Journal of Dental Medicine

Background and Aim: Increasing patient demands for esthetic, put the root coverage procedures in particular attention. Periodontal regeneration with GTR based root coverage methods is the most common treatment used. The purpose of this study was to compare guided tissue regeneration (GTR) with collagen membrane and a bone graft, with sub-epithelial connective tissue graft (SCTG), in treatment of gingival recession.

Materials and Methods: In this randomized clinical trial study, eleven healthy patients with no systemic diseases who had miller’s class I or II recession defects (gingival recession  2mm) were treated with SCTG or GTR using a collagen membrane and a bone graft. Clinical measurements were obtained at baseline and 6 months after surgery. These clinical measurements included recession depth (RD), recession width (RW), probing depth (PD), and clinical attachment level (CAL). Data were analyzed using independent t test with p<0.05 as the limit of significance.

Results: Both treatment methods resulted in a statistically significant reduction of recession depth (SCTG=2.3mm, GTR=2.1mm P<0.0001). CAL gain after 6 months was also improved in both groups (SCG= 2.5mm, GTR=2.1mm), compared to baseline (P<0.0001). No statistical differences were observed in RD, RW, CAL between test and control groups. Root coverage was similar in both methods (SCTG= 74.2%, GTR= 62.6%, P=0.87).

Conclusion: Based on the results of this study, the two techniques are clinically comparable. Therefore the use of collagen membrane and a bovine derived xenograft may alleviate the need for connective tissue graft.

Background and Aim: Microscopic differentiation between well differentiated squamous cell carcinoma and verrucous carcinoma is very difficult. As these lesions have different clinical course and treatment a reliable method to help distinguish between them is necessary. The basement membrane in oral verrucous carcinoma is generally intact whereas in oral squamous cell carcinoma is mostly discontinuous. This structure can be studied by different methods. The aim of this study was to differentiate these lesions with special staining of basement membrane.

Materials and Methods: In this tests evaluation study, a total of 26 cases consisting of 15 oral squamous cell carcinomas and 11 oral verrucous carcinomas were retrieved from Cancer Institute of Imam Khomeini hospital archive of pathology and their paraffin blocks were cut and stained with Periodic Acid Schiff method. Slides were studied with light microscope to evaluate the continuity of basement membrane. Sensitivity and specificity of this method were calculated.

Results: The sensitivity of this method for differentiating oral squamous cell carcinoma from oral verrucous carcinoma was 100% whereas the specificity was 90.9%. Positive predictive value was 93.75% and negative predictive value 100%.

Conclusion: Based on the results of this study, the sensitivity of this test for diagnosis of oral squamous cell carcinoma was high (100%). Further studies are needed to evaluate the use this method for distinguishing oral verrucous carcinoma from oral squamous cell carcinoma.

Background and Aim: One of the complications following major oral surgeries is mucosal defects and delayed healing process. Up to now, various mucocutaneous grafts have been used in this field and recently, amniotic membrane has been proposed as a biological dressing in dermatologic, ophthalmologic and otolaryngologic practices. The purpose of this pilot study was to evaluate the healing process following human amniotic membrane graft on oral keratinized mucosa of rabbit.

Materials and Methods: In this experimental animal study, two surgical mucosal defects with the same size were made in palatal mucosa of 10 rabbits with the same weight, gender and race and a graft of human amniotic membrane was used on one of the defects. On the 7th, 14th and 28th postoperative days, surgical biopsies were randomly obtained from grafted and ungrafted regions of 3, 4 and 3 rabbits, respectively and submitted for microscopic study.

Results: According to the results, grafted regions showed more surface epithelialization and thicker newly formed epithelium. Also inflammatory cells infiltration was less in these areas. In all cases, there was a remarkable cartilage formation in the connective tissue of the recipient sites.

Conclusion: The results of this study suggest that the use of amniotic membrane graft in oral surgery could be effective in healing process. Additional studies should be done using animal and human models with more samples. Furthermore, the formation of cartilage in the grafted sites and its possible potential in reconstruction of bone defects, needs to be studied.

Background and Aim: Furcation defects are one of the most challenging problems in periodontal therapy. Regenerative treatment significantly improves the prognosis of the involved teeth. The aim of this study was to compare Bio-Oss plus 10% collagen in combination with either a bioabsorbable collagen barrier (BO/GTR), or coronally advanced flap (BO/CF), in treating human mandibular class II furcation defects.

Materials and Methods: This clinical trial included 10 patients with 10 pairs of similar periodontal defects. Each defect was randomly assigned to treatment with BO/CF or BO/GTR. Following basic therapy, baseline measurements were recorded including probing pocket depth (PPD),closed horizontal probing depth (CHPD), clinical attachment level (CAL), and gingival margin position (CEJ-GM), together with plaque and gingival indices. Hard tissue measurements were performed during surgery to determine alveolar crestal height (CEJ-AC), and vertical and horizontal open probing depth (OVPD, OHPD).After 6 months, all sites were re-entered and soft and hard tissue measurements were recorded.

Results: Both surgical procedures significantly reduced probing depth and improved clinical attachment levels, with no significant difference between groups. Gingival margin position (CEJ-GM), was improved in the BO/CF group (0.66±0.51 mm, p<0.05), but not statistically different from BO/GTR group in which remained relatively constant (0.00±0.81 mm). Vertical defect resolution was significant in each groups (BO/CF:3.17±1.47 mm, BO/GTR:3.33±0.51mm). Horizontal defect resolution was also significant with either procedure (BO/CF:3.67±1.31 mm, BO/GTR:3.80±1.83 mm), with no statistically significant difference between groups. Data were analyzed with wilcoxon and Mann-Whitney tests with p<0.05 as the level of significance.

Conclusion: Based on the results of this study, treatment of mandibular class II furcation defects with both procedures resulted in statistically significant improvement in open and closed probing measurements, with no significant difference between treatment groups. In BO/CF group there was an additional improvement in gingival recession (CEJ-GM) measurement, which could be attributed to applying crown-attached sutures by the use of orthodontic brackets.