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Periodontal regenerative treatment of intrabony defects in the esthetic zone often poses a significant challenge to clinicians. Various materials and techniques have been proposed to achieve periodontal regeneration. This article presents modified vestibular incision subperiosteal tunnel access (M-VISTA) for treatment of intrabony defects in the esthetic zone. Two cases were treated using the proposed approach with enamel matrix derivatives and demineralized freeze-dried bone allograft to optimize the regenerative outcomes without affecting the soft tissue profile in the esthetic zone. Two different indications were described with addition of acellular dermal matrix and specific suturing techniques based on each particular clinical scenario. Clinical and radiographic follow-up of 18 months revealed successful outcomes of the proposed minimally invasive approach with no postoperative gingival recession. Patient-centered outcomes were highlighted as another major consideration in periodontal regeneration.

BackgroundScaling and root planning (SRP) is the gold standard approach for treatment of chronic periodontitis but used alone it may not be effective in removing periodontal pathogens from sites where access is poor.ObjectiveTo evaluate and compare the clinical and microbiological efficacy of ozone and chlorhexidine (CHX) as an adjunct to SRP in patients with chronic periodontitis.MethodsTwenty-five patients with generalized moderate to severe chronic periodontitis with presence of at least one site in each quadrant with a probing depth ≥5 mm were recruited. In a split mouth study design, two quadrants were randomly allocated to the SRP and ozone therapy and the remaining two quadrants to SRP and CHX therapy. Plaque index (PI), Gingival index (GI), probing depth (PD), clinical attachment loss (CAL) were assessed. Subgingival plaque samples were obtained for assessment of Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg).ResultsBoth groups demonstrated significant intragroup reduction in PI, GI, PD, CAL, Pg count and Aa count from baseline to 3 months follow-up. There were no significant differences between two groups for any of the parameters.ConclusionOzonated olive oil can be used as an adjunctive subgingival irrigant in patients with chronic periodontitis.

Improvement of smile esthetics is a major goal of modern dentistry. Various treatment modalities have been proposed to correct excessive gingival display (EGD), depending on the identified etiologies. This study reports on the clinical and patient-centered outcomes of a novel lip repositioning technique with vestibular shallowing approach in the treatment of three types of EGD with varying etiologies. Periosteal fenestration with cicatrization (scarification) was performed at the mucogingival junction to ensure the stability of esthetic outcomes. Suspensory triangular sutures and extraoral tissue stabilization tapes were used to facilitate the cicatrization process during the healing phase of this novel technique. Postoperative clinical examination revealed 84% reduction in gingival display that remained stable for 13 to 16 months with a high level of patient satisfaction.

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