Mucogingival surgery is a general term for periodontal surgeries that correct aberrant periodontal soft tissues. Conventional mucogingival surgeries with pedicle flap or autologous soft tissue graft for treatment of gingival recession and insufficient keratinized tissues are always related to disadvantages such as need for a second surgery site, limited supplies, and complaints for postoperative discomfort. In this regard, research and application of soft tissue substitutes have gained increasing attention. Various kinds of soft tissue substitutes, including acellular dermal matrix and xenogeneic collagen matrix, have been developed and applied to clinical treatment. This review aims to summarize advances in research of the characteristics and clinical effectiveness of several soft tissue substitutes and provide references for clinical application.
Gingiva ; Gingival Recession ; surgery ; Humans ; Tooth Root

gingival curvature in labial gingival margin of lower incisors and the gingival recession in patients with mandibular prognathism after orthognathic surgery. And then the effect of these anatomical feature of periodontal tissue to gingival recession were evaluated and compared with change of mandibular incisor inclination and genioplasty which were known as the factors of gingival recession. The pre-treatment lateral cephalograms and lateral cephalograms taken just before surgery and dental casts of 32 skeletal Class III malocclusion patients were collected. The change of inclination of mandibular incisors was estimated in the lateral cephalograms on the basis of mandibular plane and we defined the increase of clinical crown length of the lower incisors after orthognathic surgery as the amount of gingival recession. The relationship between gingival curvature, change of mandibular incisor inclination and gingival recession was evaluated by Spearman correlation analysis. And the difference of gingival recession between genioplasty group and non-genioplasty group was evaluated by T-test. Based on the result, the patients who have more prominent gingival curvature in lower incisors showed more gingival recession after orthognathic surgery and there was no relationship between the forward change of mandibular incisor inclination and gingival recession in patients with mandibular prognathism. And we concluded that genioplasty could be the cause of gingival recession in patients with mandibular prognathism after orthognathic surgery.]]>
Crowns ; Genioplasty ; Gingival Recession ; Humans ; Incisor ; Malocclusion ; Orthognathic Surgery ; Prognathism

Biological Dressings ; Dermis ; cytology ; transplantation ; Extracellular Matrix ; transplantation ; Gingival Recession ; surgery ; Humans ; Mouth Diseases ; surgery

OBJECTIVES: This study aimed to evaluate the efficacy and long-term stability of tunnel technique (TUN) and coronally advanced flap (CAF) combined with connective tissue graft (CTG) in treating gingival recession. METHODS: Databases including PubMed, Web of Science, Embase, and CNKI were electronically searched to collect randomized controlled trial (RCT) of CAF+CTG compared to TUN+CTG in the treatment of Miller class Ⅰ or Ⅱ gingival recession on September 1, 2022. RESULTS: There were 8 RCTs with 305 patients (454 recession sites) participating. The results of the Meta-analysis revealed that, in terms of mean root coverage (MRC) of main indicators, no significant difference was found between the CAF group and the TUN group in both short- and long-term results, which were [MD: 1.45%, 95%CI (-2.93%, 5.82%), P=0.52] and [MD: -0.70%, 95%CI (-6.41%, 5.00%), P=0.81]. However, the CAF group outperformed the TUN group in the long term [MD: 5.69%, 95%CI (0.87%, 10.50%), P=0.02], and the results of complete root coverage (CRC) analysis were similar to those of MRC. In the short term, the TUN group grew keratinized gingiva significantly faster than the CAF group [MD: -0.38 mm, 95%CI (-0.67 mm, -0.10 mm), P=0.008]. Long-term findings revealed no significant difference between the two groups [MD: -0.26 mm, 95%CI (-0.94 mm, 0.43 mm), P=0.46]. The TUN group's secondary index root coverage esthetic score (RES) was statistically significantly higher than the CAF group's [MD: 0.62, 95%CI (0.28, 0.96), P=0.000 3]. Given that there were few results included in the literature and the heterogeneity was too great, no significant difference was observed in the postoperative VAS pain index score [MD: 0.53, 95%CI (-1.96, 3.03), P=0.68]. CONCLUSIONS This study discovered that both CAF+CTG and TUN+CTG can achieve good root coverage in treating gingival recession, with CAF outperforming TUN and both groups achie-ving good long-term stability. After the operation, the TUN group had a higher RES than the CAF group. Given the limitations of this study, more high-quality studies are needed in the future to demonstrate the efficacy of TUN in gingival retraction surgery.
Humans ; Gingival Recession/surgery* ; Treatment Outcome ; Tooth Root ; Esthetics, Dental ; Gingiva/surgery*

This study was concerned with comparing the measured values of labial alveolar bone through the lateral cephalometric radiography and mandibular incisor cross-secional tomogram between two groups, one group of mandibular prognathism patients who needed an orthognathic surgery as an experimental group and the other group who had normal relationships as a control group. The purpose of the study was to find out the predisposing factors of bone resorption and gingival recession before orthodontic treatment. The results were as follows: 1. The cross-sectional area of labial alveolar bony plate in mandibular prognathism was significantly smaller than that of control group. 2. In mandibular prognathism, the distance between cementoenamel junction and aveolar crest was significantly greater than control group. 3. There were negative correlations between area of labial alveolar bony plate and distance from cementoenamel junction to alveolar crest, and positive correlations between area of labial alveolar bony plate and distance from alveolar crest to root apex. 4. In mandibular prognathism, there were positive correlations between IMPA and thickness of symphysis, and negative correlations between IMPA and the alveolar bony height. The results of the present study suggest the mandibular prognathism patients are prone to the gingival recession due to the small amount of labial alveolar bone around lower incisors.
Bone Resorption ; Causality ; Gingival Recession ; Humans ; Incisor* ; Orthognathic Surgery ; Prognathism* ; Radiography ; Tooth Cervix

PURPOSE: The purpose of this study was to propose a technique for periodontal biotype modification through thickening of the entire facial aspect using a volume-stable collagen matrix and autogenous subepithelial connective tissue graft (CTG) for the treatment of gingival recession. METHODS: Four systemically healthy patients showing Miller class I or class II gingival recession in the mandibular incisor area were included in this study. Full-mouth scaling and root planing procedures were performed at least 4 weeks prior to periodontal plastic surgery. A split-thickness flap with a horizontal intrasulcular incision and 2 vertical incisions was used in cases 1–3, and the modified tunnel technique was used in case 4 for coronal advancement of the mucogingival complex. After the exposed root surfaces were debrided thoroughly, double-layered volume-stable collagen matrix was placed on the apical part of the recession and a subepithelial CTG harvested from the palatal area was placed on the coronal part. The amount of root coverage at 3 months postoperatively was evaluated in cases 1–3, and facio-lingual volumetric changes were analyzed in cases 1 and 2. RESULTS: Healing was uneventful in all 4 cases and complete root coverage was shown in cases 1–3. In case 4, reduction of gingival recession was observed at 3 months after surgery. In cases 1 and 2, a comparison of stereolithographic files from the preoperative and postoperative time points demonstrated that the entire facio-lingual volume had increased. CONCLUSIONS: The surgical technique suggested herein, using a volume-stable collagen matrix and autogenous subepithelial CTG, may be an effective method for periodontal biotype modification through thickening of the entire facial aspect for the treatment of gingival recession.
Collagen ; Connective Tissue ; Gingival Recession ; Humans ; Incisor ; Methods ; Root Planing ; Surgery, Plastic ; Transplantation ; Transplants

surgery, Wonkwang university from January in 2000 to December 2002 were classified by 4 types and assessed complications. Complications in surgically assisted rapid tooth movement were divided into tooth related, periodontal related, and mechanical related complications. RESULT: There were few intraoperative or postoperative complications. In total 78 patients, gingival recession was most commonly observed in 6 cases, and transient pulpal hyperemia, root fracture, root resorption, crestal bone loss, tooth tipping and anchorage loss were observed. But most complications were not clinically significant, and did not interfere postoperative orthodontic treatments. CONCLUSIONS: Based on this study, surgically assisted rapid tooth movement have no clinically significant complications, but adequate diagnosis, careful surgical management were required for avoiding these complications.]]>
Diagnosis ; Gingival Recession ; Humans ; Hyperemia ; Postoperative Complications ; Root Resorption ; Surgery, Oral ; Tooth Loss ; Tooth Movement ; Tooth

Humans ; Gingival Recession/surgery* ; Gingivoplasty/methods* ; Connective Tissue/transplantation* ; Treatment Outcome ; Gingiva/transplantation* ; Tooth Root

OBJECTIVES: To evaluate the effectiveness of an acellular dermal matrix or a connective tissue autograft in the treatment of multiple adjacent gingival recessions through Meta-analysis. METHODS: Randomized controlled trials were screened in four electronic databases in English according to the inclusion and exclusion criteria until April 20, 2022. The main outcome indicators were keratinized gingival tissue width, recession depth, probing depth, clinical attachment level, complete root coverage, and root coverage esthetic score. RESULTS: Seven randomized controlled trials were included. After 12 months, the connective tissue graft in the control group could increase the keratinized gingival tissue width [mean difference (MD)=-0.28 (-0.47, -0.08), P=0.006], reduce the gingival recession depth [MD=0.23 (0.12, 0.35), P<0.000 1], and improve the complete root coverage [risk ratio=0.80, 95% confidence interval (0.69, 0.93), P=0.003] compared with the acellular dermal matrix in the experimental group. No significant difference was found in probing depth, clinical attachment level, and root coverage esthetic score between groups. CONCLUSIONS Connective tissue grafts have advantages in increasing the keratinized gingival tissue width, reducing the gingival recession depth, and improving the complete root coverage in surgeries for treating multiple adjacent gingival recessions. Acellular dermal matrices also have some clinical value in terms of operation simplicity and similar effectiveness.
Humans ; Gingival Recession/surgery* ; Acellular Dermis ; Surgical Flaps ; Esthetics, Dental ; Connective Tissue/transplantation*

The aim of this clinical report is to describe the complex treatment of an adult Class III malocclusion patient who was disappointed with the outcome of a previous oral rehabilitation. Interdisciplinary treatment planning was performed with a primary indication for implant removal because of marginal bone loss and gingival recession, followed by orthodontic and surgical procedures to correct the esthetics and skeletal malocclusion. The comprehensive treatment approach included: (1) implant removal in the area of the central incisors; (2) combined orthodontic decompensation with mesial displacement and forced extrusion of the lateral incisors; (3) extraction of the lateral incisors and placement of new implants corresponding to the central incisors, which received provisional crowns; (4) orthognathic surgery for maxillary advancement to improve occlusal and facial relationships; and finally, (5) orthodontic refinement followed by definitive prosthetic rehabilitation of the maxillary central incisors and reshaping of the adjacent teeth. At the three-year follow-up, clinical and radiographic examinations showed successful replacement of the central incisors and improved skeletal and esthetic appearances. Moreover, a Class II molar relationship was obtained with an ideal overbite, overjet, and intercuspation. In conclusion, we report the successful esthetic anterior rehabilitation of a complex case in which interdisciplinary treatment planning improved facial harmony, provided gingival architecture with sufficient width and thickness, and improved smile esthetics, resulting in enhanced patient comfort and satisfaction. This clinical case report might be useful to improve facial esthetics and occlusion in patients with dentoalveolar and skeletal defects.
Adult* ; Crowns ; Dental Implants ; Esthetics ; Follow-Up Studies ; Gingival Recession ; Humans ; Incisor ; Malocclusion* ; Molar ; Orthodontics ; Orthognathic Surgery ; Overbite ; Rehabilitation ; Tooth