Objectives: To describe the step-by-step procedure of a novel surgical technique consisting of a combination of the laterally closed tunnel (LCT) and the modified coronally advanced tunnel (MCAT) (ie, LCT/MCAT), designed to treat multiple mandibular adjacent gingival recessions (MAGR) and to present the clinical outcomes obtained in 11 consecutively treated patients. Method and materials: Eleven systemically and periodontally healthy patients (7 females, mean ± SD 33.62 ± 14.6 years, min. 19 years max. 67 years) with a total of 40 adjacent mandibular RT1 (ie, Miller Class 1 and 2) gingival recessions with a minimum depth ≥ 3 mm, were consecutively treated with LCT/MCAT, in conjunction with an enamel matrix derivative (EMD) and subepithelial palatal connective tissue graft (SCTG). Treatment outcomes were assessed at baseline and at 12 months postoperatively. Prior to surgery and at 12 months postoperatively, recession depth (RD) and recession width (RW) were evaluated. The primary outcome variable was complete root coverage (CRC, ie 100% root coverage), the secondary outcome was mean root coverage (MRC). Results: Postoperative pain and discomfort were low and the healing was uneventful in all cases without any complications. At 12 months, statistically significant (P < .05) root coverage (RC) was obtained in all patients. CRC was obtained in five patients with a total of 21 recessions, while MRC measured 92.9% (ie, 3.75 mm). In seven patients (ie, 63.6%), RC amounted to > 93% while the minimum RC per patient measured 83.76%. Conclusion: The results of the present case series suggest that the LCT/MCAT is a valuable technique for the treatment of mandibular RT1 MAGR. Keywords: laterally closed tunnel, modified coronally advanced tunnel, multiple adjacent mandibular gingival recessions, recession coverage, subepithelial palatal connective tissue graft, surgical technique

Objective: To evaluate the clinical outcomes 2 years after the adjunctive use of an InGaAsP diode and Er,Cr:YSGG laser for nonsurgical treatment of severe periodontitis. Method and materials: Forty-two patients (45.31 ± 9.78 years old, n = 22 females, n = 23 smokers) with stage III or IV grade B periodontitis were randomly treated either with laser (InGaAsP + Er,Cr:YSGG) adjunctive to subgingival debridement (test group, n = 21) or with subgingival debridement alone (control group, n = 21). Subjects in the test group received a second laser treatment in residual sites 2 months after the initial laser therapy. At baseline, and at 12 and 24 months after therapy, periodontal clinical parameters were evaluated. The primary outcome variable was the number of residual deep sites at 12 months (probing depth [PD] ≥ 6 mm). Results: One and two years after nonsurgical periodontal treatment, both groups yielded statistically significant clinical improvements. The adjunctive use of InGaAsP and Er,Cr:YSGG laser to mechanical debridement resulted in statistically significantly higher clinical (PD, clinical attachment level, bleeding on probing, number of sites with PD ≥ 5 mm, PD ≥ 6 mm, PD ≥ 7 mm) improvements (P < .05) compared to subgingival debridement alone both at 12 and 24 months after therapy. Conclusion: In patients with stage III or IV grade B periodontitis, InGaAsP and Er,Cr:YSGG used adjunctively to subgingival debridement may additionally improve the clinical outcomes compared to mechanical debridement alone over a period of 24 months. Keywords: YSGG, InGaAsP, periodontal laser therapy, periodontal treatment, periodontitis

Objective: To evaluate the long-term clinical results after treatment of multiple adjacent recession type (RT) I and II gingival recessions treated with the modified coronally advanced tunnel (MCAT) in conjunction with a porcine acellular dermal matrix (PADM). Method and materials: Nine periodontally healthy nonsmoking patients (seven women, 37.5 ± 7.36 years old) with a total of 41 adjacent RT I (n = 23) and RT II (n = 18) gingival recessions exhibiting a minimum depth of 2 mm were treated by means of MCAT+PADM. Recession depth and width, width of attached and keratinized tissue, probing depths, and clinical attachment level were measured at baseline and at 1 and 4 years postsurgically. The primary outcome variable was complete root coverage (ie 100% root coverage), while secondary outcomes were mean root coverage and increase in keratinized tissue and attached gingiva widths. Results: At 1 and 4 years, statistically highly significant (P < .001) root coverage was obtained in all nine patients compared to baseline. Mean root coverage decreased in these nine patients from 72.05 ± 30.18% at 1 year to 56.79 ± 27.53% at 4 years. Complete root coverage was obtained in 18 gingival recessions at 1 year (baseline RT: 12 RT I, 6 RT II) and in seven gingival recessions (5 RT I, 2 RT II) at 4 years. Most root coverage occurred in the first year postsurgically, showing a statistically significant decrease between the first and fourth year (P = .003). Mean width of attached gingiva increased statistically significantly (P < .05) from 2.85 ± 1.08 mm to 3.14 ± 1.08 mm at 1 year with a statistically significant decrease at 4 years. At 1 year, 78.05% of gingival recessions showed a root coverage > 50%, and 68.29% still exhibited a root coverage > 50% at 4 years. Conclusion: The use of MCAT+PADM represents a valuable treatment option for multiple adjacent maxillary and mandibular RT I and II gingival recessions on a long-term basis. Keywords: clinical study, coronally advanced tunnel, gingival recession, porcine acellular dermal matrix, root coverage

Objective: To evaluate clinically and microbiologically the outcomes following the combined application of InGaAsP diode laser and Er,Cr:YSGG laser for nonsurgical treatment of chronic periodontitis (ChP). Method and materials: Forty-two patients (age 45.31 ± 9.78 years, 22 female, 23 smokers) with ChP were randomly treated with subgingival debridement (SD) by means of ultrasonic and hand instruments (control group, n = 21) or with InGaAsP followed 1 week later by InGaAsP + SD + Er,Cr:YSGG (test group, n = 21). In the test group, a second laser treatment was performed for all residual sites (bleeding sites with probing depth [PD] ≥ 4 mm) 2 months after the first laser therapy. At baseline and 6 months after therapy, periodontal clinical and microbiologic parameters were evaluated. Results: Six months after therapy, statistically significant clinical and microbiologic improvements (PD reduction, clinical attachment level [CAL] gain, quantitative reduction of periopathogens) were observed in both groups compared to baseline. However, the use of InGaAsP followed by SD and the adjunctive use of an Er,Cr:YSGG laser, yielded statistically significantly higher clinical (PD, CAL, bleeding on probing, number of sites with PD ≥ 5 mm, PD ≥ 6 mm, PD ≥ 7 mm) and microbiologic (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia, Peptostreptococcus micros, Fusobacterium nucleatum) improvements (P .05) compared to SD alone. Conclusions: In patients with ChP, the adjunctive use of InGaAsP and Er,Cr:YSGG to SD may additionally improve the clinical and microbiologic parameters obtained with SD alone, thus representing a valuable approach in nonsurgical periodontal therapy. Keywords: chronic periodontitis, diode laser, Er, Cr:YSGG, InGaAsP, laser treatment, nonsurgical periodontal therapy

Purpose: To determine the impact of oral health related quality of life (OHRQoL) on general health in patients suffering from rheumatoid arthritis (RA). Materials and Methods: Ninety-one patients with RA (mean age 52.82 ± 11 years, 75.82% female, 20.87% smokers) and 30 systemically healthy patients (control) were evaluated for their OHRQoL by means of the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile (OHIP)-14 questionnaires. Self-perceived RA status was assessed using the Routine Assessment of Patient Index Data 3 (RAPID3). Results: The mean SC-GOHAI score was 3.69 ± 2.47 for RA subjects and 1.36 ± 2.69 in the control group. Statistically significant differences were seen between RA and control groups (p 0.05). RA patients with and without periodontitis (PA) exhibited similar SC-GOHAI (Simple Count GOHAI) scores (p = 0.980). No statistically significant differences were observed between any of the groups, either for the OHIP 14-extent or for the OHIP 14-prevalence. RAPID3 scores showed that the majority of the RA patients (65.93%) had high disease severity (RAPID3 >12, mean RAPID3 score 14.39 ± 5.14). Statistically significantly higher values were recorded for general health assessment (PTGE, p = 0.009) and fatigue (FT, p = 0.004) in RA with PA as compared to those without. SC-GOHAI with values between 5 and 8 was statistically significantly associated with high severity health impairment (RAPID3 >12, p = 0.014, OR: 8.64). Conclusion: Within their limits, the present findings indicate that: a) moderate OHRQoL as assessed by GOHAI may contribute to high severity impairment of health in RA patients, and b) the GOHAI questionnaire may represent a more adequate tool than OHIP-14 for assessing OHRQoL in patients suffering from RA. Keywords: general health, oral-health related quality of life, periodontitis, rheumatoid arthritis

Die Ergebnisse der Behandlung singulärer und multipler Gingivarezessionen der Miller-Klassen I und III an überkronten Oberkieferzähnen im ästhetischen Bereich mit der modifizierten Tunneltechnik wurden klinisch untersucht. Acht allgemeinmedizinisch gesunde Patienten (davon fünf Frauen) mit insgesamt 23 singulären oder multiplen Gingivarezessionen der Miller-Klassen I und III wurden konsekutiv mit der modifizierten Tunneltechnik in Kombination mit einem subepithelialen Bindegewebstransplantat behandelt. Von den 23 Rezessionen entfielen 16 auf die Miller-Klasse I und sieben auf die Miller-Klasse III. Jeder Patient wies mindestens eine faziale Rezession an einem überkronten Zahn im ästhetischen Bereich des Oberkiefers auf. Die faziale Rezession war in allen Fällen mit einer ästhetischen Beeinträchtigung assoziiert. Klinische Parameter wurden zu Behandlungsbeginn (vor der chirurgischen Therapie) und 12 Monate post operationem erhoben. Hauptzielvariable war eine komplette, d. h. 100%ige Wurzeldeckung. Die Wundheilung verlief in allen Fällen komplikationslos. Sämtliche Patienten und Defekte zeigten 12 Monate post operationem eine statistisch hochsignifikante (p 0,0001) Wurzeldeckung. Eine komplette Wurzeldeckung wurde bei 22 der 23 Rezessionen erreicht (bei 16 Miller-Klasse-I- und bei sechs der sieben Miller-Klasse-III-Rezessionen). Eine einzige Miller-Klasse-III-Rezession wies eine Wurzeldeckung von 89,1 % auf. Durch die Behandlung konnten eine mittlere Wurzeldeckung von 92,62 % bzw. 3,75 mm und ein mittlerer Gewinn an keratinisiertem Gewebe von 0,62 ± 1,15 mm (p 0,05) erzielt werden. Die Ergebnisse dieser Fallserie zeigen, dass die modifizierte Tunneltechnik in Kombination mit einem subepithelialen Bindegewebstransplantat eine gute Option für die Behandlung singulärer und multipler Gingivarezessionen an überkronten Oberkieferzähnen im ästhetischen Bereich darstellt. Keywords: Überkronte Zähne, Gingivarezession, Miller-Klasse-I-Rezession, Miller-Klasse-III-Rezession, modifizierte Tunneltechnik, subepitheliales Bindegewebstransplantat

Objective: To clinically evaluate the outcomes following surgical coverage of single and multiple Miller Class I and III gingival recessions at crown-restored teeth in the esthetic area by means of the modified coronally advanced tunnel (MCAT). Method and Materials: Eight systemically healthy patients (5 females) with a total of 23 single or multiple maxillary Miller Class I or III gingival recessions were consecutively treated with MCAT in conjunction with a subepithelial connective tissue graft (SCTG). Out of the 23 recessions, 16 were classified as Miller Class I and seven as Miller Class III. All patients presented at least one facial gingival recession at a crown-restored tooth, located in the maxillary anterior area. In all cases, the facial recession was associated with an impaired esthetic appearance. Clinical measurements were made at baseline (immediately before reconstructive surgery) and at 12 months postoperatively. The primary outcome variable was complete root coverage (CRC) (ie, 100% root coverage). Results: Healing was uneventful in all cases. At 12 months, statistically highly significant (P .0001) root coverage was obtained in all patients and defects. CRC was obtained in 22 out of the 23 recessions (in 16 Miller Class I and in six out of the seven Miller Class III recessions). In one Miller Class III recession, root coverage measured 89.10%. The treatment yielded a mean root coverage of 92.62% and 3.75 mm, respectively, and was associated with a mean gain of keratinized tissue width of 0.62 ± 1.15 mm (P .05). Conclusion: Within their limits, the present findings indicate that MCAT in conjunction with SCTG represents a valuable option for treating single and multiple gingival recessions at crown-restored teeth in the maxillary esthetic area thus avoiding the replacement of the prosthetic restorations. Keywords: crown-restored teeth, gingival recession, Miller Class I and III recessions, modified coronally advanced tunnel, root coverage, subepithelial connective tissue graft

Objective: To evaluate the clinical efficacy of a new porcine acellular dermal matrix (PADM) for the treatment of Miller Class I, II, and III multiple gingival recessions using the modified coronally advanced tunnel technique (MCAT). Method and Materials: Twelve nonsmoking, systemically healthy patients presenting at least two adjacent Miller Class I, II, or III gingival recessions (GR), with a minimal depth of 2 mm, were treated consecutively with MCAT in conjunction with PADM. At baseline and 12 months postoperatively, complete root coverage (CRC, eg 100% root coverage), mean root coverage (RC), recession depth, recession width, attached gingiva (AG), keratinized tissue (KT), periodontal pocket depths (PD), and clinical attachment level (CAL) were evaluated. The main outcome variable was CRC. Results: Postoperative healing was uneventful in all cases, without any matrix loss or exposure or infection. Statistically significant improvements (P .0001) were observed 12 months postoperatively in 53 of the included 54 GR (98.15%). Twenty two recessions (40.74%) showed CRC while the mean RC measured 73.20 ± 27.71%. Mean GR reduction was 2.06 ± 1.18 mm while the gain of AG amounted to 0.84 ± 0.73 mm and of KT to 0.69 ± 0.51 mm, respectively. There were no statistically significant changes for PD at 12 months; CAL showed a significant decrease (P .05) at 12 months from 3.77 ± 1.28 mm to 2.30 ± 1.02 mm. Conclusion: PADM in conjunction with MCAT may be successfully utilized for the treatment of Miller Class I, II, and III multiple adjacent GR. Keywords: clinical study, coronally advanced tunnel, gingival recession, porcine acellular dermal matrix, root coverage

Objective: To clinically evaluate the healing of multiple adjacent maxillary Miller Class I, II, and III gingival recessions (MAGR) treated with the modified coronally advanced tunnel (MCAT) in conjunction with an enamel matrix derivative (EMD) and subepithelial connective tissue graft (SCTG). Method and Materials: Twelve systemically healthy patients (6 females) with a total of 54 adjacent maxillary Miller Class I, II, or III MAGR were consecutively treated with MCAT in conjunction with EMD and SCTG. Out of the 54 recessions, 44 were classified as Miller Class I, five as Miller Class II, and five as Miller Class III. Patients were included in the study if they presented at least two adjacent recessions with a depth of ≥ 3 mm. Measurements were made at baseline (immediately before reconstructive surgery) and at 12 months postoperatively. The primary outcome variable was complete root coverage (CRC) (ie, 100% root coverage). Results: Healing was uneventful in all cases without any complications such as postoperative bleeding, allergic reactions, abscesses, or loss of SCTG. At 12 months, statistically highly significant (P .0001) root coverage was obtained in all patients and recessions. CRC was obtained in 37 Miller Class I, three Miller Class II, and one Miller Class III recessions, respectively. Mean root coverage was 96%. Mean keratinized tissue width increased statistically highly significantly (P .004) from 2.04 ± 0.95 mm at baseline to 2.37 ± 0.89 mm at 12 months. Conclusion: The present findings indicate that the proposed treatment concept results in predictable coverage of multiple adjacent maxillary Miller Class I, II, and III MAGR. Keywords: enamel matrix derivative, modified coronally advanced tunnel, multiple adjacent maxillary Miller Class I/II/III recessions, root coverage, subepithelial connective tissue graft

Die vorhersagbare Deckung multipler benachbarter Rezessionen stellt noch immer eine besondere Herausforderung für den Kliniker dar. Neueste Studien lieferten den Hinweis, dass der modifizierte koronal verschobene Tunnel (MKVT) eine klinisch relevante Option zur Deckung multipler Miller- Klasse-I-, -II- und -III-Rezessionen darstellen kann. Das Ziel dieser Arbeit war es, die MKVT-Technik in der Therapie von multiplen, benachbarten Miller-Klasse-I- und -II-Rezessionen darzustellen und die Ergebnisse von vier klinischen Fällen zu präsentieren. Ein Jahr nach der Therapie, zeigten alle Rezessionen eine komplette (=100 %ige) Deckung. Es kam weder zu einer Narbenbildung noch zu erhöhten Sondierungstiefen. Es kann festgehalten werden, dass der MKVT eine klinisch relevante Alternative zur Therapie von multiplen benachbarten Miller-Klasse-I- und -II-Rezessionen darstellt. Weitere Studien mit höheren Patientenzahlen und längere Beobachtungszeiten sind jedoch notwendig, um die Vorhersagbarkeit der Technik und die Stabilität der Ergebnisse zu untersuchen. Keywords: multiple Gingivarezession, Rezessionsdeckung, Bindegewebstransplantat, Tunneltechnik