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Fernández-Jiménez A, García-De-La-Fuente AM, Marichalar-Mendia X, Aguirre-Zorzano LA, Estefanía-Fresco R. Treatment of deep single RT2 and RT3 antero-mandibular gingival recessions with a combination of surgical techniques: A case series study. J ESTHET RESTOR DENT 2024; 36:363-372. [PMID: 37594747 DOI: 10.1111/jerd.13120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/18/2023] [Accepted: 07/29/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To evaluate root coverage (RC) in deep single antero-mandibular RT2 and RT3 gingival recessions (GR) and to investigate the influence of several factors in RC. MATERIALS AND METHODS Fifteen single antero-mandibular GR with a minimum depth of 3 mm were consecutively treated with a new one-stage technique (laterally positioned flap with a tunnel access and a connective tissue graft). At baseline and at 12-month follow-up, the percentage of mean root coverage (%MRC), the recession reduction (RecRed), complete root coverage (CRC) and the gain of keratinized tissue width (KTW) were assessed. Descriptive, intergroup comparative and correlation analyses were performed. RESULTS At 12 months, a %MRC of 77.29 ± 21.48% with a mean RecRed of 4.10 ± 1.51 mm was achieved. The %MRC was 84.71 ± 21.08% in RT2, and 62.43 ± 14.17% in RT3. The mean gain of KTW was 2.10 ± 0.89 mm, with a mean gain of 2.0 ± 1.03 mm for RT2 and 2.3 ± 0.57 mm for RT3. CRC was observed in six cases, all of them being RT2. A positive association was found between the %MRC and the initial position of the tooth and of both papillae. CONCLUSIONS This technique might be a valuable approach for the treatment of deep single antero-mandibular RT2 and RT3 recessions, even in malpositioned teeth. CLINICAL SIGNIFICANCE A combination of different surgical techniques could provide greater vascularization to the CTG especially in malpositioned teeth in sextant V with a large avascular area to be covered.
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Affiliation(s)
- A Fernández-Jiménez
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - A M García-De-La-Fuente
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - X Marichalar-Mendia
- Research Group: GIU21/042, Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - L A Aguirre-Zorzano
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Clínica Dr. Aguirre, Bilbao, Spain
| | - R Estefanía-Fresco
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Clínica Dr. Aguirre, Bilbao, Spain
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Blasi G, Monje A, Muñoz-Peñalver J, Oates TW, Avila-Ortiz G, Nart J. Influence of vestibular depth on the outcomes of root coverage therapy: A prospective case series study. J Periodontol 2022; 93:1857-1866. [PMID: 35482935 DOI: 10.1002/jper.21-0638] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/01/2022] [Accepted: 04/16/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the influence of vestibular depth (VD) on the outcomes of root coverage therapy. METHODS Patients presenting gingival recession defects (GRD) with a minimum depth of 2 mm underwent root coverage therapy consisting of a coronally advanced flap plus a connective tissue graft (CAF + CTG). Clinical examinations were performed, and intraoral scans were obtained at baseline, 3 and 6 months after surgery to assess changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), GRD area, marginal gingival thickness (MGT), and VD. The influence of VD on percentage of root coverage (%RC) and the likelihood of achieving complete root coverage (CRC) were explored. RESULTS A total of 20 patients were enrolled, and 44 teeth were treated. RD decreased and MGT increased in all treated sites. At 6 months, mean %RC was 87.47 ± 18.37 and CRC was observed in 61.4% of sites. Mean baseline VD was 7.33 ± 2.67 mm. Mean VD reduction from baseline to 6 months was 1.98 ± 1.27 mm. %RC and CRC were significantly correlated with baseline VD. Each additional 1 mm of baseline VD implied a gain of 6.58% for %RC and increased 2.75 times the probability of achieving CRC. Narrow baseline KTW and mandibular arch location were associated with inferior treatment outcomes. CONCLUSION Lower %RC and likelihood of achieving CRC can be expected after root coverage therapy via CAF + CTG in sites presenting a shallow vestibulum.
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Affiliation(s)
- Gonzalo Blasi
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain.,Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore School of Dentistry, Baltimore, Maryland, USA
| | - Alberto Monje
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Jesus Muñoz-Peñalver
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain
| | - Thomas W Oates
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore School of Dentistry, Baltimore, Maryland, USA
| | - Gustavo Avila-Ortiz
- Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, Iowa, USA
| | - Jose Nart
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain
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Clinical Outcomes of the Double Lateral Sliding Bridge Flap Technique with Simultaneous Connective Tissue Graft in Sextant V Recessions: Three-Year Follow-Up Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The presence of isolated or multiple gingival recessions in the mandibular anterior region is a challenge for the clinician, as they may be associated with a shallow vestibule, high frenum insertion and/or little or no attached gingiva. Only limited evidence is available on the use of the double lateral sliding bridge flap technique with connective tissue graft (CTG) technique for treating gingival recessions in the mandibular anterior region. The aim of this study was to describe and evaluate the clinical and esthetic outcomes of the double lateral sliding bridge flap technique with CTG on isolated and multiple gingival recessions at the level of the mandibular incisors. Nine patients required treatment of gingival recessions in the mandibular incisors at the University of Salamanca (Spain) (seven females, two males; mean age: 27.9 ± 6.9) with a total of 14 isolated (42.9%) and multiple (57.1%) Miller class II and III gingival recessions. After a mean follow-up of 36 months, the mean percentage of root coverage was 80.5% for all treated recessions. Statistically significant differences (p < 0.05), were observed for reduction in recession depth, increased width of keratinized tissue and increased gingival thickness, this being dependent on the Miller class. The esthetic outcome was acceptable, with a final mean esthetic score of 7.4 out of 10. The double lateral sliding bridge flap surgical technique with CTG is an effective procedure for the coverage of isolated and multiple gingival recessions in the anterior mandibular region, as it offers satisfactory esthetic results.
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Weinberg E, Kolerman R, Kats L, Cohen O, Masri D, Sebaoun A, Slutzkey G. Coronally Advanced Flap with Connective Tissue Graft for Treating Orthodontic-Associated Miller Class III Gingival Recession of the Lower Incisors: A One-Year Retrospective Study. J Clin Med 2022; 11:jcm11010235. [PMID: 35011976 PMCID: PMC8745991 DOI: 10.3390/jcm11010235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 12/04/2022] Open
Abstract
(1) Background: To assess the clinical outcome of coronally advanced flap combined with connective tissue graft for the treatment of orthodontic-associated Miller Class III gingival recession of the lower incisors. (2) Methods: This study included 15 patients who had undergone orthodontic treatment prior to development of recession. Measurements of recession depth, recession width, probing depth, and width of keratinized tissue were performed clinically immediately before surgery and after one year. In addition, digital measurements of recession depth, recession width, and root coverage esthetic score were performed on intraoral photographs. (3) Results: Significant reduction was observed for probing depth, recession depth, and recession width at one year, with significant increase in width of keratinized tissue. Mean root coverage was 83 ± 24% for recession depth, while complete root coverage was achieved in 10 out of 21 recessions (48%). The average root coverage esthetic score at 12 months was 7.1 ± 2.6. An interaction was found between initial recession depth and mean root coverage. (4) Conclusions: Within the limitations of this study, our results confirm that combination of coronally advanced flap and connective tissue graft is effective in reducing post-orthodontic Miller Class III recessions of the mandibular incisors, even when the correction of the tooth malposition, is unattainable.
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Affiliation(s)
- Evgeny Weinberg
- Departments of Periodontology and Oral Implantology, Departments of Oral Biology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
| | - Roni Kolerman
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
| | - Lazar Kats
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Omer Cohen
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
| | - Daya Masri
- Rabin Medical Center, Department of Oral and Maxillofacial Surgery, Petach-Tikva 4941492, Israel;
| | - Alon Sebaoun
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
| | - Gil Slutzkey
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
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KAYAR NA, AYTEKİN Z. IMPACT OF TOOTH LOCATION ON THE TREATMENT OF MULTIPLE GINGIVAL RECESSIONS WITH CONNECTIVE TISSUE GRAFT ASSOCIATED WITH A CORONALLY ADVANCED FLAP. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.884369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Fernández-Jiménez A, García-De-La-Fuente AM, Estefanía-Fresco R, Marichalar-Mendia X, Aguirre-Urizar JM, Aguirre-Zorzano LA. Complete root coverage in the treatment of Miller class III or RT2 gingival recessions: a systematic review and meta-analysis. BMC Oral Health 2021; 21:145. [PMID: 33752657 PMCID: PMC7986294 DOI: 10.1186/s12903-021-01494-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background The primary objective of this systematic review and meta-analysis was to assess the evidence on complete root coverage (CRC) achieved by periodontal plastic techniques in the treatment of Miller class III/RT2 gingival recessions, comparing techniques developed along the twentieth century (pre-twenty-first) versus surgical approaches of the twenty-first century (21st). Methods An electronic bibliographic search was carried out in four databases up to December 2019, focusing on studies that reported CRC results in Miller class III or RT2 recessions treatment with at least a six-month follow-up. In addition, a random-effects models’ meta-analysis was performed for the CRC, comparing pre-twenty-first versus twenty-first century techniques at 6 months, 12 months and more than 12 months. Results Thirty-seven publications were included. A total of 933 gingival recessions were treated, 298 with pre-twenty-first century surgical techniques and 635 with techniques from the twenty-first century. CRC was achieved at 6 months on half of the recessions (pre-twenty-first: 57.60% vs. 21st: 51.11%), but decreased markedly for twenty-first century techniques at 12 months (pre-twenty-first: 63.82% vs. 21st: 32.87%). Thereafter, this difference was the other way around (> 12 months: pre-twenty-first: 5.26% vs. 21st: 19.65%). The meta-analysis showed a high heterogeneity, with no significant differences amongst the techniques. Conclusions Although CRC might be achievable by treating Miller class III or RT2 recessions with any of the described techniques, its long-term stability is not predictable. More randomized clinical trials with longer follow-ups and several visits, are needed. In addition, the patient’s satisfaction should also be assessed. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01494-3.
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Affiliation(s)
- Aitziber Fernández-Jiménez
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - Ana-María García-De-La-Fuente
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain.
| | - Ruth Estefanía-Fresco
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - Xabier Marichalar-Mendia
- Department of Nursing I, University of the Basque Country (UPV/EHU), Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - José-Manuel Aguirre-Urizar
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - Luis-Antonio Aguirre-Zorzano
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
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Moro MG, Souto MLS, Rovai ES, Cesar Neto JB, Holzhausen M, Pannuti CM. Effect of magnification on root coverage surgery. BRAZILIAN JOURNAL OF ORAL SCIENCES 2020. [DOI: 10.20396/bjos.v19i0.8658221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Root coverage surgery can be performed in patients with gingival recession to cover the exposed root aiming to control hypersensitivity and promotes better aesthetic. Optical magnification has been proposed as a refinement in this surgical technique to increase root coverage. This approach may lead to enhanced soft tissue stability, less post-operative discomfort, better predictability and esthetic appearance. Aim: This systematic review aimed to evaluate the effectiveness of magnification on root coverage surgery when compared to procedures performed without magnification. Methods: Randomized controlled trials with a follow-up of at least 6 months that compared surgeries for root coverage performed under optic magnification versus conventional (macro) root coverage surgery were screened. The primary outcome was mean root coverage (mm) (MRC) and secondary outcomes were percentage of root coverage (PRC) and complete root coverage (CRC). Results: Of 569 papers relevant to this review, seven were included. Meta-analysis showed that the use of magnification may favor greater PRC (7.38%, 95% CI 3.66-11.09). Conclusion: Magnification can increase PRC in root coverage surgeries. More randomized trials with the use of magnification may be necessary to verify if this benefit is clinically relevant, in order to justify the use of this device.
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Berridge JP, Johnson TM, Lane JD, Miller PD. Focus on Epithelialized Palatal Grafts. Part 1: Multiple Adjacent Recession Defects in the Mandibular Anterior. Clin Adv Periodontics 2018. [DOI: 10.1002/cap.10035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Joshua P. Berridge
- United States Army Advanced Education Program in Periodontics; Fort Gordon GA
- Department of Periodontics; Army Postgraduate Dental School; Uniformed Services University of the Health Sciences; Fort Gordon GA
| | - Thomas M. Johnson
- United States Army Advanced Education Program in Periodontics; Fort Gordon GA
- Department of Periodontics; Army Postgraduate Dental School; Uniformed Services University of the Health Sciences; Fort Gordon GA
| | - Jonathan D. Lane
- Department of Periodontics; Korea Dental Health Activity; United States Army; Yongsan Korea
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Carranza N, Pontarolo C, Rojas MA. Laterally Stretched Flap With Connective Tissue Graft to Treat Single Narrow Deep Recession Defects on Lower Incisors. Clin Adv Periodontics 2018; 9:29-33. [DOI: 10.1002/cap.10046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/19/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Nelson Carranza
- Private practice; Carranza Institute; Buenos Aires Argentina
- Department of Periodontics; University of Buenos Aires; Buenos Aires Argentina
| | - Constanza Pontarolo
- Private practice; Carranza Institute; Buenos Aires Argentina
- Department of Periodontics; University of Buenos Aires; Buenos Aires Argentina
| | - Mariana A. Rojas
- Department of Periodontics; University of Buenos Aires; Buenos Aires Argentina
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Tavelli L, Barootchi S, Nguyen TV, Tattan M, Ravidà A, Wang H. Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta‐analysis. J Periodontol 2018; 89:1075-1090. [DOI: 10.1002/jper.18-0066] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Shayan Barootchi
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Trang V.N. Nguyen
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Mustafa Tattan
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Andrea Ravidà
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Hom‐Lay Wang
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
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