Recombinant Human Fibroblast Growth Factor-2(SVS Institute of Dental Sciences)

Nonincised papillae surgical approach (NIPSA) preserves papillae by placing incision lines away from interdental areas, achieving good outcomes. However, these techniques may be unsuitable in cases with bone defect morphology or tissue anatomy. This case series introduces the modified nonincised papillae surgical approach (M‐NIPSA), which preserves papillae while providing adequate access for periodontal defect debridement and regenerative material placement.

Ten intrabony defects were treated with M‐NIPSA using recombinant human fibroblast growth factor‐2 and carbonate apatite (CO3Ap) as regenerative materials. Clinical parameters were assessed at baseline and 6 and 12 months. Early wound healing index evaluated primary wound closure 7 days postoperatively.

All cases achieved complete flap closure without wound dehiscence, with significant probing pocket depth and clinical attachment level (CAL) improvements compared to baseline (mean CAL gain: 3.65 ± 1.20 mm). No significant changes in gingival recession or keratinized tissue were observed.

M‐NIPSA overcomes anatomical limitations of conventional techniques, ensuring primary healing with minimal incision and flap reflection. Combined with effective growth factors, it significantly improves periodontal parameters.

Modified nonincised papillae surgical approach allows access to bone defects with a shorter incision range and reduced invasiveness by positioning the incision line more coronally compared to conventional nonincised papillae surgical approach.Ensuring an adequate width of keratinized gingiva (keratinized tissue width ≥3 mm) is essential. Incisions and flap elevation should minimize damage to the gingival tissue, and sutures with fine threads must be used to preserve blood flow.This incision technique is not suitable in cases with fragile gingiva due to inflammation or extensive bone defects spanning multiple teeth that could compromise blood flow.

This case series introduces a new surgical incision design for periodontal regeneration. Periodontitis, a disease that damages gum and bone, has long been treated with regeneration surgeries to restore lost tissues. Advances in materials and surgical methods have improved the predictability and effectiveness of these treatments. Recently, techniques have been developed to minimize surgical invasion and enhance healing. One innovation is avoiding incisions and tissue separating in the interdental area, preserving blood flow and keeping space for bone regeneration. In this study, the new incision design was applied to 10 patients undergoing periodontal regeneration therapy. After 12 months, evaluations showed improved soft and hard tissue healing. The results suggest that this new design addresses some anatomical limitations of traditional methods, offering effective healing with minimal surgical damage. Based on the results, this approach suggests the potential for faster recovery and better long‐term outcomes by combining precision and reduced invasiveness.

This case study documents the application of connective tissue graft (CTG) combined with biologics on treating challenging gingival recession cases of mandibular anterior teeth caused by orthodontic tooth movement.

Three patients presented for periodontal consultation due to gingival recession resulting from orthodontic treatment. The patients reported esthetic concerns and discomfort while brushing their teeth. The gingival defects were mainly localized to the mandibular incisors, with recession depths ranging from 1 to 5 mm and complicated by loss of papilla and a lack of keratinized tissue. RT2 gingival recession with thin gingival phenotype was confirmed. All gingival defects were managed using recombinant human fibroblast growth factor‐2 (rhFGF‐2) treated CTG. The recipient sites were prepared using tunnel or modified tunnel techniques. CTG harvested from the hard palate was treated with rhFGF‐2 for 3 min then inserted into the prepared tunnel space and secured with a sling suture technique for coronal advancement.

The three patients were followed from 6 months to 6 years. Generally, initial wound healing was within normal limits during the first several weeks. The recession defects were successfully covered, achieving a nearly 100% root coverage rate. The combination of CTG+rhFGF‐2 resulted in satisfying recession depth reduction, papilla augmentation, and gain of keratinized tissue. Patients were satisfied with the improvement of esthetics and function.

This innovative approach demonstrates that rhFGF‐2 treated CTG significantly improves the mucogingival problems caused by orthodontic treatment. Successful phenotype modification provides functional and esthetic improvement as well as long‐term stability of periodontal health.

Receding gums are a common complication after wearing dental braces, which sometimes can be severe if the initial gum tissue is thin. This complication could cause tooth sensitivity, discomfort when brushing, and compromised esthetics. To regenerate the lost tissue, a connective tissue graft (CTG) harvested from the roof of the oral cavity is very commonly used as a transplantation option with substantial supporting evidence. However, for cases of severe gum recession, CTGs still have limitations on treatment. Therefore, clinicians and researchers are dedicated to improving treatment outcomes by adding biomaterials to the graft to enhance clinical outcomes. A relatively new material, recombinant human fibroblast growth factor‐2 (rhFGF‐2), has proven to be effective in periodontal regenerative treatments and could potentially augment the soft tissue regenerative capacity of the graft. This case study documents the application of rhFGF‐2 in combination with CTGs for treating severe gum recession in three patients. The treatment results demonstrate significant improvements with follow‐up data ranging from 6 months to 6 years. These improvements include the coverage of exposed root surfaces, regeneration of tissue between teeth, and thickening of gum tissue. Patients were satisfied with the positive changes in function and esthetics resulting from this approach.