Perio Plastics III Flashcards
What is included in “1st generation” treatment for root coverage?
Pedicle flaps w/ or w/o autologous CTG
GTR based root coverage procedures
What is included in “2nd generation” root coverage procedures?
Pedicle flaps w/ CTG substitutes (ADM/CM)
What is included in “3rd generation” root coverage procedures?
pedicle flaps w/ tissue-engineered biomaterials: EMD/PDGF/PRP/Cell Therapy
What are pros/cons of ADM/CM?
no donor site
less time
unlimited amount
Long term instability/rebound
CTG better
NO CREEPING ATTACHMENT
What are pros/cons of 3rd generation treatments?
no donor site
may promote regeneration
less results
less predictable
expensive
What are the 3 (broad) procedures that can be used to correct soft tissue defects?
Mucogingival procedures (pedicle flaps)
Soft tissue grafts (xCTG, FGG, ADM)
GTR (resorbable or non-resorbable)
What pair coined the term “compartmentalization” and what was the new term? What was the evolution?
McCulloch et al. 1987 (with Melcher)
Melcher said compartmentalization just with PDL
McCulloch said PDL/Cementum/Bone Cells (Open Compartmentalization)
Who first used GTR for recession coverage?
Tinti & Vicenzi 1990
What kind of membrane did they use in the first GTR for recession coverage?
ePTFE
How does GTR w/ non-resorbable membrane compare to mucogingival surgeries for root coverage?
Pini Prato et al. 1992 (RCT) & 1996 (4yr follow up)
GTR w/ ePTFE vs FGG then CAF
NSSD in root coverage
Stable over 4 years
What are advantages of Collagen Membranes in GTR for Root Coverage?
Wang et al. 2012 (BiG CHeeSe) Biocompatible Gingival Thickness Chemotactic Hemostatic Semi-permeable (gas and nutrient exchange)
How does CAF compare to CAF+XCM?
Jepsen et al. 2013
RCT-Split Mouth
Root coverage: NSSD
Complete root coverage: NSSD
How does CAF+CTG compare to CAF+XCM?
Tonetti et al. 2018
RCT - 187pts
CM+CAF: Shorter surgery, 2days shorter healing
CAF+CTG: OR for CompleteRC=4.0 vs CM+CAF
What articles can you use to support an opinion of mucogingival surgery > GTR for root coverage?
Al-Hamdan et al. 2003
Cairo et al. 2014
Would you consider performing a GTR for a recession defect instead of other recession coverage procedures?
NO!
Al-Hamdan et al. 2003 (Dr. Wang)
Meta-Analysis: GTR vs Conventional Mucogingival Surgery (CMGS) for root coverage
Recession reduction: CMGS > GTR
CRC: CMGS > GTR
KG gain: CMGS > GTR
Cairo et al. 2014
CAF + GTR: No benefit vs CAF alone
CAF + CTG: superior clinical outcomes - more CRC vs CAF+EMD, CAF+GTR, CAF+CM
How does cGTR compare to CAF?
Lee et al. 2002
NSSD Clinical outcomes
CAF had more KT increase
GTR had more New Attachment at CT in histology
DID NOT MEASURE GT!!! - Necessary for success
What types of ADM are there?
Freeze-Dried (FDADM) Solvent Dehydrated (SDADM)
how is FDADM made?
Epidermis removed using buffered saline solution
Non-denaturing detergent used to dissolve cell types within dermis
Cryo-preservant used to prevent crystal formation when tissue is freeze dried
How is SDADM made?
Osmotic, Oxidative, and Alkaline treatments
Tissue placed in gradients of Acetone (solvent dehydration)
Limited-dose gamma irradiation to sterilize
How does CAF + FDADM compare to CAF + SDADM?
Wang et al. 2014/2015
NSSD 1yr outcomes
How does ADM compare to sCTG for root coverage?
Network Meta-analysis
Barootchi et al. 2021
Root Coverage: CTG > ADM > CM
GT: CTG > ADM = CM
KTW: FGG > ADM > CM > APF
What examples are there for tissue scaffold (citations)
Milinkovic et al. 2015 - Fibroblast seeded scaffold
McGuire & Nunn 2005 - human fibroblast derived dermal substitute
McGuire & Nunn 2005
Allograft cell + Scaffold had similar outcomes to FGG
FGG 1-2mm > KTW
Milinkovic et al. 2015
Autologous Fibroblast Cell Culture (AFCC) + Collagen matrix + CAF
Recession coverage, KTW, CAL NSSD
KTW greater in CTG
What types of tissue enginering are there?
Passive
Active
What is an example of “passive” tissue engineering?
No Cells
ADM
Collagen
GTR based (ePTFT/Collagen/Periostium)
What are the implications of PASSIVE tissue engineering?
No cells
so NO Creeping attachment
NO KG
Cannot tolerate exposure
What is a strip graft?
use of things like ADM as a wound dressing material
What is “active” tissue engineering?
“Living Cell Construct” - McGuire
What is “living cell construct?
ADM/Dermis
Collagen
GTR base
WITH - cells impregnated
What is the prevalence of recession in older populations? (Citation)
88% of people 65yrs and older
Kassab & Cohen 2003
How can you grow papilla orthodontically?
Move 2 teeth! Not just 1
Moving just 1 doesnt change the interproximal papilla
Moving 2, then implant, bone is higher for papilla
After performing a CTG - what how do you get it to express KG?
Remove epithelial covering after 8-10 wks (Karring 1975)
How thick does the tissue have to be for GTR based root coverage? Citation
Harris et al.
<0.5mm 26% coverage
>0.5mm 96% coverage
Hwang & Wang: >1mm
What is the average root coverage for GTR based root coverage?
75%
What types of root conditioning is there?
Citric Acid
Tetracycline (pH 1-3)
EDTA (pH 7.2-7.6)
What is the problem with Citric acid or Tetracycline?
Its more acidic - causes constriction of the blood vessels/coagulation
What 3 factors should be considered for root coverage studies?
GT
KTW
Bone level of adjacent teeth
