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Root coverage in molar recession: report of 50 consecutive cases treated with subepithelial connective tissue grafts.

BACKGROUND: The purpose of this study was to evaluate root coverage of molar recession defects. METHODS: Fifty patients with a molar recession defect on one molar were treated with a subepithelial connective tissue graft. The procedure was performed as previously reported. RESULTS: Complete root coverage was obtained in 29 of the 50 defects (58%). A mean root coverage of 91.1% was obtained. There was a statistically significant decrease in recession depth (4.4 mm to 0.5 mm), increase in quantity of keratinized tissue (0.9 mm to 3.1 mm), decrease in probing depth (3.0 mm to 2.3 mm), and decrease in attachment level loss (7.4 mm to 2.8 mm). CONCLUSION: The subepithelial connective tissue graft is an effective method to obtain root coverage of recession defects on molars.

Adult↗

Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 1: Comparison of clinical parameters.

BACKGROUND: Recession defects around teeth have been treated with a variety of surgical techniques. Most of the literature suggests that the subepithelial connective tissue graft has the highest percentage of mean root coverage with the least variability. Previous studies have demonstrated that enamel matrix derivative (EMD) has the ability to improve clinical parameters. The purpose of this study was to compare the clinical efficacy of enamel matrix derivative placed under a coronally advanced flap to subepithelial connective tissue placed under a coronally advanced flap in patients with recession type defects. METHODS: Twenty patients with incisors or premolars presenting with a facial recession of > or = 4 mm in contralateral quadrants of the same jaw were treated; 17 patients completed the study. One tooth in each patient was randomized to receive either a coronally advanced flap with a subepithelial connective tissue graft (control) or a coronally advanced flap with EMD (test). Clinical parameters measured at baseline and at 6, 9, and 12 months included amount of recession; width at the coronal extent of the gingival defect; width of keratinized tissue; probing depth; clinical attachment level; inflammation score; plaque score; plaque index; alveolar bone level; tissue texture and color; and patient perception of pain, bleeding, swelling, and sensitivity. RESULTS: Results for both the test and control groups were similar for all measured clinical parameters with the exception of early healing, self-reported discomfort, and the amount of keratinized tissue obtained. The coronally advanced flap with EMD was superior to the subepithelial connective tissue graft with regard to early healing and patient-reported discomfort, whereas the subepithelial connective tissue graft demonstrated greater amount of keratinized tissue during the 12-month evaluation period. However, both the test and control showed a significant increase in the amount of keratinized tissue at 9 and 12 months compared to baseline. No significant difference in the amount of root coverage was found between the test and control groups (n = 19; P = 0.82). On average, a gain of 4.5 mm (range 4 to 8 mm) tissue covering the previously exposed root surfaces was achieved with both treatment groups. The average percentages of root coverage for control and test groups were 93.8% and 95.1%, respectively. One hundred percent root coverage was obtained 89.5% of the time with the coronally advanced flap with EMD and 79% of the time with the subepithelial connective tissue graft. CONCLUSION: Based on the results of this investigation, the addition of EMD to the coronally advanced flap resulted in root coverage similar to the subepithelial connective tissue graft but without the morbidity and potential clinical difficulties associated with the donor site surgery.

Adult↗

Autosomal recessive polycystic kidney disease: long-term sonographic findings in patients surviving the neonatal period.

OBJECTIVE: We studied the sonographic findings and the changes in renal function seen on long-term follow-up of children who had the initial diagnosis of autosomal recessive polycystic kidney disease made in the neonatal period. MATERIALS AND METHODS: The case records and sonograms of 14 children with biopsy evidence of autosomal recessive polycystic kidney disease were evaluated. Nine children who survived the neonatal period were followed up for a mean of 13 years (range, 5-19 years) after diagnosis and form the basis of this study. Serial changes in renal size, echogenicity, and function were assessed sonographically. The imaging findings were compared with those described in published reports. RESULTS: The sonographic findings showed that five of the nine children had a decrease in renal size, and three had stable renal size over a minimum follow-up period of 5 years. Only one of the nine survivors showed progressive increase in renal size. All had increased cortical echogenicity and large kidneys. Three patients showed a subjective change in renal echogenicity over time. A change in the echogenic pattern to one that resembles autosomal dominant polycystic kidney disease was noted with no evidence of increase in size of the kidneys. None of the surviving children had renal stones or massively enlarged kidneys. The renal function of seven of the nine survivors has remained stable with creatinine clearance nearly normal (> 60 ml/min/1.73 m2), and there was no correlation between renal size and renal function. CONCLUSION: In patients with autosomal recessive polycystic kidney disease who survive the neonatal period, kidney size as seen on sonograms does not continue to increase despite the patients' linear growth and maintained normal renal function. Rather, a decrease in kidney size and change in echogenicity occurs, producing a pattern that is similar to that seen on sonograms of patients with autosomal dominant polycystic kidney disease but without the marked increase in kidney size that occurs in that entity. This changing cystic pattern on follow-up sonograms may be the reason that previous descriptions of the sonographic findings in cases of autosomal recessive polycystic kidney disease have varied and why a decrease in size may not herald deteriorating renal function.

Biopsy↗

The effects of recessive white and dominant white genotypes on early growth rate.

The purpose of the studies reported herein was to determine whether the depressing effects on growth rate of dominant white (I) and recessive white (c/c) are additive or possibly interact with each other. A synthetic stock was used that was segregating for both dominant white and recessive white. Using phenotypic observations of down color and juvenile plumage color; it was possible to identify the genotypes at the I and C+ loci and to utilize a factorial experiment that provided for an evaluation of interaction effects between the loci. Five replications of this design were conducted with the following results: 1) the main effect of dominant white on 6 and 8 week body weight was not statistically significant; 2) recessive white consistently depresses early growth rate and the difference (congruent to 4%) between C+/- vs. c/c was highly significant (P less than .01); 3) there was a significant interaction (P less than .05) between I and c indicating that depressing effects of these loci are not additive. It does not appear to be necessary to eliminate (I) from recessive white broiler stocks, but it would be economically advantageous to remove hypostatic (c) from dominant white lines.

Age Factors↗

Redundancy of a functional melanocortin 1 receptor in the anti-inflammatory actions of melanocortin peptides: studies in the recessive yellow (e/e) mouse suggest an important role for melanocortin 3 receptor.

The issue of which melanocortin receptor (MC-R) is responsible for the anti-inflammatory effects of melanocortin peptides is still a matter of debate. Here we have addressed this aspect using a dual pharmacological and genetic approach, taking advantage of the recent characterization of more selective agonists/antagonists at MC1 and MC3-R as well as of the existence of a naturally defective MC1-R mouse strain, the recessive yellow (e/e) mouse. RT-PCR and ultrastructural analyses showed the presence of MC3-R mRNA and protein in peritoneal macrophages (M phi) collected from recessive yellow (e/e) mice and wild-type mice. This receptor was functional as Mphi incubation (30 min) with melanocortin peptides led to accumulation of cAMP, an effect abrogated by the MC3/4-R antagonist SHU9119, but not by the selective MC4-R antagonist HS024. In vitro M phi activation, determined as release of the CXC chemokine KC and IL-1 beta, was inhibited by the more selective MC3-R agonist gamma(2)-melanocyte stimulating hormone but not by the selective MC1-R agonist MS05. Systemic treatment of mice with a panel of melanocortin peptides inhibited IL-1 beta release and PMN accumulation elicited by urate crystals in the murine peritoneal cavity. MS05 failed to inhibit any of the inflammatory parameters either in wild-type or recessive yellow (e/e) mice. SHU9119 prevented the inhibitory actions of gamma(2)-melanocyte stimulating hormone both in vitro and in vivo while HS024 was inactive in vivo. In conclusion, agonism at MC3-R expressed on peritoneal M phi leads to inhibition of experimental nonimmune peritonitis in both wild-type and recessive yellow (e/e) mice.

Animals↗

[Mutagenic effect of different types of irradiation on the sex cells of male mice. X. Frequency of recessive lethal mutations and reciprocal translocations in the spermatogonia of mice subjected to fractional gamma-irradiation].

The frequency of recessive lethal mutations and reciprocal translocations was investigated in spermatogonia of CBA male mice which were thrice gamma-irradiated at doses of 300 r with 28 days intervals. The rate of induced recessive lethals was estimated 1) by comparison of embryos survival between the irradiated and control groups in mating of the F1 males with their daughters, and 2) by estimation the frequency of males heterozygotes for recessive lethals in the first generation. In the first case the frequency of recessive lethals was 2,8 +/- 0,8-10(-4) per r per gamete (for the pre- and post-implantation death) and 1,6 +/- 0,1-10(-4) per r per gamete (for the pre- and post-implantation death) and 1,6 +/- 0,1-10(-4) per r per gamete in the second case. The frequency of heterozygotes for reciprocal translocations in the first generations of males was 3,1 +/- 0,9-10(-5) per r per gamete.

Animals↗

[Treatment of multiple recession-type defects in a young patient with esthetic demands].

Treatment of gingival recession has become an important therapeutic issue due to the increasing number of cosmetic demands from patients. Frequently, gingival recessions affect groups of adjacent teeth. In order to optimize the esthetic result all the contiguous recessions should be treated at the same time. The purpose of this article is to compare some techniques of root coverage in a patient with Miller class 1 recessions. A mean of 80% of root exposure was covered using the free gingival graft and free connective tissue graft with repositioned flap compared to 67% using coronally positioned flap over a connective tissue graft. In conclusion, partial root coverage and gingival augmentation with a good esthetic appearance were obtained by a one-step connective tissue graft procedure.

Adult↗

A promising periodontal procedure for the treatment of adjacent gingival recession defects.

Various clinical reports on the reconstruction of gingival recession defects have been published in the past decade. Several techniques have been used to achieve root coverage, including creation of free gingival grafts, laterally positioned flaps or semilunar coronally positioned flaps, as well as guided tissue regeneration and connective tissue grafting. This article focuses on the importance of connective tissue grafting, combined with a recent approach known as the tunnel procedure, in managing gingival recession defects with a single operation. This procedure originated in 1985 with an envelope design and a subepithelial connective tissue graft for single gingival recession defects and is used today for coverage of multiple adjacent gingival recession defects. Histological evaluation of such connective tissue grafts demonstrates periodontal regeneration in human subjects. Clinical trials have yielded good results, including early tissue healing because of increased blood supply, good esthetic results, excellent patient cooperation and avoidance of secondary periodontal plastic surgery. These benefits underline the appropriateness of this technique, which improves the success rate of connective tissue grafting and increases the amount of root coverage.

Connective Tissue↗

Coronally positioned flap with or without enamel matrix protein derivative for the treatment of gingival recessions.

PURPOSE: To evaluate, histometrically, the healing of gingival recessions treated by coronally positioned flaps associated with enamel matrix protein derivative (EMD-Group) and to compare it to that obtained with coronally positioned flaps alone (CPF-Group). METHODS: Five mongrel dogs were used. Gingival recessions were surgically created on the buccal aspect of the upper cuspids. The defects (5 x 7 mm) were exposed to plaque accumulation for 3 months. After a preparation period, the contralateral defects were randomly assigned to each group. After 3 months of healing, the dogs were sacrificed and the blocks were processed. The histometric parameters evaluated included: gingival recession, length of epithelium, new connective tissue attachment and new bone. RESULTS: The gingival recession was -0.1 +/- 0.2 mm for the EMD-Group and -0.8 +/- 1.3 mm for the CPF-Group (P = 0.17). The extension of the epithelium was 1.2 +/- 1.0 mm for the EMD-Group and 1.3 +/- 0.7 mm for the CPF-Group (P = 0.89). The new connective tissue attachment was 4.8 +/- 0.7 in the EMD-Group and 4.0 +/- 1.4 in the CPF-Group (P = 0.22). The new bone was 0.1 +/- 1.8 mm and -0.5 +/- 1.4 mm in the EMD-Group and CPF-Group, respectively (P = 0.50). Histologically, the defect coverage observed was 98.2% for the EMD-Group and 85.8% for the CPF-Group.

Acid Etching, Dental↗

Double laterally-rotated bilayer flap operation for treatment of gingival recession.

BACKGROUND AND PURPOSE: Many root coverage techniques, such as lateral pedicle flap, double papilla flap, free gingival graft, connective tissue graft, and guided tissue regeneration (GTR) procedure have been widely applied in clinical dental practice. Although they all provide various degrees of successful root coverage, some procedures are technique-sensitive and others require a 2-stage operation. METHODS: In this study, we describe a new technique with a double laterally-rotated bilayer flap for root coverage. Briefly, 2 partial-thickness flaps were prepared, one on each side of the gingival recession, and then laterally repositioned (with mutual overlapping) to cover the root exposure. After thorough planing of the exposed root surfaces, root conditioning with saturated citric acid solution (pH = 1.0) was performed. One partial-thickness flap was de-epithelialized and then rotated to cover the citric acid-conditioned root surface. Another partial-thickness flap was further rotated to cover the de-epithelialized flap. Both flaps were sutured to the recipient periosteal bed. This new root coverage technique was used to treat 2 teeth with gingival recession. RESULTS: The results demonstrated that this new technique provides satisfactory root coverage of gingival recession and improves root dentin hypersensitivity of treated teeth. The main advantages of this technique are simple 1-stage surgery, esthetic color matching of the soft tissue, and a good blood supply of the reflected flap. CONCLUSIONS: We conclude that the double laterally-rotated bilayer flap operation may provide a new alternative for the treatment of gingival recession.

Adult↗

The effect of an anticalculus dentifrice on supragingival calculus formation and gingival recession in Thai adults: a one-year study.

A one-year, double-blind clinical study was conducted on a population of male and female adults to determine the effect of the twice daily use of an anticalculus dentifrice on supragingival calculus formation and gingival recession, as compared to the use of a placebo dentifrice. The subjects were initially evaluated for calculus using the Volpe-Manhold scoring procedure and for gingival recession using the Gingival Recession Total (GRT) scoring procedure of Volpe, Triratana and Rustogi. All subjects received an oral prophylaxis and were assigned to the use of either a placebo dentifrice containing 0.243% sodium fluoride in a silica base or an anticalculus dentifrice containing 1.3% soluble pyrophosphate and 1.5% Gantrez copolymer in a 0.243% sodium fluoride/silica base. After six months, the subjects using the anticalculus dentifrice had 24.14% significantly less supragingival calculus than the placebo dentifrice subjects. After one year, the subjects using the anticalculus dentifrice had 40.76% significantly less supragingival calculus than the placebo dentifrice subjects. Also, after one year, the subjects using the anticalculus dentifrice had 27.75% significantly less gingival recession than the placebo dentifrice subjects.

Adult↗

The effect of an anticalculus dentifrice on calculus formation and gingival recession in Thai children and teenagers: one-year study. Study #1. An anticalculus dentifrice containing 3.3% soluble pyrophosphate and 1.0% of a copolymer.

A one-year, double-blind clinical study was conducted on a population of Thai children and teenagers to determine the effect of the twice daily use of an anticalculus dentifrice on supragingival calculus formation and gingival recession, as compared to the use of a placebo dentifrice and the continuation of customary oral hygiene procedures. The subjects were initially evaluated for calculus using the Volpe-Manhold procedure and for gingival recession using the GRT procedure of Volpe, Triratana, and Rustogi. All subjects received an oral prophylaxis and were assigned to the use of 1) a placebo dentifrice containing 0.243% sodium fluoride in a silica base, 2) an anticalculus dentifrice containing 3.3% soluble pyrophosphate and 1.0% Gantrez copolymer--in a 0.243% sodium fluoride/silica base, or 3) continuation of customary oral hygiene procedures. After one year, the subjects using the anticalculus dentifrice had 37.01% less supragingival calculus and 25.09% less gingival recession than the subjects using the placebo dentifrice. Additionally, after one year, the subjects using the anticalculus dentifrice had 34.86% less supragingival calculus and 29.95% less gingival recession than the subjects who continued their customary oral hygiene procedures. All reductions were statistically significant at the 95% or greater level of confidence.

Adolescent↗

The effect of an anticalculus dentifrice on calculus formation and gingival recession in Thai children and teenagers: one-year study. Study #2. An anticalculus dentifrice containing 1.3% soluble pyrophosphate and 1.5% of a copolymer.

A one-year, double-blind clinical study was conducted on a population of Thai children and teenagers to determine the effect of the twice daily use of an anticalculus dentifrice on supragingival calculus formation and gingival recession, as compared to the use of a placebo dentifrice and the continuation of customary oral hygiene procedures. The subjects were initially evaluated for calculus using the Volpe-Manhold procedure and for gingival recession using the GRT procedure of Volpe, Triratana, and Rustogi. All subjects received an oral prophylaxis and were assigned to the use of the following: (1) a placebo dentifrice containing 0.243% sodium fluoride in a silica base, (2) an anticalculus dentifrice containing 1.3% soluble pyrophosphate and 1.5% Gantrez copolymer in a 0.243% sodium fluoride/silica base, or (3) continuation of customary oral hygiene procedures. After six months, the subjects using the anticalculus dentifrice had 35.93% less supragingival calculus than the placebo dentifrice subjects, and 52.74% less supragingival calculus than the subjects who continued their regular/customary oral hygiene procedures. After one year, the subjects using the anticalculus dentifrice had 39.76% less supragingival calculus and 18.33% less gingival recession than the subjects using the placebo dentifrice. Also, after one year, the subjects using the anticalculus dentifrice had 57.86% less supragingival calculus and 16.55% less gingival recession than the subjects who continued their customary oral hygiene procedures. All reductions were statistically significant at the 99% level of confidence.

Adolescent↗

Current trends in gingival recession coverage--part I: the tunnel connective tissue graft.

The recession of the gingiva is increasingly becoming a more prominent condition in the oral health of many patients and should be treated at its earliest detection. The multifactorial etiology, decision modality, and current trends followed in the treatment of gingival recession are discussed in this presentation. The correction of Class I and II gingival recessions are presented as a means of minimizing surgical trauma and achieving predictable aesthetic results. Part II of this discussion will present alternative techniques in treating gingival recession.

Adult↗

The relationship between chewing sticks (Miswak) and periodontal health. 3. Relationship to gingival recession.

Aggressive or improper toothbrushing techniques may have a detrimental impact on the gingiva. The purpose of this study was to examine the relationship between chewing sticks (Miswak) and gingival recession. Gingival recession was measured on the mid facial surfaces of the incisors, canines, and premolars in 238 patients presenting for routine dental appointments. All patients had been interviewed previously regarding their oral hygiene habits and use of Miswak. Patients were divided into three groups: Miswak group, toothbrush group, and Miswak/toothbrush group. The Miswak users had significantly more (P less than or equal to .05) sites gingival recession than did the toothbrush users. Furthermore, the severity of the recession was significantly more (P less than or equal to .05) pronounced in the Miswak users than it was in the toothbrush users.

Adolescent↗

Anterior open bite and gingival recession in children and adolescents.

Gingival recession is a manifestation of periodontal breakdown. Plaque microorganisms are the primary aetiological factor, but other secondary conditions are also associated with its presence. This study examined the hypothesis that localized gingival recession is more prevalent in open-bite cases. The study included 26 children with untreated anterior open bite and a matched control group. Clinical crown length, recession depth, oral habits and periodontal indices were recorded for each individual. Although the plaque index was not significantly different between the two groups, the open-bite group showed significantly greater clinical crown length and gingival inflammation. This may be attributed to increased virulence of dehydrated plaque and it is suggested that open bite may predispose to the development of localized gingival recession in the anterior segments of young individuals.

Adolescent↗

Gene inactivation as a mechanism for the expression of recessive phenotypes.

A series of Chinese hamster ovary cell hybrids were constructed which were heterozygous at the emtB and chr loci. These loci encode two recessive drug-resistance genes (emetine resistance and chromate resistance, respectively) located on a structurally hemizygous region on the long arm of chromosome 2. These heterozygous hybrids therefore exhibit wild-type sensitivity to both emetine and chromate. Drug-resistant variants were then selected in medium containing either emetine or chromate, and the mechanism of reexpression of the recessive drug-resistant allele was determined by karyotypic analysis of the resultant colonies. In previous studies at these loci we have determined that segregation of the recessive phenotype occurs primarily by (1) the loss of the chromosome 2 carrying the wild-type, drug-sensitive, allele, (2) deletion of the long arm of chromosome 2, or (3) loss of one chromosome 2 followed by duplication of the remaining homologue. However, a small proportion of segregants have also been detected which may have arisen by the mechanisms of de novo gene inactivation or mutation. In this report, hybrids are described which were constructed to allow selection for the retention of the chromosome carrying the wild-type allele and which therefore optimize isolation of these rare segregants. We demonstrate by karyotypic analysis, mutation frequency analysis, and microcell-mediated chromosome transfer that these rare segregants occur primarily by gene inactivation. We also demonstrate a dramatic increase in the proportion of segregants occurring by gene inactivation in two of these hybrids as compared with those previously reported, indicating that this mechanism may be an important mode of phenotype segregation in diploid cells and, therefore, in the development of cancers--such as the childhood tumors retinoblastoma and Wilms tumor--resulting from recessive alleles

Animals↗

[Partially buried connective tissue grafts for gingival recession: clinical results apropos of 22 cases].

A connective tissue graft technique described by Langer and Langer for treating gingival recession was attempted in 22 clinical cases using connective tissue above. 100% root coverage was obtained where only 3 mm of recession existed, 94% when recession was 3 to 5 mm and 58% root coverage occurred where recession was greater than 6 mm. This technique was compared with the classical technique of free gingival grafts and the connective tissue graft technique for covering exposed root surfaces proposed by Nelson.

Adolescent↗