Gingival recession is a common finding in daily clinical practice. Several issues may be associated with the apical shift of the gingival margin such as dentine hypersensitivity, root caries, non-carious cervical lesions (NCCLs), and compromised aesthetics. The first step in an effective management and prevention program is to identify susceptibility factors and modifiable conditions associated with gingival recession. Non-surgical treatment options for gingival recession defects include establishment of optimal plaque control, removal of overhanging subgingival restorations, behaviour change interventions, and use of desensitising agents. In cases where a surgical approach is indicated, coronally advanced flap and tunnelling procedures combined with a connective tissue graft are considered the most predictable treatment options for single and multiple recession defects. If there is a contraindication for harvesting a connective tissue graft from the palate or the patient wants to avoid a donor site surgery, adjunctive use of acellular dermal matrices, collagen matrices, and/or enamel matrix derivatives can be a valuable treatment alternative. For gingival recession defects associated with NCCLs a combined restorative-surgical approach can provide favourable clinical outcomes. If a patient refuses a surgical intervention or there are other contraindications for an invasive approach, gingival conditions should be maintained with preventive measures. This paper gives a concise review on when and how to treat gingival recession defects.

Different types of bioabsorbable and nonresorbable membranes have been widely used for guided tissue regeneration (GTR) with its ultimate goal of regenerating lost periodontal structures. The purpose of the present study was to evaluate the biological effects of various bioabsorbable and nonresorbable membranes in cultures of primary human gingival fibroblasts (HGF), periodontal ligament fibroblasts (PDLF) and human osteoblast-like (HOB) cells in vitro.

Recent studies indicate that nanocrystalline hydroxyapatite (nano-HA) paste represents a promising class of bone graft substitute. However, the underlying molecular mechanisms of nano-HA function have not yet been determined. This study was conducted to investigate the proliferation of human periodontal ligament (PDL) cells cultured in the presence of nano-HA paste and to characterize associated changes in intracellular signaling pathways. Cultured PDL cells were stimulated with nano-HA paste and enamel matrix derivative (EMD) in a soluble form. Proliferation of PDL cells was determined by incorporation of bromodeoxyuridine (BrdU) in the DNA of proliferating cells. In order to understand the signaling mechanisms underlying the increased cell proliferation of PDL cells exposed to nano-HA, the phosphorylation status of the serine/threonine protein kinase Akt, of the signal regulated kinases ERK 1/2 and of the epidermal growth factor receptor (EGFR) was analyzed by Western blotting using phospho-specific antibodies. Nano-HA paste showed two-fold less proliferation potential than EMD, but both substrates increased the proliferation rate significantly (P < 0.05) as compared with the negative control. The increased proliferation rate of PDL cells in the presence of nano-HA paste was mechanistically linked to activation of the epidermal growth factor receptor (EGFR) and its downstream targets ERK1/2 and Akt. In conclusion, our findings suggest that nano-HA paste is a stimulator of cell proliferation, possibly contributing to the main processes of periodontal tissue regeneration. (J. Oral Sci. 50, 279-285, 2008)

Background: The aim of this study was to compare the clinical outcome of intrabony periodontal defects following treatment with a novel nanocrystalline hydroxyapatite (NHA) paste to open flap debridement.Methods: Twenty‐eight subjects, each displaying one intrabony defect with probing depth (PD) ≥6 mm and radiographic evidence of an intraosseous component ≥3 mm participated in the present study. Subjects were allocated randomly to treatment with NHA paste (test group) or open flap debridement (control group). At baseline and at 6 months after surgery, the following clinical parameters were recorded by a masked examiner: plaque index, gingival index, PD, clinical attachment level (CAL), and gingival recession.Results: A significant improvement in PD and CAL was observed at 6 months after surgery compared to baseline in both treatment groups (P <0.001). At 6 months following therapy, the test group showed a reduction in mean PD from 7.4 ± 1.3 mm to 3.4 ± 1.2 mm and a change in mean CAL from 8.0 ± 1.3 mm to 4.4 ± 1.7 mm, whereas in the control group the mean PD decreased from 7.4 ± 0.8 mm to 4.9 ± 0.9 mm, and mean CAL decreased from 8.1 ± 1.2 mm to 6.4 ± 1.3 mm. The intergroup comparison demonstrated significantly more PD reductions (P = 0.012) and CAL gains (P = 0.005) in the test group compared to the control group.Conclusion: Treatment of intrabony periodontal defects with NHA paste significantly improved clinical outcomes compared to open flap debridement.