Background: This paper aims to create a “bridge” between research and practice by developing a practical, extensive, and clinically relevant study that translates evidence-based findings on soft tissue root coverage (RC) of recession-type defects to daily clinical practice.Methods: This review is prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused questions. A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE and EMBASE databases up to and including June 2013. Systematic reviews (SRs), randomized clinical trials, controlled clinical trials, case series, and case reports evaluating recession areas that were treated by means of RC procedures were considered eligible for inclusion through the three parts of the study (part I, an overview of the base of SRs; part II, an alternative random-effects meta-analyses on mean percentage of RC and sites exhibiti...

Periodontal Soft Tissue Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop

Background: Soft tissue grafting for the purposes of increasing the width of keratinized tissue (KT) is an important aspect of periodontal treatment. A systematic review was analyzed, focusing on non-root coverage tissue grafts. The references were updated to reflect the current literature. Methods: To formulate the consensus report, group members submitted any new literature related to the topic that met criteria fitting the systematic review, and this information was reviewed for inclusion in this report. A consensus report was developed to summarize the findings from the systematic review and to guide clinicians in their treatment decision-making process. Results: Forty-six articles met the criteria for inclusion in the final analysis, and two articles were added that were used to formulate this consensus report. A list of eight clinically relevant questions was posed, and consensus statements were developed. Conclusions: The evidence suggests that a minimum amount of KT is not needed to prevent attachment loss (AL) when optimal plaque control is present. However, if plaque control is suboptimal, a minimum of 2 mm of KT is needed. The standard procedure to predictably gain KT is the autogenous gingival graft. There is limited evidence for alternative treatment options. However, additional research may offer promising results in certain clinical scenarios. Clinical Recommendations: Before patient treatment, the clinician should evaluate etiology, including the role of inflammation and various types of trauma that contribute to AL. The best outcome procedure (autograft) and alternative options should be reviewed with the patient during appropriate informed consent. Proper assessment of the outcome should be included during supportive periodontal care. J Periodontol 2015;86(Suppl.):S73-S76.

Periodontal soft tissue non-root coverage procedures: a consensus report from the AAP Regeneration Workshop.

Background: Management of gingival recession defects, a common periodontal condition, using root coverage procedures is an important aspect of periodontal regenerative therapy. The goal of the periodontal soft tissue root coverage procedures group was to develop a consensus report based on the accompanying systematic review of root coverage procedures, including priorities for future research and identification of the best evidence available to manage different clinical scenarios.Methods: The group reviewed and discussed the accompanying systematic review, which covered treatment of single-tooth recession defects, multiple-tooth recession defects, and additional focused questions on relevant clinical topics. The consensus group members submitted additional material for consideration by the group in advance and at the time of the meeting. The group also identified priorities for future research.Results: All reviewed root coverage procedures provide significant reduction in recession depth, especially for M...

Periodontal Soft Tissue Root Coverage Procedures: A Consensus Report From the AAP Regeneration Workshop

Recently, sealers based on calcium silicates were developed as a new class of endodontic sealers. Inspired by the excellent sealing ability and biocompatibility of calcium silicate-based cements, these sealers establish a biological point of view on the obturation of root canals. No longer, the bacteria-tight seal against reinfection of the root canal is the only goal of root canal obturation. Antibacterial properties as well as bioactive inducement of periapical healing and hard tissue formation are added to the portfolio of sealers. Ready-to-use sealers consisting of only one component with a need for external water supply from, e.g., body fluid and two components sealers with internal water supply were introduced to the market. Both of these material types have the same setting reactions in common whereby a hydration reaction of the calcium silicate is followed by a precipitation reaction of calcium phosphate. Though the available sealers are all based on calcium silicates, they consist of different compositions. Due to this aspect, differences in their physical and chemical properties as well as in their in vitro characteristics were described. Studies addressing the clinical impact of calcium silicate-based sealers on outcome are still sparse. The bioactive potential of sealers based on calcium silicates is a consequence of the slight solubility of these materials even after setting, but solubility of the sealer might also compromise the quality of sealing a root canal against regrowth and reinfection. Further clinical investigations are required to evaluate the clinical relevance of the gulf between bioactivity and solubility.

Endodontic sealers based on calcium silicates: a systematic review

This study aimed to compare fluid movements generated from photon-induced photoacoustic streaming (PIPS) and passive ultrasonic irrigation (PUI). Particle Image Velocimetry (PIV) was performed using 6-μm melamine spheres in water. Measurement areas were 3-mm-long sections of the canal in the coronal, midroot and apical regions for PIPS (erbium/yttrium-aluminium garnet (Er:YAG) laser set at 15 Hz with 20 mJ), or passive ultrasonic irrigation (PUI, non-cutting insert at 30 % unit power) was performed in simulated root canals prepared to an apical size #30/0.04 taper. Fluid movement was analysed directly subjacent to the apical ends of ultrasonic insert or fiber optic tips as well as at midroot and apically. During PUI, measured average velocities were around 0.03 m/s in the immediate vicinity of the sides and tip of the ultrasonic file. Speeds decayed to non-measureable values at a distance of about 2 mm from the sides and tip. During PIPS, typical average speeds were about ten times higher than those measured for PUI, and they were measured throughout the length of the canal, at distances up to 20 mm away. PIPS caused higher average fluid speeds when compared to PUI, both close and distant from the instrument. The findings of this study could be relevant to the debriding and disinfecting stage of endodontic therapy. Irrigation enhancement beyond needle irrigation is relevant to more effectively eradicate microorganisms from root canal systems. PIPS may be an alternative approach due to its ability to create high streaming velocities further away from the activation source compared to ultrasonic activation.

Irrigant flow during photon-induced photoacoustic streaming (PIPS) using Particle Image Velocimetry (PIV)

Background: Numerous surgical approaches for the treatment of single gingival recession (GR) defects are documented in the literature. The aim of this 5-year, split mouth–design, randomized clinical trial was to evaluate the effectiveness of coronally advanced flap (CAF) alone versus CAF with connective tissue graft (CAF+CTG) in the treatment of single Miller Class I and II GR defects.Methods: Thirty-seven patients with 114 bilateral, single Miller Class I and II GR defects were treated with CAF on one side of the mouth and CAF+CTG on the other side. Clinical measurements (GR length [REC], keratinized tissue width [KT], complete root coverage [CRC], and percentage of root coverage [PRC]) were evaluated before surgery and after 6, 12, 24, and 60 months.Results: There was a significant reduction of REC and increase of KT after surgery in both groups. CAF+CTG showed significantly better results for all evaluated clinical parameters in all observed follow-up periods. Miller Class I defects showed better resul...

Coronally Advanced Flap Alone or With Connective Tissue Graft in the Treatment of Single Gingival Recession Defects: A Long-Term Randomized Clinical Trial

The aim of the study was to evaluate the efficacy of photon-initiated photoacoustic streaming (PIPS) in the removal of filling remnants from root canals after rotary phase of retreatment and to examine the difference in the amount of residual material considering the type of sealer. Thirty-six extracted single-rooted human teeth were instrumented and randomly divided into three groups according to the filling material used: group 1: EndoSequence BC Sealer (Brassler, USA), group 2: MTA Fillapex (Angelus Solucoes Odontologicas, Londrina, Brasil), and group 3: AH Plus sealer (Dentsply DeTrey, Konstanz, Germany). Cold lateral condensation technique was used. After 2 weeks, the root canals were retreated with a rotary phase retreatment system (ProTaper Universal Retreatment, Maillefer, Ballaigues, Switzerland), followed by Er:YAG laser-activated irrigation (photon-initiated photoacoustic streaming, PIPS). The specimens were scanned in a micro-computed tomographic (micro-CT) device after root canal filling, after the rotary retreatment, and after the PIPS. There was significant reduction in the amount of filling material after the rotary phase of retreatment in all groups (p < 0.05), the highest in the MTA Fillapex group (p < 0.001) and no difference between the EndoSequence BC and the AH Plus (p = 0.608). There was significant reduction of the filling remnants after the PIPS in all groups (p < 0.05). The MTA Fillapex was the most easily removed during rotary phase of the retreatment, and there were no differences in the amount of the remaining filling material between EndoSequence BC and the AH Plus groups after rotary phase of the retreatment. The PIPS improved the removal of filling remnants in all groups.

The efficacy of photon-initiated photoacoustic streaming in the removal of calcium silicate-based filling remnants from the root canal after rotary retreatment.

www.cmj.hr Aim To analyze the influence of the needle type, insertion depth, and irrigant flow rate on irrigant flow pattern, flow velocity, and apical pressure by ex-vivo based endodontic irrigation computational fluid dynamics (CFD) analysis. Methods Human upper canine root canal was prepared using rotary files. Contrast fluid was introduced in the root canal and scanned by computed tomography (CT) providing a three-dimensional object that was exported to the computer-assisted design (CAD) software. Two probe points were established in the apical portion of the root canal model for flow velocity and pressure measurement. Three different CAD models of 27G irrigation needles (closed-end side-vented, notched open-end, and bevel open-end) were created and placed at 25, 50, 75, and 95% of the working length (WL). Flow rates of 0.05, 0.1, 0.2, 0.3, and 0.4 mL/s were simulated. A total of 60 irrigation simulations were performed by CFD fluid flow solver. Results Closed-end side-vented needle required insertion depth closer to WL, regarding efficient irrigant replace ment, compared to open-end irrigation needle types, which besides increased velocity produced increased irrigant apical pressure. For all irrigation needle types and needle insertion depths, the increase of flow rate was followed by an increased irrigant apical pressure. Conclusions The human root canal shape obtained by CT is applicable in the CFD analysis of endodontic irrigation. All the analyzed values –irrigant flow pattern, velocity, and pressure – were influenced by irrigation needle type, as well as needle insertion depth and irrigant flow rate.

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Irrigation of human prepared root canal – ex vivo based computational fluid dynamics analysis

The aim of this study was to determine the amount of extruded endodontic irrigant among needle-syringe irrigation (NSI) and laser-activated irrigation (LAI) regimens. Twenty extracted maxillary central incisors were prepared utilizing GT professional rotary files (size 40, taper 0.06). Irrigation was performed with two 27 G irrigation needles (notched open ended (ON) and single side vented (SV)) each at two different irrigant volumetric flow rates (VFR)—0.05 ml/s (3 ml/min) and 0.10 ml/s (6 ml/min). LAI was performed with Er:YAG (erbium-doped yttrium aluminum garnet) using different fiber types (X-Pulse-14/400 cylindrical tip, Preciso- 14/300 flat cylindrical tip, PIPS- 14/400 quartz tapered tip). The Er:YAG laser with a wavelength of 2940 nm (Lightwalker AT, Fotona, Ljubljana, Slovenia) was used according to the following protocol: 10 mJ per pulse, 15 Hz, pulse duration 50 μs. Irrigation time was 60 s for all protocols. Precision syringe pump (PSP) maintained constant irrigant volumetric flow rate. Apically extruded irrigant was collected and net weighed for each protocol (N = 10). Data were analyzed by t tests and Kruskal-Wallis. All LAI regimens had statistically significant lower irrigant extrusion compared with NSI except for the SV 27 G needle used with 0.05 ml/s VFR when compared with the Preciso fiber tip (p = 0,230). The largest amount of extruded irrigant was with the ON 27 G needle at the 0.10 ml/s VFR, while the smallest was after LAI with PIPS fiber tip. The lower quantity of apically extruded irrigant during LAI (X-Pulse and PIPS) points out a safer endodontic irrigation method compared with conventional irrigations.

Comparison of apical irrigant solution extrusion among conventional and laser-activated endodontic irrigation.

Background/Aim. Among numerous sociodental indicators the Oral Impacts on Daily Performance (OIPD) is one of the most broadly applied. The aim of this study was to develop and test psychometric properties of a Croatian version of OIDP scale. Methods. The OIDP instrument was translated from English to Croatian in a forward-backward method. The Croatian version was tested for reliability, construct validity and responsiveness on a sample of 702 participants (255 men), aged 18-86 years. Results. Internal consistency of Croatian version of the OIDP was acceptable (alpha = 0.80) and 69.4% of the examinees had oral impacts relating to one or several performances. The most frequently affected performance was eating (53.7%). The test-retest reliability was high (r = 0.99; 95% CI: 0.97-0.99), the mean difference between the OIDP summary scores in two-week interval was not statistically significant. In construct validity testing there was statistically significant correlation between OIDP and self-assessed general and oral health, somatisation, depression and Oral Health Impact Profile ranging from 0.157 to 0.516. Responsiveness was confirmed by a significant reduction of oral impacts on daily performances in subjects before and after treatment of acute dental pain (p < 0.001). Conclusion. The Croatian OIDP index showed good psychometric properties in terms of construct validity, internal consistency, test-retest reliability and responsiveness confirming its appropriateness for use among Croatian population.

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Damir Šnjarić

Papers

Coronally Advanced Flap Alone or With Connective Tissue Graft in the Treatment of Single Gingival Recession Defects: A Long-Term Randomized Clinical Trial

The efficacy of photon-initiated photoacoustic streaming in the removal of calcium silicate-based filling remnants from the root canal after rotary retreatment.

Irrigation of human prepared root canal – ex vivo based computational fluid dynamics analysis

Comparison of apical irrigant solution extrusion among conventional and laser-activated endodontic irrigation.

Translation and validation of the Croatian version of the Oral Impacts on Daily Performances (OIDP) scale.