autologous fibroblast cell culture in gingival recession treatment. Evaluation of four modalities of periodontal therapy. Mean probing depth, probing attachment level and recession changes. Improved periodontal conditions following therapy. Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial. Periodontal healing following reconstructive surgery: effect of guided tissue regeneration. Clinical comparison of resorbable and non-resorbable barriers for guided periodontal tissue regeneration. Quality assessment of randomized control trials in dental research. II. Results: periodontal research. A randomized four-years study of periodontal therapy. Control of periodontal infections: a randomized controlled trial I. The primary outcome attachment gain and pocket depth reduction at treated sites. A comparative study of root coverage with connective tissue and platelet concentrate grafts: 8-month results.
BACKGROUND The primary aims of this two-part prospect i ve study were : 1 ) to compare the safety and efficacy of beta-tricalcium phosphate ( beta-TCP ) + 0.3 mg/ml recombinant human platelet-derived growth factor-BB ( rhPDGF-BB ) with a bioabsorbable collagen wound-healing dressing and a coronally advanced flap ( CAF ) to a subepithelial connective tissue graft ( CTG ) in combination with a CAF in subjects with gingival recession defects using a r and omized , controlled , split-mouth design ; and 2 ) to compare , through histologic and microcomputed tomography ( micro-CT ) examination , the periodontal regenerative potential of these two therapies in surgically created gingival recession defects in restoring missing cementum , periodontal ligament ( PDL ) , and supporting alveolar bone . METHODS In the r and omized controlled trial ( RCT ) , 30 patients with Miller Class II buccal gingival recession , > or = 3 mm deep and > or = 3 mm wide in contralateral quadrants of the same jaw were treated and followed for 6 months . Using a split-mouth design with similar bilateral recession defects , test sites were treated with 0.3 mg/ml rhPDGF-BB + beta-TCP + bioabsorbable collagen wound-healing dressing ; contralateral control sites were treated with a CTG , each in combination with a CAF . In the histologic/micro-CT study segment , recession defects were created in six teeth , each requiring extraction for orthodontic therapy . These defects were created with a recession depth > or = 3 mm , the osseous crest 2 to 3 mm apical to the gingival margin , and with 2 to 3 mm of keratinized tissue . The defects were treated with a CTG ( control ) or rhPDGF-BB + beta-TCP + wound-healing dressing ( test ) , plus CAF . Nine months after surgical correction , en bloc resections were obtained and examined histologically and with micro-CT . RESULTS In the RCT , test and control treatments demonstrated clinical ly significant improvements from baseline through month 6 . Statistically significant results favoring the CTG were found in recession depth reduction ( -2.9 + 0.5 mm , test ; -3.3 + 0.6 mm , control ; P = 0.009 ) , root coverage ( 90.8 % , test ; 98.6 % , control ; P = 0.013 ) , and -3.9 + /- 0.7 mm , control , -3.3 + /- 1.3 mm , test , recession width reduction ( P = 0.035 ) , whereas mid-buccal probing depth ( PD ) and PD reduction ( PDR ) reduction favored the test group ( 1.4 + /- 0.4 mm , test ; 1.8 + /- 0.1 mm , control ; P < 0.001 PD and -0.0 mm test ; + 0.4 mm control PDR ) . For all other parameters , the two treatments were statistically equivalent , including increases in keratinized tissue , esthetic results , and subject satisfaction . In the histologic/micro-CT portion , all four sites treated with rhPDGF-BB + beta-TCP showed evidence of regeneration of cementum , PDL with inserting connective tissue fibers , and supporting alveolar bone , whereas neither CTG-treated site exhibited any signs of periodontal regeneration . CONCLUSIONS CTG and rhPDGF-BB + beta-TCP + wound-healing dressing are effective treatment modalities for clinical ly correcting gingival recession defects . In addition , the current study demonstrated that regeneration of the periodontium in gingival recession defects was possible through a growth factor-mediated approach 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 OBJECTIVES To study publication trends , as well as the number and proportion of r and omised controlled trials covering different areas of periodontal research ( RCT -Ps ) . MATERIAL AND METHODS The study was based on Medline search es ( MeSH terms ) for the period 1980- 2000 . The RCT -Ps ( n = 675 ) were examined for relevance for different areas of periodontal research , journals of publication , and the countries of origin . RESULTS In periodontal research the annual number of publications had increased from 162 in 1980 to 440 in 2000 . Moreover , clinical trials in periodontal research ( CT-Ps ) had increased more than 10-fold , and RCT -Ps more than 15-fold . More than 4 out of 10 RCT -Ps covered the areas ' periodontal surgery ' and ' gingivitis and plaque treatment or prevention ' . More than 6 out of 10 RCT -Ps in total and more than 8 out of 10 RCT -Ps about ' periodontal surgery ' , were published in two different journals . U.S.A was the most common country of origin of RCT -Ps , contributing to almost 4 out of 10 RCT -Ps during 1988 - 2000 . CONCLUSION The annual number of RCT -Ps increased substantially during 1980 - 2000 , and a few clinical research areas predominated . Future research should give priority to areas where clinical evidence is scarce and where high- quality RCT -Ps are most needed AIM A clinical trial was performed to determine ( i ) the initial outcome of non-surgical and surgical access treatment in subjects with advanced periodontal disease and ( ii ) the incidence of recurrent disease during 12 years of maintenance following active therapy . MATERIAL AND METHODS Each of the 64 subjects included in the trial showed signs of ( i ) generalized gingival inflammation , ( ii ) had a minimum of 12 non-molar teeth with deep pockets ( > or = 6 mm ) and with > or = 6 mm alveolar bone loss . They were r and omly assigned to 2 treatment groups ; one surgical ( SU ) and one non-surgical ( SRP ) . Following a baseline examination , all patients were given a detailed case presentation which included oral hygiene instruction . The subjects in SU received surgical access therapy , while in SRP non-surgical treatment was provided . After this basic therapy , all subjects were enrolled in a maintenance care program and were provided with meticulous supportive periodontal therapy ( SPT ) 3 - 4 times per year . Sites that at a recall appointment bled on gentle probing and had a PPD value of > or = 5 mm were exposed to renewed subgingival instrumentation . Comprehensive re-examinations were performed after 1 , 3 , 5 and 13 years of SPT . If a subject between annual examinations exhibited marked disease progression ( i.e. , additional PAL loss of > or = 2 mm at > or = 4 teeth ) , he/she was exited from the study and given additional treatment . RESULTS It was observed that ( i ) surgical therapy ( SU ) was more effective than non-surgical scaling and root planing ( SRP )  in reducing the overall mean probing pocket depth and in eliminating deep pockets , ( ii ) more SRP-treated subjects exhibited signs of advanced disease progression in the 1 - 3 year period following active therapy than SU-treated subjects . CONCLUSION In subjects with advanced periodontal disease , surgical therapy provides better short and long-term periodontal pocket reduction and may lead to fewer subjects requiring additional adjunctive therapy Background and Objective Prospect i ve studies that investigated the influence of surgical and nonsurgical procedures in the recurrence of periodontitis and tooth loss  in periodontal maintenance therapy ( PMT ) programs have not been previously reported . The objective of this study was to evaluate longitudinally the recurrence of periodontitis in regular compliers ( RC ) and irregular compliers ( IC ) individuals undergoing surgical and non-surgical procedures over 5 years in a program of PMT .  Material s and Methods A total of 212 individuals participated in this study .  Full-mouth periodontal examination including bleeding on probing , probing depth , and clinical attachment level were determined at all PMT visits over 5 years . The recurrence of periodontitis was evaluated in RC and IC individuals undergoing surgical and non-surgical procedures in PMT . The influences of risk variables of interest were tested through univariate analysis and multivariate logistic regression . Results Recurrence of periodontitis was significantly lower among RC when compared to IC . Individuals with recurrence of periodontitis and undergoing surgical procedures showed higher probing depth and clinical attachment loss than those who received non-surgical procedures . Recurrence of periodontitis was higher in individual undergoing surgical procedures and irregular compliance during PMT . Conclusions Irregular compliance and surgical procedures in individuals undergoing PMT presented higher rates of recurrence of periodontitis when compared to regular compliant patients undergoing non-surgical procedures Eighty-two periodontal patients were treated in a split mouth design with coronal scaling ( CS ) , root planing ( RP ) , modified Widman surgery ( MW ) , and flap with osseous resection surgery ( FO ) which were r and omly assigned to various quadrants in the dentition . Therapy was performed in 3 phases : non-surgical , surgical , and supportive periodontal treatment ( SPT ) < or = 7 years . Clinical data consisted of probing depth ( PD ) , clinical attachment level ( CAL ) , gingival recession ( REC ) , bleeding on probing ( BOP ) , suppuration ( SUP ) , and supragingival plaque ( PL ) . Because of the necessity to exit many CS treated sites due to breakdown , data for CS were reported only up to 2 years . All therapies produced mean PD reduction with FO > MW > RP > CS following the surgical phase for all probing depth severities . By the end of year 2 there were no differences between the therapies in the 1 to 4 mm sites . There were no differences in PD reduction between MW and RP treated sites by the end of year 3 in the 5 to 6 mm sites and by the end of year 5 in the > or = 7 mm sites . FO produced greater PD reduction in > or = 5 mm sites through year 7 of SPT . Following the surgical phase , FO produced a mean CAL loss and CS and RP produced a slight gain in 1 - 4 mm sites . RP and MW produced a greater gain of CAL than CS and FO following the surgical phase in 5 to 6 mm sites , but the magnitude of difference decreased during SPT . Similar CAL gains were produced by RP , MW , and FO in sites > or = 7 mm . These gains were greater than that produced by CS and were sustained during SPT . Recession was produced with FO > MW > RP > CS . This relationship was maintained throughout SPT . The prevalences of BOP , SUP , and PL were greatly reduced throughout the study and were comparable between sites treated by RP , MW , and FO while the CS sites had more BOP and SUP BACKGROUND The purpose of this study is to investigate the association of the periodontal risk assessment ( PRA ) model with the recurrence of periodontitis and tooth loss during  periodontal maintenance therapy ( PMT ) . METHODS In a prospect i ve PMT program , 75 regular complier ( RC ) and 89 erratic complier ( EC ) patients were selected .  A periodontal examination and PRA were performed after active periodontal therapy and after 3 years of PMT . Risk profiles ( low , moderate , or high ) of participants were evaluated , and the recurrence of periodontitis and tooth loss were analyzed using univariate and multivariate analyses . RESULTS RCs showed less recurrence of periodontitis and tooth loss than ECs ( P < 0.05 ) . Rates of periodontitis recurrence in RCs and ECs were 2.7 % and 3.4 % , respectively , for the moderate-risk profile and 6.7 % and 11.2 % , respectively , for the high-risk profile . During PMT , 49 teeth ( 0.65 ± 1.4 teeth per participant ) were lost in the RC group , and 70 teeth ( 0.78 ± 2.1 teeth per participant ) were lost in the EC group . High-risk profile participants showed more recurrence of periodontitis and lost significantly more teeth than did participants with moderate- or low-risk profiles in RC and EC groups ( P < 0.05 ) . CONCLUSION The risk profile influenced the recurrence of periodontitis and tooth loss . RCs had less recurrence of periodontitis and less tooth loss . The PRA model can be useful in particularizing the risk of patients and adjusting recall intervals BACKGROUND AND OBJECTIVE Gingival recession is defined as soft and hard tissue displacement result ing in root surface exposure . The optimal outcome of gingival recession treatment is complete , predictable and long-lasting root coverage with a significant level of tissue regeneration . Tissue engineering , which applies active regeneration principles , presents the contemporary treatment approach in the restitution and regeneration of lost tissues . The objective of the present study was to evaluate and compare the clinical results of application of an autologous fibroblast cell culture ( AFCC ) on a collagen matrix and a connective tissue graft ( CTG ) placed under a coronally advanced flap ( CAF ) , in the treatment of single and multiple gingival recessions . MATERIAL AND METHODS Eighteen patients from the Department of Periodontology , School of Dentistry , University of Bel grade , were r and omly enrolled in this study . Inclusion criteria were the bilateral presence of Miller Class I or II single or multiple maxillary gingival recessions . A split-mouth design was used in the study . The experimental group was treated with AFCC on a collagen scaffold , which was placed under a CAF . The control group received a combination of CTG and CAF . Clinical parameters such as gingival recession coverage , keratinized tissue width , clinical attachment level and gingival index were recorded at baseline and at 12 mo postoperatively . The oral hygiene level was assessed by plaque index evaluation . Postoperative healing was evaluated through the healing index , recorded 1 , 2 and 3 wk postoperatively . The final esthetic outcome was assessed using the mean root coverage esthetic score ( RES ) . RESULTS Statistically significant improvement of all parameters assessed was found compared with baseline . A statistically significant difference between groups was observed only in keratinized tissue width . Greater keratinized tissue width is still obtained with the use of CTG . Regarding the tissue-healing results , no statistically significant difference was achieved . The RES results were similar for both groups . CONCLUSIONS Within the limitations of the present study , both procedures proved to be efficient in gingival recession treatment . AFCC , as a novel tissue-engineering concept and living cell-based therapy , proved to be a reliable and successful treatment concept Eighty-two periodontally involved patients were treated in a split mouth design such that one quadrant received coronal scaling ( CS ) , root planing ( RP ) , modified Widman surgery ( MW ) , and flap with osseous resection surgery ( FO ) . The therapy was performed in three phases : Phase I : the teeth previously design ated to receive RP , MW , and FO were thoroughly root planed and the teeth design ated to receive CS were scaled with no subgingival instrumentation , plaque control was initiated and reinforced for the entire mouth ; Phase II : the design ated teeth received MW or FO surgery ; and Phase III : maintenance therapy every three months . The CS teeth received coronal scaling and polishing during maintenance appointments , while RP , MW , and FO teeth received supragingival instrumentation , subgingival instrumentation and polishing .  Clinical measurements were taken initially , four weeks post-Phase I , 10 weeks post-Phase II , and after each of two years of maintenance care . All therapy modalities result ed in a decrease of mean probing depth with the FO producing the greatest decrease followed by MW , RP , and CS . The deeper the initial probing depth , the greater was the mean reduction of probing depth . FO created a loss of mean probing attachment in the 1 to 4 mm category . RP and MW produced the greatest gain of mean probing attachment in the 5 to 6 mm category . RP , MW , and FO produced similar gains in the greater than or equal to 7 mm category . FO created the most gingival recession followed by MW , RP , and CS The aim of the present clinical trial was to evaluate the effect of different modes of periodontal therapy on patients with moderately advanced periodontal disease and to express the findings in terms of probing pocket depth and attachment level alterations at periodontal sites with different initial probing depths . The material consisted of 16 patients , 35 - 65 years of age . Following a Baseline examination including assessment s of oral hygiene status , gingival conditions , probing pocket depths and probing attachment levels , the patients were subjected to periodontal treatment . A " split-mouth " design approach of therapy was used and the jaw quadrants were r and omly selected for the following different treatment procedures : ( 1 ) scaling and root planning , ( 2 ) scaling and root planing in conjunction with a gingivectomy procedure , ( 3 ) scaling and root planing in conjunction with an apically repositioned flap procedure without bone recontouring , ( 4 ) scaling and root planing in conjunction with an apically repositioned flap procedure including bone recontouring , ( 5 ) scaling and root planing in conjunction with a modified Widman flap procedure without bone recontouring and ( 6 ) scaling and root planing in conjunction with a modified Widman flap procedure including bone recontouring . The patients were following active treatment enrolled in a supervised maintenance care program including " professional tooth cleaning " once every 2 weeks during a 6-month period of healing , after which a final examination was performed . The investigation demonstrated that active therapy including meticulous subgingival debridement result ed in a low frequency of gingival sites which bled on probing , a high frequency of sites with shallow pockets ( less than 4 mm ) and the disappearance of pockets with a probing depth of greater than 6 mm . Between the Baseline examination and the 6-month re-examination , the probing attachment level for initially shallow pockets remained basically unaltered , but with a tendency of a minor apical shift . This occurred in all 6 treatment groups . For sites with initial probing depths of 4 - 6 mm and greater than 6 mm , there was in all groups some gain of probing attachment . This gain was most pronounced in the initially deeper ( greater than 6 mm ) pockets . With the use of regression analysis , the " critical probing depth " ( CPD ) value ( i.e. the initial probing depth value below which loss of attachment occurred as a result of treatment and above which gain of probing attachment level result ed ) was calculated for each of the 6 methods of treatment used . A comparison of the CPD-values between the 6 treatment groups did not reveal any major differences BACKGROUND A newly developed collagen matrix ( CM ) of porcine origin has been shown to represent a potential alternative to palatal connective tissue grafts ( CTG ) for the treatment of single Miller Class I and II gingival recessions when used in conjunction with a coronally advanced flap ( CAF ) . However , at present it remains unknown to what extent CM may represent a valuable alternative to CTG in the treatment of Miller Class I and II multiple adjacent gingival recessions ( MAGR ) . The aim of this study was to compare the clinical outcomes following treatment of Miller Class I and II MAGR using the modified coronally advanced tunnel technique ( MCAT ) in conjunction with either CM or CTG . METHODS Twenty-two patients with a total of 156 Miller Class I and II gingival recessions were included in this study . Recessions were r and omly treated according to a split-mouth design by means of MCAT + CM ( test ) or MCAT + CTG ( control ) . The following measurements were recorded at baseline ( i.e. prior to surgery ) and at 12 months : Gingival Recession Depth ( GRD ) , Probing Pocket Depth ( PD ) , Clinical Attachment Level ( CAL ) , Keratinized Tissue Width ( KTW ) , Gingival Recession Width ( GRW ) and Gingival Thickness ( GT ) . GT was measured 3-mm apical to the gingival margin . Patient acceptance was recorded using a Visual Analogue Scale ( VAS ) . The primary outcome variable was Complete Root Coverage ( CRC ) , secondary outcomes were Mean Root Coverage ( MRC ) , change in KTW , GT , patient acceptance and duration of surgery . RESULTS Healing was uneventful in both groups . No adverse reactions at any of the sites were observed . At 12 months , both treatments result ed in statistically significant improvements of CRC , MRC , KTW and GT compared with baseline ( p < 0.05 ) . CRC was found at 42 % of test sites and at 85 % of control sites respectively ( p < 0.05 ) . MRC measured 71 ± 21 % mm at test sites versus 90 ± 18 % mm at control sites ( p < 0.05 ) . Mean KTW measured 2.4 ± 0.7 mm at test sites versus 2.7 ± 0.8 mm at control sites ( p > 0.05 ) . At test sites , GT values changed from 0.8 ± 0.2 to 1.0 ± 0.3 mm , and at control sites from 0.8 ± 0.3 to 1.3 ± 0.4 mm ( p < 0.05 ) . Duration of surgery and patient morbidity was statistically significantly lower in the test compared with the control group respectively ( p < 0.05 ) . CONCLUSIONS The present findings indicate that the use of CM may represent an alternative to CTG by reducing surgical time and patient morbidity , but yielded lower CRC than CTG in the treatment of Miller Class I and II MAGR when used in conjunction with MCAT Clinical healing following guided tissue regeneration ( GTR ) in deep intrabony pockets was compared to healing following gingival flap surgery alone ( GFS ) . 15 patients received the GTR treatment including an exp and ed polytetrafluoroethylene membrane . 13 other patients received the control treatment GFS .  A postsurgery protocol emphasizing wound stability and infection control was used . Treatment effects were evaluated 6 months postsurgery . Mean pre-surgery probing depth for the GTR and control treatments was 7.5 + /- 1.0 and 7.7 + /- 1.5 mm , respectively . Significant probing depth reduction ( 3.8 + /- 1.2 and 2.9 + /- 1.1 mm ) , attachment level improvement ( 2.4 + /- 2.1 and 2.2 + /- 1.2 mm ) and bone fill ( 2.0 + /- 2.0 and 2.4 + /- 0.9 mm ) followed the GTR and control protocol s , respectively ( p < 0.01 ) . Significant differences between GTR and control treatments were observed in probing depth reduction ( p < 0.01 ) and in gingival recession increase ( 1.7 + /- 1.5 and 0.7 + /- 0.9 mm , respectively ; p < 0.05 ) . The results suggest that GTR procedures compared to GFS have similar clinical potential in intrabony pockets , under the present protocol The purpose of this study was to compare the clinical results of guided periodontal tissue regeneration ( GPTR ) using a resorbable barrier manufactured from a copolymer of polylactic and polyglycolic acids ( Resolut Regenerative Material ) with those of non-resorbable e-PTFE barrier ( Gore-Tex Periodontal Material ) .  12 subjects participated , 6 with similarly paired class II furcations and 6 with 2 similar 2 , 3-wall periodontal lesions . The resorbable and non-resorbable barriers were r and omly assigned to 1 defect in each subject . Non-resorbable barriers were removed in six weeks . Plaque index ( PlI ) , gingival index ( GI ) , probing depth ( PD ) , clinical attachment level ( CAL ) and gingival recession ( R ) were recorded at baseline , ( i.e. , immediately prior to surgery ) and at 12 months postsurgically . The clinical healing was similar and uneventful in both groups . Intrabony pockets depicted significant changes from baseline ( p < 0.05 ) for probing depth reduction and gain in clinical attachment levels . No differences were found between treatments . Class II furcations showed significant improvements from baseline ( p < or = 0.05 ) for probing depth reduction and clinical attachment gain . No differences were detected between treatments . It is concluded that the resorbable barrier tested is as effective as the nonresorbable e-PTFE barrier for the treatment of class II furcations and intrabony defects Twenty-one reports of 14 r and omized control trials ( RCTs ) published between 1968 and 1984 comparing methods of periodontal treatment  were evaluated using a system to assess the quality of RCTs based on published reports . The quality assessment system evaluates the design , implementation , and analytic methods used . An index of quality is calculated with a maximum score attainable of 1.00 . The mean quality score for these 14 RCTs was 0.35±0.07 ( ISD ) . There was no evidence of improvement in scores over time . Ninety-five percent of the trials used the ' split-mouth ’ protocol . Although the results of 17 reports cl aim ed no statistically significant differences between treatments , in no case was a type II error calculated to ensure that a sample size sufficient to detect a difference of clinical interest had been used . It is recommended that future RCTs of periodontal treatment utilize and report a st and ard design protocol so that results may be better compared and combined The purpose of this study was to compare the long term effectiveness of scaling and root planing alone to scaling and root planing followed by periodontal surgery .  Seventeen subjects with moderate to advanced periodontitis received through scaling and root planing as well as oral hygiene instruction . A modified Widman flap was then r and omly performed for one-half of each subject 's dentition . Recall prophylaxis and oral hygiene reinforcement were administered for 4 years after completion of therapy . Shallow crevices ( 1 - -3 mm)subjected to either procedure tended to increase slightly in depth and exhibit a slight loss of attachment when compared to pretreatment measurements . Moderately deep pockets ( 4 - -6 mm ) treated by either procedure were reduced and demonstrated a sustained gain or maintenance of attachment level . Pockets initially greater than or equal to 7 mm exhibited the greatest reduction in depth and attachment gain . Gingivitis was reduced following either procedure for moderate and deep pockets . No difference in supragingival plaque retention was noted and both procedures reduced calculus . The results indicate that both procedures were effective in treating moderate to advanced periodontitis . However , the additional flap procedure tended to result in greater pocket reduction and attachment gain for deeper pockets OBJECTIVE To compare the treatment outcome of scaling and root planing ( SRP ) in combination with systemic antibiotics , local antibiotic therapy and /or periodontal surgery . MATERIAL AND METHODS One hundred and eighty-seven patients were assigned to eight groups treated by SRP plus none , one , two or three adjunctive treatments and monitored for 24 months in a r and omized controlled clinical trial using a 2 × 2 × 2 factorial design . Systemic amoxicillin + metronidazole ( SMA ) , local tetracycline delivery ( LTC ) and periodontal surgery ( SURG ) were evaluated as adjuncts . Changes in clinical attachment level ( CAL ) and probing pocket depth ( PPD ) were statistically evaluated by ancova of main effects . RESULTS Effects of adjunctive therapy to SRP were minimal at 3 months . Between 3 and 6 months PPD reduction occurred particularly in patients receiving periodontal surgery . After 6 months , both CAL gain and PPD reduction reached a plateau that was maintained at 24 months in all groups . The 24-month CAL gain was improved by SMA ( 0.50 mm ) while PPD was reduced by SMA ( 0.51 mm ) and SURG ( 0.36 mm ) . Smoking reduced CAL gain and PPD reduction . CONCLUSION Patients receiving adjunctive therapies  generally exhibited improved CAL gain and /or PPD reduction when compared with the outcome of SRP alone . Only additive , not synergistic effects of the various adjunctive therapies were observed BACKGROUND Gingival recession presents destruction of both soft and hard tissues . The objectives of this r and omized clinical trial were to assess the clinical efficacy of platelet concentrate grafts ( PCG ) in the treatment of Miller Class I or II buccal gingival defects and to compare their soft tissue healing with those of subepithelial connective tissue grafts ( SCTG ) . METHODS Seventeen arches in 15 patients with bilateral gingival recessions were treated with SCTG and PCG covered by coronally advanced flaps . Vertical recession depth ( VRD ) , clinical attachment level ( CAL ) , clinical probing depth ( PD ) , and width of keratinized tissue ( KTW ) were measured preoperatively and 8 months postsurgery . Surveys on post-surgical discomfort level ( PSDL ) and manual platelet count were also performed . Esthetic outcomes were also evaluated . Paired t test , repeated measures analysis of variance ( ANOVA ) , and chi-square and signed-rank tests were used to access statistical significance ( alpha = 0.05 ) . RESULTS Mean VRD statistically significantly decreased from 2.43 mm presurgery to 0.48 mm with PCG ( 80 % root coverage ) and from 2.48 mm to 0.17 mm with SCTG ( 95 % root coverage ) . No statistically significant differences between the treatments were found for VRD , CAL , and KTW , while mean PD was significantly shallower in the PCG group ( 1.05 mm ) than that in the SCTG group ( 1.79 mm ) . Complete coverage was achieved in 60 % of the PCG group and in 65.5 % of the SCTG group . PSDL was significantly lower in the PCG group 1 month post-surgery . Platelet counts demonstrated a five-fold increase in PC . Soft tissue in the PCG group demonstrated superior contour and texture matching when compared to the SCTG group . CONCLUSIONS The platelet concentrate graft may be an alternative graft material for treating gingival recession . Treatment with this graft may result in better esthetic appearance
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 .