PDGF‐BB‐enriched collagen matrix to treat multiple gingival recessions with the tunneled coronally advanced flap

Abstract

Background: With technological advancements in reconstructive periodontology, traditional protocols for the treatment of gingival recessions (GRs) can be challenged. This manuscript presents preliminary findings of a novel minimallyinvasive approach for the regenerative treatment of multiple adjacent GR defects. Methods: Two healthy adults were treated as part of this study. Multiple adjacent GRs in both subjects (1 in the mandible, and 1 in the maxilla) were treated employing a tunneled coronally advanced flap (TCAF) design, with the application of a cross-linked collagen matrix (CCM) that was enriched with recombinant human platelet-derived growth factor-BB (PDGF-BB) that was also applied on the prepared root surfaces. Clinical, ultrasonographic, esthetic, and patient-reported outcomes were observed at approximately 6-and 18-month time points. Results: All sites healed uneventfully after the treatments. Complete root coverage was achieved and maintained throughout the follow-up observations, from 6 to 18 months. Patients reported minimal discomfort and reduction of dentinal hypersensitivity at the augmented sites. The areas augmented with CCM + PDGF-BB revealed an increased soft tissue thickness relative to baseline (pretreatment) measures, as well as reduction in the level of the facial bone dehiscences. Conclusion:This article describes the success of two cases of a novel minimally invasive regenerative approach for the treatment of multiple adjacent GR defects by the TCAF, using a CCM loaded with PDGF-BB. This approach offers potential as a minimally-invasive method to repair multiple adjacent GRs.

Risk indicators for gingival recession in the esthetic zone: A cross‐sectional clinical, tomographic, and ultrasonographic study

“…12 While bone augmentation is overall not recommended for GR treatment, 51 in particular when the tooth is buccally positioned and outside of the bony envelope/housing, 57 soft tissue grafting has shown to be effective in obtaining root coverage and augmentation of KT and GT. 12,18,50,51,54 Interestingly, it should be highlighted that the only factors that were found to be significantly associated with dental hypersensitivity were KT and AG, further supporting the key role of gingival phenotype as it relates to patient-reported outcomes. While limited evidence is available on the factors associated with dental hypersensitivity, we can speculate that having an adequate band of keratinized, firm, and attached gingiva may provide a better seal in the cervical area, so that stimuli, such as the one provoked by the air/water syringe, may not be perceived by the receptors on the apical regions of the root.…”

“…18,[48][49][50][51] It is therefore reasonable to assume that multilevel regression analyses assessing risk indicators of GRs should also include GT, BBD, and BBT using imaging technologies. 25,29,[52][53][54] The goal of the present cross-sectional study was to combine clinical examination with radiographic (CBCT), ultrasonographic, and volumetric assessment of natural dentition in the esthetic zone to identify risk indicators of midfacial GR.…”

“…HFUS has been shown to be a reliable and reproducible tool for visualizing oral structures without exposing patients to ionizing radiation. [25][26][27][28][29] The aim of the present study was to assess the risk indicators of midfacial GR in the esthetic zone by combining clinical measurements with CBCT, intraoral optical scanning, and HFUS.…”

Living cellular constructs for keratinized tissue augmentation: A 13‐year follow‐up from a split‐mouth randomized, controlled, clinical trial

“…Nevertheless, the concept of “gold standard” based on clinical efficacy has been often challenged in the literature 15,17–21 . The relatively high patient morbidity, the need for a second surgical site, and patient anxiety towards palatal harvesting that characterize autogenous grafts, 22,23 led clinicians to investigate several graft substitutes for KTW augmentation, including tissue engineered grafts possessing living cells 15,17,16,24–26 .…”

“…[14][15][16] Nevertheless, the concept of "gold standard" based on clinical efficacy has been often challenged in the literature. 15,[17][18][19][20][21] The relatively high patient morbidity, the need for a second surgical site, and patient anxiety towards palatal harvesting that characterize autogenous grafts, 22,23 led clinicians to investigate several graft substitutes for KTW augmentation, including tissue engineered grafts possessing living cells. 15,17,16,[24][25][26] In a split-mouth clinical trial, McGuire et al demonstrated that an LCC containing allogeneic fibroblasts and keratinocytes regenerated at least 2 mm of KTW in 95.3% of patients after 6 months, although conventional FGG obtained significantly higher KTW gain (4.57 vs. 3.21 mm, on average, respectively).…”