Clinical Research Directory

Impact of Microneedling on the Gingival Tissue Surrounding Implant Supported Fixed Restoration.

This randomized clinical trial aims to evaluate the effect of microneedling with and without accelerated growth factor (AGF) injection on gingival tissue surrounding implant-supported fixed restorations. The peri-implant soft tissue phenotype is an important determinant of long-term implant stability and esthetic success. Patients with thin gingival biotype are more susceptible to mucosal recession, soft tissue transparency, and peri-implant complications. Enhancing gingival thickness and keratinized tissue width using minimally invasive methods can improve esthetic and biological outcomes. Microneedling has recently been proposed as a simple and minimally invasive approach that stimulates local healing by inducing controlled micro-injury. It triggers angiogenesis and the release of intrinsic growth factors that promote soft tissue regeneration. Accelerated Growth Factor (AGF) is an autologous platelet concentrate obtained through a single-step centrifugation technique. It contains a high concentration of platelet-derived and vascular growth factors that enhance tissue repair and collagen synthesis. Combining microneedling with AGF may therefore produce synergistic effects, improving the soft tissue phenotype and peri-implant mucosal stability. The study will include 20 participants aged 18-34 years with thin gingival biotype (0.8-1 mm) around maxillary anterior implants. Participants will be randomly assigned to one of two groups: 1. AGF group: AGF injection alone. 2. Microneedling + AGF group: Microneedling using sterile disposable lancets until pinpoint bleeding occurs, followed by AGF injection (0.2-0.3 mL per site). Clinical parameters including gingival thickness (GT), keratinized tissue width (KTW), probing depth (PD), and bleeding index (BI) will be recorded at baseline, 3 months, and 6 months. All participants will receive standardized zirconia restorations following osseointegration. Statistical analysis will include intra- and inter-group comparisons, with significance set at p \< 0.05. The study is expected to clarify whether combining microneedling with AGF enhances peri-implant soft tissue thickness more effectively than AGF alone. If successful, this combined minimally invasive approach may offer a practical and biologically based technique to improve soft tissue health and esthetics around dental implants.

Prevalence of Lower and Upper Incisor Periodontal Phenotypes and Risk Indicators.

The determination of the periodontal phenotype is an essential part of the periodontal diagnostic process, which must guide not only treatment but also prognosis (Kim et al. 2020). This determination is based on the clinical assessment of 3 individual variables: gingival height/thickness and alveolar bone cortical thickness. Although these anatomical characteristics are genetically determined, they are also influenced by numerous acquired, endogenous or exogenous factors that can act at a general and/or local level. The periodontal phenotype is therefore specific to an individual and its 3 components vary over time according to the dental sectors and sites of each individual. For example, the morphology of this phenotype varies according to whether the gingiva is thick or thin, high or reduced, and the bone cortex is thick or thin, with all possible combinations. Clinicians need to know the distribution of these different types of phenotypes, particularly in the aesthetic areas they are concerned with, in order to better identify the most fragile ones in the face of the multiple daily stresses to which the periodontium may be subjected: muscular force, dental plaque, oral hygiene manoeuvres, parafunctionality, dental procedures.... However, studies on the prevalence of the periodontal phenotype are limited and mainly concern Asian, Indian and American populations, with very few studies on European populations. Main objective: To assess the prevalence of periodontal phenotypes in the upper and lower incisors of French subjects, according to tooth type and at the individual level. Secondary objective: Identification of potential risk indicators in relation to the type of periodontal phenotype."

Comparison of Free Gingival Graft and Linear Incision for Connective Tissue

A randomized controlled non-inferiority trial will be conducted with 24 individuals aged 18 or older, who are periodontally healthy and require root coverage in bilateral multiple RT1-type recessions involving at least two teeth on each side of the mouth. The number of teeth to be covered must be equal on both sides to avoid imbalance in patient-centered comparisons. Patients included in the study will undergo the bilateral multiple root coverage technique with coronally repositioned flap (Zucchelli and De Sanctis) in both groups. The donor areas for connective tissue will be the hard palate region, with grafts harvested using the linear technique on one side and the free de-epithelialized gingival graft technique on the other side. Each patient will undergo a preparatory phase for study inclusion, consisting of supragingival scaling, polishing, and oral hygiene instructions at least 3 weeks before study inclusion. Patients will be instructed on personalized and proper use of toothbrush, dental floss, and/or interdental brush. All surgical procedures in both groups will be performed by the same operator (CCO). Randomization will determine the side to be operated on first. The other side will be operated on after 30 days or until the patient reports complete absence of symptoms in the area of the first surgery to avoid confusion in patient-centered outcomes regarding pain and satisfaction with the techniques. Outcomes evaluated at 3, 6, 9, and 12 months include: gingival recession depth, probing depth, visible plaque, bleeding on probing, width of keratinized tissue, three-dimensional tissue assessment from intraoral scanning, and quality of life related. Linear and logistic generalized estimating equation models considering the longitudinal nature of the study will be used for data analysis. INCLUSION CRITERIA Patients aged 18 or older requiring root coverage in bilateral multiple recessions involving at least two teeth on each side of the mouth will be included. The number of teeth to be covered must be equal on both sides to avoid imbalance in patient-centered comparisons. Recessions should be RT1 type according to the 2017 Workshop on the Classification of Periodontal Conditions and Diseases (Jepsen et al. 2018) and without non-carious cervical lesions. EXCLUSION CRITERIA Individuals will not be considered eligible if they: * Present any form of immunological compromise; * Have diseases or systemic conditions contraindicating surgical procedures or affecting periodontal healing pattern, such as diabetes and autoimmune diseases; * Present active periodontitis, defined by presence of \>=10% subgingival bleeding and probing depth and clinical attachment loss proximal \>4mm (Tonetti et al. 2018); * Are current or ex-smokers; * Have allergies to ibuprofen and chlorhexidine digluconate. Research Objective: PRIMARY OBJECTIVE The overall objective of this study is to compare free gingival graft and subepithelial connective tissue graft in outcomes related to multiple recession coverage. SECONDARY OBJECTIVE Compare the two grafts in terms of clinical outcomes of root coverage; Compare the two grafts in terms of digital outcomes of root coverage obtained in scanning and tomography; Compare the two grafts in terms of patient-centered outcomes.