The present study aimed to assess the molecular profiles of subepithelial connective tissue grafts (CTGs) obtained at different locations and depths in the human palate. Sixty-four CTGs belonging to anterior deep (AD), anterior superficial (AS), posterior deep (PD), and posterior superficial (PS) groups were subjected to RNA-Sequencing and their transcriptomes were analyzed computationally. Functional correlations characterizing the CTG groups were validated by cell biological experiments using primary human palatal fibroblasts (HPFs) extracted from the CTGs. A clearly more pronounced location-dependent than depth-dependent difference between the grafts, with a minimal number of genes (4) showing no dependence on the location, was revealed. Epithelial, endothelial, and monocytic cell migration was strongly (P < 0.001) potentiated by AD- and PS-HPFs. Moreover, significantly increased expression of genes encoding C-C and C-X-C motif chemokine ligands as well as significantly (P < 0.01) activated p38 signaling suggested immunomodulatory phenotype for AD- and PS-HPFs. Increased growth factor gene expression and significantly activated (P < 0.001) Erk and Akt signaling in HPFs originating from A-CTGs implied their involvement in cell survival, proliferation, and motility. Prominent collagen-rich expression profile contributing to high mechanical stability, increased osteogenesis-related gene expression, and strongly activated (P < 0.001) Smad1/5/8 signaling characterized HPFs originating from P-CTGs. The present data indicate that in humans, differences between palatal CTGs harvested from different locations and depths appear to be location- rather than depth-dependent. Our findings provide the basis for future personalization of the therapeutic strategy by selecting an optimal graft type depending on the clinical indications.
Humans ; Connective Tissue/transplantation* ; Palate ; Collagen ; Fibroblasts ; Signal Transduction

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*

PURPOSE: To evaluate the effects of intra-alveolar socket grafting, subepithelial connective tissue grafts, and individualized abutments on peri-implant hard and soft tissue outcomes following immediate implant placement. METHODS: This randomized experimental study employed 5 mongrel dogs, with 4 sites per dog (total of 20 sites). The mesial roots of P3 and P4 were extracted in each hemimandible and immediate dental implants were placed. Each site was randomly assigned to 1 of 4 different treatment groups: standardized healing abutment (control group), alloplastic bone substitute material (BSS) + standardized healing abutment (SA group), BSS + individualized healing abutment (IA group), and BSS + individualized healing abutment + a subepithelial connective tissue graft (IAG group). Clinical, histological, and profilometric analyses were performed. The intergroup differences were calculated using the Bonferroni test, setting statistical significance at P<0.05. RESULTS: Clinically, the control and SA groups demonstrated a coronal shift in the buccal height of the mucosa (0.88±0.48 mm and 0.37±1.1 mm, respectively). The IA and IAG groups exhibited an apical shift of the mucosa (−0.7±1.15 mm and −1.1±0.96 mm, respectively). Histologically, the SA and control groups demonstrated marginal mucosa heights of 4.1±0.28 mm and 4.0±0.53 mm relative to the implant shoulder, respectively. The IA and IAG groups, in contrast, only showed a height of 2.6 mm. In addition, the height of the mucosa in relation to the most coronal buccal bone crest or bone substitute particles was not significantly different among the groups. Volumetrically, the IA group (−0.73±0.46 mm) lost less volume on the buccal side than the control (−0.93±0.44 mm), SA (−0.97±0.73 mm), and IAG (−0.88±0.45 mm) groups. CONCLUSIONS: The control group demonstrated the most favorable change of height of the margo mucosae and the largest dimensions of the peri-implant soft tissues. However, the addition of a bone substitute material and an individualized healing abutment resulted in slightly better preservation of the peri-implant soft tissue contour.
Animals ; Bone Substitutes ; Connective Tissue ; Dental Implants ; Dogs ; Mucous Membrane ; Shoulder ; Tissue Transplantation ; Transplants

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

BACKGROUND: The objective of this study was to place bone graft materials in cranial defects in a rabbit model and compare their bone regenerating ability according to the size and density of demineralized dentin matrix (DDM). METHODS: We selected nine healthy male rabbits that were raised under the same conditions and that weighed about 3 kg. Two circular defects 8 mm in diameter were created in each side of the cranium. The defects were grafted with DDM using four different particle sizes and densities: 0.1 mL of 0.25- to 1.0-mm particles (group 1); 0.2 mL of 0.25- to 1.0-mm particles (group 2); 0.1 mL of 1.0- to 2.0-mm particles (group 3); and 0.2 mL of 1.0- to 2.0-mm particles (group 4). After 2, 4, and 8 weeks, the rabbits were sacrificed, and bone samples were evaluated by means of histologic, histomorphometric, and quantitative RT-PCR analysis. RESULTS: In group 1, osteoblast activity and bone formation were greater than in the other three groups on histological examination. In groups 2, 3, and 4, dense connective tissue was seen around original bone even after 8 weeks. Histomorphometric analysis of representative sections in group 1 showed a higher rate of new bone formation, but the difference from the other groups was not statistically significant. RT-PCR analysis indicated a correlation between bone formation and protein (osteonectin and osteopontin) expression. CONCLUSIONS: DDM with a space between particles of 200 μm was effective in bone formation, suggesting that materials with a small particle size could reasonably be used for bone grafting.
Bone Regeneration* ; Bone Transplantation ; Connective Tissue ; Dentin* ; Humans ; Male ; Osteoblasts ; Osteogenesis ; Particle Size* ; Rabbits ; Skull ; Transplants

Gingival recession could occur after orthodontic or endodontic treatment. This could influence not only functional and aesthetic problem, but also patient's treatment satisfaction. There are a lot of techniques for preventing gingival recession, but laterally positioned flap with subepithelial connective tissue graft could get definite advantages such as increase of keratinized gingival width and harmonious color match between graft tissue and surrounding tissue. Clinician should select a right patient case and diagnosis with clinical and radiography exam. In a surgical procedure, getting enough amounts of subepithelial connective tissue and flap coverage should be taken into consideration. The clinical outcomes in this case report shows laterally positioned flap with subepithelial connective tissue graft could be a treatment with predictive outcome.
Connective Tissue* ; Diagnosis ; Gingival Recession* ; Humans ; Iatrogenic Disease ; Radiography ; Surgical Flaps ; Transplantation ; Transplants*

Bone Regeneration ; Connective Tissue ; transplantation ; Dental Implants, Single-Tooth ; Dental Prosthesis, Implant-Supported ; Esthetics, Dental ; Guided Tissue Regeneration, Periodontal ; Humans ; Incisor

PURPOSE: In the anterior maxilla, hard and soft tissue augmentations are sometimes required to meet esthetic and functional demands. In such cases, primary soft tissue closure after bone grafting procedures is indispensable for a successful outcome. This report describes a simple method for soft tissue coverage of a guided bone regeneration (GBR) site using the double-rotated palatal subepithelial connective tissue graft (RPSCTG) technique for a maxillary anterior defect. METHODS: We present a 60-year-old man with a defect in the anterior maxilla requiring hard and soft tissue augmentations. The bone graft materials were filled above the alveolar defect and a titanium-reinforced nonresorbable membrane was placed to cover the graft materials. We used the RPSCTG technique to achieve primary soft tissue closure over the graft materials and the barrier membrane. Additional soft tissue augmentation using a contralateral RPSCTG and membrane removal were simultaneously performed 7 weeks after the stage 1 surgery to establish more abundant soft tissue architecture. RESULTS: Flap necrosis occurred after the stage 1 surgery. Signs of infection or suppuration were not observed in the donor or recipient sites after the stage 2 surgery. These procedures enhanced the alveolar ridge volume, increased the amount of keratinized tissue, and improved the esthetic profile for restorative treatment. CONCLUSIONS: The use of RPSCTG could assist the soft tissue closure of the GBR sites because it provides sufficient soft tissue thickness, an ample vascular supply, protection of anatomical structures, and patient comfort. The treatment outcome was acceptable, despite membrane exposure, and the RPSCTG allowed for vitalization and harmonization with the recipient tissue.
Alveolar Process ; Alveolar Ridge Augmentation ; Bone Regeneration ; Bone Transplantation ; Connective Tissue ; Guided Tissue Regeneration ; Humans ; Maxilla ; Membranes ; Middle Aged ; Necrosis ; Palate ; Suppuration ; Surgical Flaps ; Tissue Donors ; Transplants* ; Treatment Outcome

Pneumatosis intestinalis (PI) is a very rare condition that is defined as the presence of gas within the subserosal or submucosal layer of the bowel. PI has been described in association with a variety of conditions including gastrointestinal tract disorders, pulmonary diseases, connective tissue disorders, organ transplantation, leukemia, and various immunodeficiency states. We report a rare case of a 74-year-old woman who complained of dyspnea during the management of acute asthma exacerbation and developed PI; but, it improved without any treatment.
Adrenal Cortex Hormones ; Aged ; Asthma* ; Connective Tissue ; Dyspnea ; Female ; Gastrointestinal Tract ; Humans ; Leukemia ; Lung Diseases ; Organ Transplantation ; Pneumatosis Cystoides Intestinalis ; Pneumoperitoneum* ; Transplants