Clinical Advances in Periodontics最新文献

{"title":"Effect of aesthetic crown lengthening on life quality and self-esteem: 2-year study.","authors":"Leticia S Arroteia, Camila S Stolf, Hélvis E S Paz, Thais F M Paschoal, Mabelle F Monteiro, Márcio Z Casati, Mauro P Santamaria, Renato C V Casarin","doi":"10.1002/cap.70030","DOIUrl":"10.1002/cap.70030","url":null,"abstract":"<p><strong>Background: </strong>A gummy smile can result from several factors, often leading to a disharmonious appearance and causing physical and psychological discomfort for the patient. This study aimed to evaluate changes in self-esteem and quality of life for patients, as well as the recidivism rate, following aesthetic crown lengthening (ACL) surgery.</p><p><strong>Methods: </strong>Twenty-two periodontally healthy patients who expressed interest in undergoing ACL and met the procedural indications were selected. Before surgery, at 30 days, and 2 years postoperatively, the Oral Health Impact Profile - 14 items (OHIP-14) and the Rosenberg Self-Esteem Scale were used to assess patients' perceptions of quality of life and self-esteem. Crow dimensions, gingival phenotype, and the recidivism rate were assessed.</p><p><strong>Results: </strong>ACL significantly improved the psychosocial parameters of patients (p < 0.05). Both self-esteem and quality of life showed improvement 30 days post-surgery (p = 0.02 and 0.00024, respectively). After 2 years, further improvements were observed in the self-esteem index compared to the 30-day results (from 11 [interquartile range {IQR}: 8.0-14.0] to 14 [IQR:12-15, p < 0.05]) and in the OHIP score (from 19 [IQR:14-27] to 6 [IQR: 0.0-8.0]). The clinical crown length established 30 days after surgery remained stable after 2 years (0.82 ± 0.11).</p><p><strong>Conclusions: </strong>ACL can enhance patients' quality of life and self-esteem, serving as a valuable procedure in aesthetic periodontics.</p><p><strong>Plain language summary: </strong>A \"gummy smile,\" where too much gum tissue shows when a person smiles, can affect both appearance and confidence. This study looked at whether aesthetic crown lengthening surgery (a procedure that reshapes the gums and exposes more of the teeth) could improve how people feel about themselves and their daily lives. We followed 22 patients who underwent this surgery and measured their self-esteem and quality of life before the procedure, 1 month later, and again 2 years after the procedure. Results showed that patients felt noticeably better about their smiles and overall quality of life just 1 month after surgery. Even more encouraging, these benefits continued to grow over the course of 2 years, with patients reporting higher self-esteem and fewer problems related to their oral health. Importantly, the changes achieved by the surgery-such as the new tooth and gum proportions-remained stable, with no return of the gummy smile. These findings suggest that crown lengthening is not only an effective and lasting solution for improving the appearance of a gummy smile but also has meaningful, long-term benefits for patients' confidence and well-being.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"703-711"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13603051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supracrestal tissue attachment dimension modulates outcomes of periodontal therapy across gingival phenotypes.","authors":"Sakshi Verma, Rajinder K Sharma, Shikha Tewari, Ritika Arora","doi":"10.1002/cap.70032","DOIUrl":"10.1002/cap.70032","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Incompatibility of supracrestal tissue attachment (SCTA) violation with periodontal health leading to sequelae associated with persistent periodontal inflammation has been established. Limited data exist on how SCTA variations affect outcomes of periodontal therapy. This study aims to evaluate effect of SCTA dimensions on efficacy of subgingival instrumentation (SI) and open flap debridement (OFD) in stage II/III periodontitis patients with different gingival phenotypes (GPs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Thirty-eight patients with 152 teeth and 912 sites underwent SI and OFD. Clinical parameters along with SCTA and GP were assessed at baseline, 8 weeks, and 6 months. Logistic regression analysis was performed to identify factors influencing the outcomes at patient-level, tooth-level, and site-level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Two distinct groups were identified: one with higher supracrestal-attached tissue volume-SCTV (SCTA ≥ 2 mm/SCTA ≤ 1 mm: Thick GP; SCTA ≥ 2 mm: Thin GP) and another with lesser SCTV (SCTA ≤ 1 mm: Thin GP). Significantly difference was observed in the group with higher SCTV following OFD for bleeding on probing (0.21 ± 0.42 vs. 0.07 ± 0.42), probing pocket depth (1.44 ± 1.51 mm vs. 1.04 ± 1.39 mm), and clinical attachment level (CAL: 1.35 ± 1.45 mm vs. 0.83 ± 1.48 mm). In logistic regression model, the odds of having unit gain in CAL is 1.8 times more at sites with ≥2 mm SCTA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study offers a comprehensive view of multi-dimensional SCTV and emphasizes SCTV as important factor in influencing the clinical outcomes of periodontitis interventions. The findings highlight SCTV as a key determinant of healing, treatment predictability, and periodontal stability, providing a basis for more targeted and personalized therapies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Supracrestal tissue attachment dimension has the potential to modulates the outcomes of periodontal therapy across GP. Patients with higher SCTV show superior improvements in BOP, PPD, and CAL after open flap debridement, and sites with SCTA ≥2 mm are nearly twice as likely to achieve significant clinical attachment gain. Recognizing SCTV as one of the determinants of healing can improve case selection, optimize surgical outcomes, and guide personalized periodontal therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Supracrestaltissue attachment (SCTA) plays a critical role in maintaining periodontal health, yet limited data exist on how variations in SCTA influence outcomes of periodontal therapy. This study evaluated the effect of SCTA dimensions on the effectiveness of subgingival instrumentation and open flap debridement in stageII/III periodontitis patients with different gingival phenotypes. Patients were treated and monitored over six months, with clinical outcomes assessed at multiple time points. Sites with higher supracrestal tissue volume demonstrated greater improvements in bleeding c","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"712-722"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient satisfaction among periodontally stable patients with veneer restorations-A retrospective study.","authors":"Amelie M Bäumer, Christoper T Riemer, Christopher Büsch, Gerd A Körner, Johanna A Gaß","doi":"10.1002/cap.70020","DOIUrl":"10.1002/cap.70020","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Successful periodontal therapy may yield poor esthetic outcomes, impacting patient satisfaction, and while adhesive ceramic veneers demonstrate success in esthetically compromised cases, their effectiveness in periodontally compromised patients' satisfaction remains unexplored. Therefore, this retrospective study assesses patient-reported quality of life and satisfaction in periodontally healthy and stable patients with anterior ceramic veneer restorations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients, both periodontally healthy and stable, who received anterior veneer restorations at least 5 years ago, participated in the study. Satisfaction data, Oral Health Impact Profile (OHIP-G14), and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) scores were collected, and groups were categorized based on periodontal diagnosis (healthy, stage I/II, stage III/IV). Veneers were evaluated using pink esthetic score (PES) and white esthetic score (WES) criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Analysis of 68 patients and 312 veneers with an average 8-year follow-up revealed high satisfaction with anterior veneer restorations. The study indicates that veneers positively impact oral health-related quality of life (OHRQoL) for patients with and without severe attachment loss, with mild periodontitis potentially enhancing satisfaction. The PES score is lower in patients with severe periodontitis (mean ± SD: 7.33 ± 1.78, p &lt; 0.01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The results emphasize the positive impact on functionality and esthetic quality, suggesting that veneer restorations in the anterior region are a beneficial treatment option for improving OHRQoL, independent from attachment loss due to periodontitis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Veneer restorations significantly improve patient satisfaction and oral health-related quality of life (OHRQoL), even in patients with a history of periodontitis. This suggests veneers are a viable esthetic solution regardless of previous periodontal attachment loss. While patients with severe periodontitis may exhibit lower pink esthetic scores (PES), the white esthetic outcome (WES) and overall patient satisfaction remain high. This underlines the importance of managing expectations regarding soft tissue esthetics without compromising the perceived success of the treatment. Anterior ceramic veneers should be considered a reliable treatment option for esthetic rehabilitation in both periodontally healthy and previously compromised patients, when periodontal stability is achieved.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Periodontal disease can compromise both the function and appearance of anterior teeth, and even after successful treatment, patients may remain dissatisfied with esthetic outcomes. This study evaluated whether anterior ceramic veneers could improve patient-reported outcomes, particularly oral health-related quality of life (OHRQoL), in individuals with varyi","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"692-702"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implant-related orofacial pain managed with implant apicoectomy: A case report.","authors":"Oscar Durán-Garnica, Karen Villarreal-Arizpe, Hong Chen, Hsun-Liang Chan, Guo-Liang Cheng","doi":"10.1002/cap.70054","DOIUrl":"10.1002/cap.70054","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In recent years, the use of implants has emerged as a widely accepted method for the replacement of missing teeth. Although rare, chronic pain associated with implant placement has been reported in the literature. Conversely, apicoectomy, the removal of the apical portion has been integrated into the implantology field in cases with retrograde peri-implantitis, allowing for cleaning and reconstructing the affected area without losing the implant. This case report aims to introduce an alternative treatment for managing orofacial pain associated with a buccally positioned implant with its apex outside the bone contour through the technique of apicoectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 63-year-old Asian female presents with chronic pain localized to the left side of her face, accompanied by nasal discharge and tenderness upon palpation of the surrounding soft tissues of implant #9. The cross-sectional view from cone-beam computed tomography (CBCT) demonstrated that implant #9 was positioned too buccally, leading to insufficient facial bone coverage, with the apex of the implant situated outside of the bone contour. Implant apicoectomy and soft tissue augmentation with connective tissue graft (CTG) was performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Two weeks following the surgical procedure, the patient reported a complete resolution of her chronic orofacial pain and nasal discharge.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;An apicoectomy approach may be a viable method for addressing an implant without retrograde periimplantitis yet having the apex out of the bone housing. This approach allows for the retention of an implant that is fully integrated within the oral cavity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Implant apicoectomy may relieve chronic pain when the implant apex extends beyond the bone, offering a conservative alternative to full implant removal. Minimally invasive microsurgery and ultrasound imaging support precise diagnosis, flap design, and soft tissue preservation. This enables targeted access, implant apex removal, and enhanced healing. Tunneling with connective tissue grafting effectively augments peri-implant soft tissue without disrupting the mucosal margin or interdental papilla.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Dental implants are a popular solution for replacing missing teeth. While it is uncommon, some patients do experience persistent pain after the placement of an implant. An apicoectomy, which removes the implant's tip, can effectively treat infections localized in the implant's apex, allowing cleaning, and reconstructing the affected area while preserving the implant itself. This case report presents an alternative treatment for orofacial pain caused by a misaligned implant with its apex extending beyond the bone contour, utilizing the apicoectomy technique. A 63-year-old Asian female experienced persistent left-side facial pain, along with nasal discharge and tenderness around her ","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"682-691"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13603050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flap perfusion of superficial split flap design for guided bone regeneration: A case report with ultrasonography.","authors":"Oscar Durán-Garnica, Karen Villarreal-Arizpe, Amanda Rodríguez, Oliver Kripfgans, Hsun-Liang Chan","doi":"10.1002/cap.70053","DOIUrl":"10.1002/cap.70053","url":null,"abstract":"<p><strong>Background: </strong>Effective flap management is crucial for successful bone regeneration procedures. Traditional flap release has been performed by the deep split design; recently, the superficial split design revives for its proposed anatomical and biomechanical advantages. To understand the risk of this new flap management design on flap vitality, the aim of this case report is to investigate the perfusion of the flap with ultrasound.</p><p><strong>Methods: </strong>A single patient with an edentulous ridge exhibiting a horizontal bone deficiency underwent a regenerative procedure utilizing the superficial split technique (Secured Anatomy-Driven Flap Extension [SAFE] technique). Ultrasonography assessments were conducted before the surgery (baseline [BL]) and at days (D) 3, 10, 21, and at 5 months (MO) post-surgery. They included brightness-mode and color velocity/power (CV/CP) at the buccal flap. CV and CP cine loops (videos) were recorded to assess tissue perfusion by surrogate. Three distinct regions of interest were selected, i.e., keratinized mucosa (KM), lining mucosa (LM), and muscle (M).</p><p><strong>Results: </strong>KM perfusion (CV) increased significantly at D3, then decreased at D10 and D21. The 5MO value was insignificant from BL. LM perfusion non-significantly decreased at D3 and D10, and returned to BL at D21 and 5MO. Muscle perfusion showed a nonsignificant decreasing trend. CP showed nonsignificant changes post-surgery relative to BL for the three regions.</p><p><strong>Conclusion: </strong>Ultrasound could be able to longitudinally quantify post-surgery tissue perfusion with sufficient spatial resolution to assess KM, LM, and M separately. This pilot ultrasonography study may ease the concern that the superficial split flap design jeopardizes flap vitality.</p><p><strong>Key points: </strong>Preliminary ultrasound data suggested that the Secured Anatomy-Driven Flap Extension (SAFE) technique, based on the superficial split approach, does not jeopardize flap vitality. Ultrasound may be a valuable tool for monitoring oral wound healing and guiding treatment decisions.</p><p><strong>Plain language summary: </strong>Ultrasound imaging technology, being a superior modality for evaluating soft tissue characteristics and able to quantify blood perfusion, is becoming a promising research tool to study oral wound healing. This case report used dental ultrasound to monitor the blood flow of an oral wound for 5 months after a jawbone augmentation procedure. Ultrasound showed gum blood flow peaked at day 3 after the surgery and decreased exponentially until 5 months. Mucosa and muscle may have various blood perfusion recovery patterns than gum tissues that deserve further investigation.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"665-675"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13603055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epithelial inclusion cyst at de-epithelialized gingival graft site: A cautionary case study.","authors":"Andrew W Egger, Jennifer Hawie, Kimberly Ann Inouye, Adam R Lincicum, Kenneth Hussey, Thomas M Johnson","doi":"10.1002/cap.70092","DOIUrl":"https://doi.org/10.1002/cap.70092","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Multiple palatal graft harvesting techniques are available for clinicians providing root coverage and gingival augmentation procedures. However, existing research does not establish the risk of epithelial inclusion-related sequelae for each graft type. Hypothetically, use of a de-epithelialized gingival graft (DGG) may both increase the burden of seeded epithelial cells and heighten the risk of a rare late complication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A male patient aged 44 years presented with a firm, painless, ovoid nodule (approximately 12 × 9 × 3 mm) in the alveolar mucosa overlying the maxillary right canine. The patient reported receiving a root coverage procedure in the maxillary right quadrant approximately 9 months prior, and the implanted graft was confirmed to be a DGG. The patient elected an excisional biopsy to remove the lesion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The nodule was removed through a single vertical incision, and histologic assessment confirmed the diagnosis of epithelial inclusion cyst. Eight weeks following the biopsy, no gingival recession was noted at the canine. However, some scarring was observed in the alveolar mucosa.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Limited evidence suggests complete elimination of epithelial cells from palatal grafts is rarely, if ever, attainable. Additional clinical investigation is needed to determine whether DGGs pose increased risk of inclusion-related complications. During the informed consent process, clinicians should advise patients of the small risk of inclusion-related complications and the limitations in available evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Compared with alternative autogenous graft types, de-epithelialized gingival grafts (DGGs) are associated with reduced inclusion of adipose and glandular tissue, superior clinical handling, and enhanced augmentation of tissue thickness. Complete removal of epithelial cells prior to DGG implantation appears unattainable. Intuitively, use of a DGG may increase the risk of epithelial inclusion cyst formation, although existing research is inadequate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;When treating gingival recession (exposed tooth root surfaces), various techniques for obtaining soft tissue from the roof of the mouth are available for dental surgeons. One problem associated with use of tissue from the roof of the mouth in surgical procedures is that epithelial cells can become trapped beneath the gum tissue. The trapped epithelial cells may lead to cyst formation or presence of a pasty white or yellowish material months after the procedure. Compared with alternative methods, one of the techniques (the de-epithelialized palatal graft) may be more likely to produce problems related to trapped epithelial cells. However, the research necessary to establish this increased risk has not been conducted. This report presents a case of cyst formation in a patient who had previously received a de-e","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vestibular incision subperiosteal tunnel access (VISTA)-based management of a periodontal defect with limited bony support.","authors":"Toru Matsuura","doi":"10.1002/cap.70097","DOIUrl":"https://doi.org/10.1002/cap.70097","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Periodontal regenerative outcomes are strongly influenced by defect morphology. Maintaining a stable regenerative space under soft-tissue pressure is challenging when treating defects with limited bony support.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 26-year-old female patient presented with hypersensitivity and bleeding during toothbrushing in the maxillary right posterior region. Following initial periodontal therapy, a localized periodontal defect with limited bony support and associated supra-alveolar and interdental-tissue loss persisted between the maxillary right second premolar and first molar. A vestibular incision subperiosteal tunnel access (VISTA)-based tunneling approach was used, and a suspension suture was applied to coronally stabilize the interdental soft tissue before placement of recombinant human fibroblast growth factor-2-impregnated freeze-dried bone allograft. A resorbable collagen membrane and connective tissue graft were placed on the buccal aspect to support graft containment and wound stability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At 12 months, probing depths remained within 2-3 mm, with a maximum clinical attachment gain of 4 mm. Improved soft-tissue contours, partial root coverage, and radiographic defect fill were maintained.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This case suggests that the Suspension-Created Regenerative Envelope (SCREEN) concept, which involves suspension-created stabilization of a regenerative envelope before graft placement, may be a useful adjunctive strategy for managing periodontal defects with limited bony support.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;The Suspension-Created Regenerative Envelope (SCREEN) concept describes suspension-created stabilization of a regenerative envelope before graft placement in a periodontal defect with limited bony support. A VISTA-based approach allowed preservation of the marginal gingiva and interdental papilla while facilitating coronal stabilization of the interdental soft tissue. At 12 months, probing depth reduction, clinical attachment gain, improved soft tissue architecture, and radiographic defect fill were maintained; however, longer follow-up is needed to evaluate stability and reproducibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Some periodontal defects are difficult to treat because the missing bone does not provide enough support to hold the healing tissues and grafting material in a stable position. In this case, a young female patient had a localized periodontal defect with gingival recession, loss of tissue between the teeth, tooth sensitivity, and bleeding during toothbrushing. A tunnel-type surgical approach was used to avoid cutting the gingival tissue between the teeth. Before placing the bone-grafting material, the interdental soft tissue was carefully repositioned and stabilized in a more coronal position using a suspension suture. This created a protected space for healing. The space was then filled with graft","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-stage regenerative approach for persistent RT3 gingival recession following orthodontic improvement of tooth position.","authors":"Takeshi Haga, Akira Hasuike, Taito Watanabe, So Higuchi, Serhat Aslan","doi":"10.1002/cap.70088","DOIUrl":"https://doi.org/10.1002/cap.70088","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Management of gingival recession type 3 (RT3) defects remains a clinical challenge due to interproximal attachment loss and soft tissue deficiency. This case report describes a regenerative strategy for a malpositioned anterior tooth presenting with severe recession.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and results: &lt;/strong&gt;Following orthodontic alignment to correct the tooth position, a single-stage regenerative surgery was performed using the entire papilla preservation technique (EPPT) combined with a modified connective tissue graft (m-CTG) wall and adjunctive biologically active regenerative materials, including enamel matrix derivative, recombinant human basic fibroblast growth factor-2, plasma rich in growth factors, and deproteinized bovine bone mineral. This multidisciplinary approach resulted in successful root coverage, significant clinical attachment gain, and increased keratinized tissue width. Clinical and radiographic outcomes remained stable, with high esthetic satisfaction achieved over a 30-month follow-up period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A strategic combination of orthodontic therapy and periodontal regeneration using EPPT and m-CTG wall technique may offer a clinically favorable treatment approach for managing complex RT3 recessions in the esthetic zone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;This case presents an integrated approach with orthodontic alignment and the entire papilla preservation technique and a m-CTG wall to treat severe recession type 3 gingival recession. Favorable outcomes were attributed to the synergistic effect of correcting the tooth position and the stability provided by the m-CTG wall, which contained the regenerative materials within the non-contained defect. Despite significant improvements in root coverage and attachment levels, complete regeneration of the interdental papilla remains biologically limited by the extent of underlying interproximal bone loss.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Severe gum recession with interdental bone loss (recession type 3 [RT3]) is highly challenging to treat, particularly when the affected tooth is also malpositioned. This case report describes a 28-year-old woman with an upper front tooth presenting persistent RT3 recession following orthodontic correction of its position. A single-stage surgery was performed to restore both gum and bone defects simultaneously. The surgeon used a minimally invasive tunneling technique to access the defect without cutting the delicate tissue between the teeth, preserving blood supply and wound stability. A palatal gum graft was inserted to cover the exposed root and thicken the surrounding tissue. To stimulate regeneration, three biological agents-for attachment regeneration, bone formation, and wound stabilization-were combined with a bone substitute to fill the defect. At 30 months, the root was successfully covered, gum width increased significantly, and the bone remained stable. This case ","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential regenerative therapy using biologic-based regeneration and connective tissue graft wall technique for a severe infrabony defect: A case report.","authors":"Wenwen Liu, Yilong Chen, Muhammad Saleh, Hom-Lay Wang","doi":"10.1002/cap.70093","DOIUrl":"https://doi.org/10.1002/cap.70093","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Regenerative therapy based on the principles of guided tissue regeneration (GTR) is an effective approach for the treatment of periodontal infrabony defects. However, complete resolution for deep and complex defects is not always predictable. The connective tissue graft (CTG) wall technique has recently been proposed to enhance outcomes in such challenging defects. This case report describes a staged regenerative approach combining biologic-enhanced regenerative procedure and CTG wall technique for the management of a severe infrabony defect accompanied with gingival recession.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 47-year-old female presented with a severe infrabony defect at tooth #12 extending toward the apical region, accompanied by gingival recession. The first surgical procedure consisted of minimally invasive surgical technique using an allograft combined with recombinant human platelet-derived growth factor-BB. After 12 months, a second surgery using the CTG wall technique with a coronally advanced flap was performed to address the residual non-containable defect and associated soft tissue recession.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Following the first surgery, probing depth was reduced from 8 to 3 mm, clinical attachment level gain was 5 mm. Radiographs demonstrated substantial bone fill, although a residual defect remained. After the second procedure, approximately 1.8 mm of buccal aspect root coverage was achieved, with improved papillary fill. Probing depth remained 4 mm with no bleeding on probing or mobility, and radiographs showed bone fill of the mesial defect. The gingiva margin remained stable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This case demonstrates that a staged regenerative approach combining tissue regeneration and CTG wall technique may provide a viable strategy for managing severe infrabony defects with associated gingival recession. Favorable hard and soft tissue regeneration outcomes were achieved, allowing preservation of a tooth that was initially considered for extraction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;This case report describes how an upper premolar was saved with staged periodontal treatment. The tooth had a deep bone defect, gingival recession, and complex root anatomy, and it had already been recommended for extraction. After initial therapy, the first surgery was performed. Bone graft and recombinant human platelet-derived growth factor-BB were used to improve periodontal regeneration and reduce probing depth. This helped improve the prognosis of the tooth, but a residual defect and soft tissue recession remained. In the second surgery, a connective tissue graft wall technique was used to treat the remaining defects and improve the gum. At follow-up, the tooth remained stable and vital, with less probing depth, improved bone filling, and better soft tissue appearance. This case shows that even a tooth with a poor initial prognosis may sometimes be saved with a carefull","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucogingival loss secondary to oral tuberculosis and its management using periodontal plastic surgery: A case report.","authors":"Gerado J Chacon Ramirez, Hend Abulatifa, Maria A Zamora, Vanessa Castillo, Muhammad H A Saleh, Mariana Villarroel-Dorrego","doi":"10.1002/cap.70087","DOIUrl":"https://doi.org/10.1002/cap.70087","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis is widely recognized for its pulmonary manifestations; however, the oral cavity may serve as an early and overlooked site of disease. Although the tongue is the most affected region, gingival involvement is not rare and may cause severe mucogingival destruction. The nonspecific nature of these lesions frequently leads to diagnostic delay.</p><p><strong>Methods: </strong>A 25-year-old female presented with a persistent gingival ulcer in the maxillary anterior region associated with progressive recession and soft-tissue loss. Histopathologic examination demonstrated necrotizing granulomatous inflammation with multinucleated giant cells. Although Ziehl-Neelsen staining was negative, chest radiography, sputum testing, and GeneXpert polymerase chain reaction confirmed tuberculosis with pulmonary involvement. Following 9 months of systemic anti-tubercular therapy, residual severe mucogingival defects were managed using a modified split-full-split coronally advanced flap combined with a subepithelial connective tissue graft and periosteal compartment stabilization.</p><p><strong>Results: </strong>Healing was uneventful. At 2-year follow-up, complete root coverage was achieved in the incisors and premolars, with approximately 95% root coverage at the maxillary canine. Increased gingival thickness, stable soft-tissue margins, and resolution of hypersensitivity were observed.</p><p><strong>Conclusions: </strong>This case highlights the importance of considering tuberculosis in the differential diagnosis of persistent gingival lesions and demonstrates that advanced periodontal plastic surgery can successfully rehabilitate extensive mucogingival defects following medical stabilization.</p><p><strong>Key points: </strong>Severe mucogingival destruction can occur as a rare manifestation of oral tuberculosis and may persist despite resolution of infection. Accurate diagnosis relies on combining histopathologic findings with systemic and molecular investigations. Modified periodontal plastic surgery techniques can achieve predictable root coverage and long-term soft-tissue stability in complex defects.</p><p><strong>Plain language summary: </strong>Tuberculosis (TB) usually affects the lungs, but in rare cases, it can also involve the oral cavity. This report describes a young patient whose first sign of TB was a painful gum lesion that caused severe gingival recession and loss of tissue around several teeth. After medical treatment for TB, the infection resolved, but the significant mucosal damage did not resolve. To restore the lost tissue, the patient underwent advanced periodontal plastic surgery using a connective tissue graft and a specialized flap technique. The procedure restored most of the lost gum and improved both comfort and appearance.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}