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Di Domenico GL, Di Martino M, Arrigoni G, Aroca S, de Sanctis M. Multiple coronally advanced flap with a selective use of connective tissue graft: A 3-year prospective clinical and histological study. J Periodontol 2023; 94:1200-1209. [PMID: 37036093 DOI: 10.1002/jper.22-0632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/15/2023] [Accepted: 03/29/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND The purpose of the present study was to prospectively evaluate the 3-year changes in the gingival dimensions following multiple coronally advanced flap (MCAF) with selective use of connective tissue graft (CTG). In addition, the secondary aim was to histologically identify the factors related to phenotype changes. METHODS Twenty patients treated with MCAF and site-specific application of a CTG were available for the 3-year follow-up. Outcome measures included complete root coverage (CRC), recession reduction, keratinized tissue width (KTW), marginal tissue thickness changes, and primary flap position. Biopsies were harvested at one of the sites treated with the adjunct of CTG. All sections were stained with hematoxylin and eosin, Masson trichrome, Verhoeff-van Gieson, tenascin, and alcian blue stain for semiquantitative evaluation. RESULTS At 3 years, CRC was detected in 86% of sites treated with MCAF alone and 81% of sites treated with MCAF + CTG. The 47% of sites treated with MCAF + CTG presented an apical shift of primary flap from its original position. Linear regression showed a significant association between KTW change and the initial KTW in MCAF-treated sites, while both initial KTW and position of primary flap were statistically significantly associated factors with KTW changes in the MCAF + CTG group. In all the biopsies examined, there is always a marked and clear separation between the connective tissue of the gingival flap and the palatal connective tissue of the graft. CONCLUSIONS The selective use of CTG is an effective treatment for multiple gingival recessions. Only a limited increase in KTW can be expected in a bilaminar technique if, during the healing phases, the connective tissue is maintained completely covered.
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Affiliation(s)
| | - Maria Di Martino
- Department of Periodontology, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianluigi Arrigoni
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sofia Aroca
- 26K Center for Clinical Research, Paris, France
- Department of Periodontology, Bern University, Bern, Switzerland
| | - Massimo de Sanctis
- Department of Periodontology, Vita-Salute San Raffaele University, Milan, Italy
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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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Sethiya K, Dhadse P, Bajaj P, Durge K, Subhadarsanee C, Hassan S. Platelet rich fibrin in combination with bioabsorbable guided tissue regeneration (GTR) membrane and GTR membrane alone using double lateral sliding bridge flap for treatment of multiple gingival recession defects in humans: A randomized controlled clinical trail. J Indian Soc Periodontol 2022; 26:245-253. [PMID: 35602531 PMCID: PMC9118950 DOI: 10.4103/jisp.jisp_322_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/22/2021] [Accepted: 12/12/2021] [Indexed: 11/04/2022] Open
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Govindasamy BR, Naik VK, Balasundaram A. Comparison of coronally advanced versus semilunar coronally repositioned flap in the management of maxillary gingival recessions. Saudi Dent J 2021; 33:642-649. [PMID: 34803313 PMCID: PMC8589608 DOI: 10.1016/j.sdentj.2020.05.005] [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: 03/04/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/07/2022] Open
Abstract
Objectives Maxillary gingival recessions can be managed by both semilunar coronally repositioned flap (SLCRF) and coronally advanced flap (CAF). The objective of this study was to compare SLRCF and CAF in terms of wound healing and periodontal parameters in the presence of magnification. Materials and methods Thirty patients with Miller’s class I gingival recession in maxillary anteriors and premolars were assigned to 2 groups including SLCRF and CAF. All procedures were performed using 2.5× magnifying loupes. Wound healing and periodontal clinical parameters were assessed at baseline and at 2nd, 4th, 8th and 12th week. Results No significant difference was observed in wound healing and mean percentage root coverage in both the groups at 12th week (p > 0.05). However, SLCRF showed a statistically significant reduction in percentage of root coverage (PRC) at 12th week compared to 2nd week (p < 0.05). A significant gain in Clinical attachment level, width of keratinised tissue and a significant reduction in Recession Depth and Probing Depth were seen in both the groups at 12th week. Conclusion Within the limitation of this study, both techniques resulted in similar wound healing at 12th week with the use of magnification. CAF provided more root coverage compared to SLCRF technique in the maxillary class I gingival recession defects.
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Affiliation(s)
| | - Vanaja Krishna Naik
- Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK.,Department of Periodontics, SRM Dental College, Chennai, India
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Lafzi A, Abolfazli N, Faramarzi M, Eyvazi M, Eskandari A, Salehsaber F. Clinical comparison of coronally-advanced flap plus amniotic membrane or subepithelial connective tissue in the treatment of Miller's class I and II gingival recessions: A split-mouth study. J Dent Res Dent Clin Dent Prospects 2016; 10:162-8. [PMID: 27651882 PMCID: PMC5025217 DOI: 10.15171/joddd.2016.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/21/2016] [Indexed: 11/17/2022] Open
Abstract
Background. The aim of the present study was to compare coronally advanced flap (CAF) plus amniotic membrane (AM) to CAF with connective tissue graft (CTG) in the treatment of Miller’s class I and II gingival recessions. Methods. Eleven healthy subjects with thirty Miller’s class І and ІІ gingival recessions ≥3 mm, were selevted for this research and randomly assigned to two groups in a split-mouth design. In the control group gingival recessions were treated with CAF and CTG; however, in the test group the lesions were treated with (AM) and CAF. The clinical parameters, including recession depth (RD), recession width (RW), keratinized tissue width (WKT), probing depth (PD) and clinical attachment level (CAL), were measured at baseline and 1, 3 and 6 months postoperatively. Statistical significance was set at P < 0.01. Results. Position changes of RD, RW, CAL, and MGJ were significant between baseline and one month after surgery (P < 0.01) in both the test and control groups and these values remained unchanged at 3- and 6-month follow-ups. There were no statistically significant differences in PD and WKT between baseline and 1-, 3- and 6-months intervals postoperatively. The mean root coverage values after 6 months were 75.5% and 63.1% for two groups, respectively. The mean recession depth reductions were 2.63±0.63 mm and 2±1.4 mm in the test and control groups, respectively. Conclusion. The results of this research showed that application of AM instead of connective tissue decreased surgical operation time and patient discomfort but the amount of root coverage was not significantly different between the two methods.
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Affiliation(s)
- Ardeshir Lafzi
- Professor, Department of Periodontics, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Abolfazli
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Associate Professor, Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoumeh Faramarzi
- Associate Professor, Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoumeh Eyvazi
- Assistant Professor, Department of Periodontics, Faculty of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Eskandari
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Assistant Professor, Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Salehsaber
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Assistant Professor, Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
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Rajaram V, Thyegarajan R, Balachandran A, Aari G, Kanakamedala A. Platelet Rich Fibrin in double lateral sliding bridge flap procedure for gingival recession coverage: An original study. J Indian Soc Periodontol 2016; 19:665-70. [PMID: 26941518 PMCID: PMC4753712 DOI: 10.4103/0972-124x.164764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Gingival recession is a common occurrence in periodontal disease leading to an unaesthetic appearance of the gingiva. The effect of platelet-rich fibrin (PRF), when used along with double lateral sliding bridge flap (DLSBF), remains unknown. The aim of this study is to evaluate the effect of PRF in conjunction with DLSBF for multiple gingival recessions. Materials and Methods: Twenty systemically healthy individuals exhibiting Grade II gingival recession on their mandibular central incisors were recruited in this study. These patients were randomly assigned into two groups: DLSBF and PRF + DLSBF. The clinical parameters that were evaluated in this study were gingiva recession height, gingiva recession width, width of keratinized gingiva, clinical attachment level, and probing depth. PRF was procured from the patient's blood at the time of the surgery and used for the procedure. The follow-up was performed at 12 and 24 weeks postsurgery. Results: Statistically significant difference was observed between the clinical parameters at baseline and 12 and 24 weeks within the groups. There was no statistically significant difference, between the groups. Mean root coverage (RC) was 80% ±29.1% in the DLSBF group and 78.8% ±37.6% in the DLSBF + PRF group with no statistically significant difference. Conclusion: From the results obtained in this study, the addition of PRF to DLSBF gives no additional benefits to the clinical parameters measured in RC.
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Affiliation(s)
- Vijayalakshmi Rajaram
- Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu, India
| | - Ramakrishnan Thyegarajan
- Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu, India
| | - Ashwath Balachandran
- Department of Periodontics, Chettinad Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Geetha Aari
- Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu, India
| | - Anilkumar Kanakamedala
- Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu, India
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de Sanctis M, Clementini M. Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 2014; 41 Suppl 15:S108-22. [PMID: 24640996 DOI: 10.1111/jcpe.12189] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/27/2022]
Abstract
AIM To identify critical elements in design and execution of coronally advanced flap, lateral positioned flap and their variations for the treatment of facial gingival recessions or peri-implant soft tissue dehiscences. MATERIALS AND METHODS Clinical studies were identified with both electronic and hand searches, and examined for the following aspects: flap design and incision techniques, flap elevation, root conditioning, flap mobility, flap stability and suturing. Moreover, prognostic factors for complete recession coverage were identified. RESULTS Some critical elements are evident in flap design and execution: the dimension and the thickness of tissue positioned over the denuded roots; the use on root surface of enamel matrix derivate; the stability and suturing of the flap in a position coronal to the cemento-enamel junction. The pre-determination of the clinical cemento-enamel junction, smoking status, operator surgical skills and the compliance to a supportive care programme have a role in obtaining and maintaining a complete root coverage. CONCLUSIONS Different flap approaches are available when performing periodontal plastic surgery, resulting in a great variability in clinical outcomes. The possibility of using pedicle flaps alone to achieve complete soft tissue coverage of facial implant dehiscence has not yet been investigated.
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Affiliation(s)
- Massimo de Sanctis
- Department of Periodontology, Tuscany Dental School, Univesity of Siena-Florence, Siena, Italy
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Multiple marginal tissue recession treated with a simplified lateral sliding flap technique. Case Rep Dent 2014; 2014:432960. [PMID: 25400955 PMCID: PMC4221904 DOI: 10.1155/2014/432960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/02/2014] [Indexed: 11/18/2022] Open
Abstract
Marginal tissue recession is a common esthetic problem that is usually accompanied by dentin sensitivity, and patients frequently report a fear of dental loss. Lateral sliding flaps have been used for localized recession, but they are rarely used for multiple recessions. The aim of this paper was to report a case of coverage of multiple marginal tissue recessions by means of a lateral sliding flap associated with a connective tissue graft. This was a modification of Nelson's technique, which was originally described as the combination of the double papilla technique, lateral sliding flap, and connective tissue graft. In the present case, double papilla was not performed, rendering the maneuver less complicated. After surgery on teeth #23 to #25, total root coverage, decreased dentin sensitivity, and increased keratinized tissue band and gingival thickness were achieved. In the present case, modified Nelson technique proved to be a more simple procedure for the treatment of multiple recessions in one session, resulting in adequate healing, predictable root coverage, and, more importantly, esthetic and functional success.
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Agarwal K, Chandra C, Agarwal K, Kumar N. Lateral sliding bridge flap technique along with platelet rich fibrin and guided tissue regeneration for root coverage. J Indian Soc Periodontol 2014; 17:801-5. [PMID: 24554895 PMCID: PMC3917215 DOI: 10.4103/0972-124x.124525] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 04/29/2013] [Indexed: 11/04/2022] Open
Abstract
Gingival recession is defined as the apical migration of the gingival margin with exposure of root surfaces. The etiology of the condition is multifactorial. Given the high rate of gingival recession defects among the general population, it is imperative that dental practitioners have an understanding of the etiology, complications and management of the condition. A recent innovation in dentistry is the preparation and use of platelet-rich fibrin (PRF) for recession defects. The article presents a case report, which highlights the use of lateral sliding bridge flap along with PRF in a collagen membrane carrier (guided tissue regeneration) for the treatment of multiple recession defects.
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Affiliation(s)
- Kriti Agarwal
- Department of Periodontology, DJ Dental College, Modinagar, India
| | - Chetan Chandra
- Department of Periodontology, Sardar Patel Institute of Dental and Medical Sciences, Lucknow, India
| | - Kanika Agarwal
- Department of Periodontology, Sardar Patel Institute of Dental and Medical Sciences, Lucknow, India
| | - Nishant Kumar
- Department of Oral and Maxillofacial Surgery, ITS Dental College, Greater Noida, Uttar Pradesh, India
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Verma PK, Srivastava R, Chaturvedi TP, Gupta KK. Root coverage with bridge flap. J Indian Soc Periodontol 2013; 17:120-3. [PMID: 23633786 PMCID: PMC3636931 DOI: 10.4103/0972-124x.107487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 09/20/2012] [Indexed: 11/04/2022] Open
Abstract
Gingival recession in anterior teeth is a common concern due to esthetic reasons or root sensitivity. Gingival recession, especially in multiple anterior teeth, is of huge concern due to esthetic reasons. Various mucogingival surgeries are available for root coverage. This case report presents a new bridge flap technique, which allows the dentist not only to cover the previously denuded root surfaces but also to increase the zone of attached gingiva at a single step. In this case, a coronally advanced flap along with vestibular deepening technique was used as root coverage procedure for the treatment of multiple recession-type defect. Here, vestibular deepening technique is used to increase the width of the attached gingiva. The predictability of this procedure results in an esthetically healthy periodontium, along with gain in keratinized tissue and good patient's acceptance.
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Affiliation(s)
- Pushpendra Kumar Verma
- Department of Conservative Dentistry and Endodontics, I. M. S., Banaras Hindu University, Varanasi, India
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Gupta V, Bains VK, Mohan R, Bains R. Bridge flap technique as a single-step solution to mucogingival problems: A case series. Contemp Clin Dent 2011; 2:110-4. [PMID: 21957387 PMCID: PMC3180842 DOI: 10.4103/0976-237x.83075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Shallow vestibule, gingival recession, inadequate width of attached gingiva (AG) and aberrant frenum pull are an array of mucogingival problems for which several independent and effective surgical solutions are reported in the literature. This case series reports the effectiveness of the bridge flap technique as a single-step surgical entity for increasing the depth of the vestibule, root coverage, increasing the width of the AG and solving the problem of abnormal frenum pull. Eight patients with 18 teeth altogether having Millers class I, II or III recession along with problems of shallow vestibule, inadequate width of AG and with or without frenum pull underwent this surgical procedure and were followed-up till 9 months post-operatively. The mean root coverage obtained was 55% and the mean average gain in width of the AG was 3.5 mm. The mean percentage gain in clinical attachment level was 41%. The bridge flap technique can be an effective single-step solution for the aforementioned mucogingival problems if present simultaneously in any case, and offers considerable advantages over other mucogingival surgical techniques in terms of simplicity, limited chair-time for the patient and the operator, single surgical intervention for manifold mucogingival problems and low morbidity because of the absence of palatal donor tissue.
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Affiliation(s)
- Vivek Gupta
- Department of Periodontology, Saraswati Dental College and Hospital, Lucknow, India
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Ozturan S, Durukan SA, Ozcelik O, Seydaoglu G, Cenk Haytac M. Coronally advanced flap adjunct with low intensity laser therapy: a randomized controlled clinical pilot study. J Clin Periodontol 2011; 38:1055-62. [DOI: 10.1111/j.1600-051x.2011.01774.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2011] [Indexed: 01/16/2023]
Affiliation(s)
- Seda Ozturan
- Department of Periodontology; Faculty of Dentistry; Cukurova University; Adana; Turkey
| | - Sulhi Andac Durukan
- Department of Periodontology; Faculty of Dentistry; Cukurova University; Adana; Turkey
| | - Onur Ozcelik
- Department of Periodontology; Faculty of Dentistry; Cukurova University; Adana; Turkey
| | - Gulsah Seydaoglu
- Department of Biostatistics; Faculty of Medicine; Cukurova University; Adana; Turkey
| | - Mehmet Cenk Haytac
- Department of Periodontology; Faculty of Dentistry; Cukurova University; Adana; Turkey
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Bains VK, Gupta V, Singh GP, Bains R. Mucogingival surgery: where we stand today. JOURNAL OF THE CALIFORNIA DENTAL ASSOCIATION 2011; 39:573-83. [PMID: 21957822 DOI: 10.1080/19424396.2011.12221930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2024]
Abstract
Mucogingival problems are developmental and acquired aberrations in the morphology, position, and/or the amount of gingiva surrounding teeth. According to an academic report by American Academy of Periodontology, mucogingival therapy should be advocated for gingival augmentation and to create adequate vestibular depth in areas with insufficient attached gingiva. This paper provides an overview on mucogingival surgical procedures from its inception to the current time.
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Affiliation(s)
- Vivek K Bains
- Department of Periodontics, Saraswati Dental College and Hospital, Lucknow, India.
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Santamaria MP, Ambrosano GMB, Casati MZ, Nociti FH, Sallum AW, Sallum EA. The Influence of Local Anatomy on the Outcome of Treatment of Gingival Recession Associated With Non-Carious Cervical Lesions. J Periodontol 2010; 81:1027-34. [DOI: 10.1902/jop.2010.090366] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Santana RB, Mattos CML, Dibart S. A clinical comparison of two flap designs for coronal advancement of the gingival margin: semilunar versus coronally advanced flap. J Clin Periodontol 2010; 37:651-8. [PMID: 20528963 DOI: 10.1111/j.1600-051x.2010.01582.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The semilunar incision was introduced in oral surgery more than a century ago. The semilunar coronally re-positioned flap (SLCRF) is one of the variants of this procedure; however, no previous controlled clinical study has evaluated the SLCRF performed as originally described. The objective of the present study was to compare the clinical outcomes of the SLCRF and coronally advanced flap (CAF) procedure in the treatment of maxillary Miller class I recession (GR) defects. MATERIALS AND METHODS Twenty-two patients, with 22 contra-lateral Miller class I GR defects, were randomly assigned to CAF or SLCRF. Clinical parameters assessed included recession height, width of keratinized tissue, probing depth, vertical clinical attachment level, visual plaque score and bleeding on probing. Clinical recordings were performed at baseline and 6 months later. Inter-measurements differences were analysed with a chi(2) or a paired t-test, with significance set at alpha<0.05. RESULTS Both flap designs were effective in obtaining and maintaining a coronal displacement of the gingival margin. The CAF resulted in clinical improvements significantly better than SLCRF for percentage of root coverage (RC), frequency of complete RC and gain in clinical attachment level. RC obtained in the immediate post-surgical period of SLCRF-treated sites was not maintained throughout the subsequent evaluations. CONCLUSION RC is significantly better with CAF compared with the original SLCRF technique in the treatment of shallow maxillary Miller class I GR defects.
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Affiliation(s)
- Ronaldo B Santana
- Graduate Program in Dentistry, Department of Periodontology, Dental School, Federal Fluminense University, Niteroi, Rio de Janeiro, Brazil.
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Castellanos A, de la Rosa M, de la Garza M, Caffesse RG. Enamel Matrix Derivative and Coronal Flaps to Cover Marginal Tissue Recessions. J Periodontol 2006; 77:7-14. [PMID: 16579697 DOI: 10.1902/jop.2006.77.1.7] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Correcting recession defects is one of the goals of periodontal therapy, and the efficacy and predictability of the various techniques are important considerations for both patients and clinicians. Several reports have examined the outcome of gingival recession treatment by means of coronally positioned flaps (CPF) and enamel matrix derivative (EMD). The purpose of this study was to clinically evaluate the use of EMD in association with CPF to cover localized gingival recessions compared to CPF alone. METHODS Twenty-two patients with Miller Class I or II gingival recessions >2 mm were included. One recession from each patient was treated in the study. Two treatments were randomly assigned: coronally positioned flap with EMD (test) and coronally positioned flap alone (control). Clinical parameters measured at baseline and 1, 6, and 12 months included gingival index, plaque index, probing depth, clinical attachment level, vertical and horizontal recession, and width of keratinized gingiva. RESULTS At 12 months, both treatment modalities showed significant root coverage, gain in clinical attachment, and gain in width of keratinized gingiva (P <0.05). Vertical recessions were reduced from 2.68 +/- 1.63 mm to 0.36 +/- 0.60 mm in the test group and from 2.31 +/- 1.52 mm to 0.90 +/- 0.95 mm in the control group. Horizontal recessions decreased from 4.27 +/- 2.06 mm to 0.77 +/- 0.87 mm in the test group and from 3.68 +/- 1.91 mm to 1.72 +/- 1.31 mm in the control group. Changes in keratinized gingiva went from 3.81 +/- 1.95 mm to 4.63 +/- 2.15 mm in the test group and from 3.31 +/- 1.81 mm to 3.27 +/- 1.80 mm in the control group. When both treatments were compared at 12 months, there was a significant difference in vertical tooth coverage and gain in keratinized gingiva in favor of the experimental group (P <0.05). The average percentage of root coverage for test and control groups was 88.6% and 62.2%, respectively. CONCLUSIONS The coronally positioned flap alone or with EMD is an effective procedure to cover localized gingival recessions. The addition of EMD significantly improves the amount of root coverage.
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Affiliation(s)
- Adriana Castellanos
- Graduate Periodontics, Autonomous University of Nuevo Leon, Monterrey, Nuevo Leon, Mexico
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Greenwell H, Fiorellini J, Giannobile W, Offenbacher S, Salkin L, Townsend C, Sheridan P, Genco R. Oral reconstructive and corrective considerations in periodontal therapy. J Periodontol 2005; 76:1588-600. [PMID: 16171452 DOI: 10.1902/jop.2005.76.9.1588] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. It is intended to provide information for the dental profession and other interested parties. The purpose of this paper is to provide a general overview of oral reconstructive and corrective procedures used in periodontal therapy. It is not intended to be a comprehensive review of this subject.
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Gürgan CA, Oruç AM, Akkaya M. Alterations in Location of the Mucogingival Junction 5 Years After Coronally Repositioned Flap Surgery. J Periodontol 2004; 75:893-901. [PMID: 15295958 DOI: 10.1902/jop.2004.75.6.893] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this clinical study was to evaluate whether the mucogingival junction (MGJ) reverts back towards its original location following coronally repositioned flap (CRF) procedure over a 5-year follow-up period. METHODS Thirteen systemically healthy patients with 26 Miller Class I buccal gingival recessions were treated using the CRF technique. At baseline, and 1, 6, 12, and 60 months after surgery, location of gingival margin (LGM), probing depth (PD), clinical attachment level (CAL), width of keratinized gingiua (WKG), and location of mucogingival junction (LMGJ) were recorded. The alterations in the clinical measurements at the different evaluation times were analyzed using the Friedman and the repeated measure analysis of variance (ANOVA) tests, where applicable. Degree of association between continuous variables was calculated by the Pearson's correlation coefficient. RESULTS The mean percentage of root coverage obtained at the end of 1 month was 68.26% +/- 30.37% (P<0.05) and at 60 months, it was reduced to 44.86% +/- 33.91% (P<0.01). LGM (r=0.592, P<0.001), CAL (r=0.590, P<0.01), WKG (r=0.442, P<0.05), and LMGJ (r=0.653, P<0.001) were found to be significantly correlated with the 60-month postoperative values of LMGJ. At the end of the 60-month follow-up period, the mean apical displacement of LGM was 0.67 +/- 0.72 mm and the same mean apical displacement value for LMGJ was 0.98 +/- 1.19 mm. CONCLUSIONS Within the limits of this study, the 60-month follow-up findings indicated that the CRF procedure failed to maintain the gingival tissue in a coronal position and that the observed movement of the MGJ back to its original position was partially dependent on the apical movement of gingival margin.
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Affiliation(s)
- Cem A Gürgan
- Ankara University Faculty of Dentistry, Department of Periodontology, Ankara, Turkey.
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Woodyard JG, Greenwell H, Hill M, Drisko C, Iasella JM, Scheetz J. The Clinical Effect of Acellular Dermal Matrix on Gingival Thickness and Root Coverage Compared to Coronally Positioned Flap Alone. J Periodontol 2004; 75:44-56. [PMID: 15025216 DOI: 10.1902/jop.2004.75.1.44] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The primary aim of this randomized, controlled, blinded, clinical investigation was to compare the coronally positioned flap (CPF) plus an acellular dermal matrix (ADM) allograft to CPF alone to determine their effect on gingival thickness and percent root coverage. METHODS Twenty-four subjects with one Miller Class I or II buccal recession defect of > or = 3 mm were treated with a CPF plus ADM or a CPF alone. Multiple additional recession sites were treated with the same flap procedure, and all sites were studied for 6 months. Tissue thickness was measured at the sulcus base and at the mucogingival junction of all teeth, with an SDM ultrasonic gingival thickness meter. RESULTS For the ADM sites, mean initial recession of 3.46 mm was reduced to 0.04 mm for defect coverage of 3.42 mm or 99% (P < 0.05). For the CPF group, mean initial recession of 3.27 mm was reduced to 1.08 mm for defect coverage of 2.19 mm or 67% (P < 0.05). The difference between ADM and CPF groups was statistically significant (P < 0.05). Marginal soft-tissue thickness was increased by 0.40 mm (P < 0.05) for the ADM group, whereas the CPF group remained essentially unchanged. Keratinized tissue was increased for the ADM group by 0.81 mm (P < 0.05), whereas the CPF group increased by 0.33 mm (P > 0.05). No additional root coverage was gained due to creeping attachment between 2 and 6 months for either group. CONCLUSIONS Treatment with a CPF plus an ADM allograft significantly increased gingival thickness when compared with a CPF alone. Recession defect coverage was significantly improved with the use of ADM.
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Affiliation(s)
- James G Woodyard
- School of Dentistry, University of Louisville, Louisville, KY 40292, USA
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Oates TW, Robinson M, Gunsolley JC. Surgical Therapies for the Treatment of Gingival Recession. A Systematic Review. ACTA ACUST UNITED AC 2003; 8:303-20. [PMID: 14971258 DOI: 10.1902/annals.2003.8.1.303] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A variety of soft tissue augmentation procedures directed at root coverage have been documented in the literature utilizing autogenous or allogenic soft tissue grafting or guided tissue regeneration (GTR). RATIONALE The purpose of this systematic review was to assess the literature regarding the efficacies of various surgical gingival augmentation procedures relative to clinical and patient-oriented outcomes. FOCUSED QUESTION What is the effect of surgical therapy for root coverage in patients with gingival recession compared with other treatment modalities or baseline values? SEARCH PROTOCOL PubMed and the Cochrane Oral Health Group Trials Register were searched to identify human studies in English investigating the therapeutic use of a soft tissue surgical procedure to treat gingival recession. Searches were performed for articles published by April 2002. SELECTION CRITERIA Initial screening of identified abstracts accepted all studies evaluating surgical intervention of gingival recession. Independent review by 2 reviewers evaluated full-text reports regarding study characteristics. Only those studies determined to be randomized clinical trials (RCTs) were included in the final analysis. DATA ANALYSIS AND COLLECTION: Outcome measures included changes in root coverage, clinical attachment levels (CAL), probing depth (PD), and width of keratinized tissue (KT). The only data suitable for meta-analysis were comparisons of the efficacy of connective tissue grafts with GTR. MAIN RESULTS 1. Thirty-two articles (total study population: 687) met the criteria for RCTs: 11 (population: 286) related to various autogenous soft tissue augmentation procedures; 18 (population: 360) to GTR; and 3 (population: 41) to allogenic soft tissue augmentation. 2. Meta-analysis identified greater gains in both root coverage and keratinized tissue width for connective tissue graft procedures compared to GTR. 3. No other data were compatible with meta-analysis. REVIEWERS' CONCLUSIONS 1. Soft tissue augmentation procedures are effective means of obtaining root coverage. 2. Connective grafting techniques appear to have an advantage over GTR. 3. There is a need for further efficacy studies and for investigation of these procedures relative to patient-oriented outcomes such as esthetics, root sensitivity, and postoperative morbidities.
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Affiliation(s)
- Thomas W Oates
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
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McGuire MK, Nunn M. Evaluation of Human Recession Defects Treated with Coronally Advanced Flaps and Either Enamel Matrix Derivative or Connective Tissue. Part 1: Comparison of Clinical Parameters. J Periodontol 2003; 74:1110-25. [PMID: 14514224 DOI: 10.1902/jop.2003.74.8.1110] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recession defects around teeth have been treated with a variety of surgical techniques. Most of the literature suggests that the subepithelial connective tissue graft has the highest percentage of mean root coverage with the least variability. Previous studies have demonstrated that enamel matrix derivative (EMD) has the ability to improve clinical parameters. The purpose of this study was to compare the clinical efficacy of enamel matrix derivative placed under a coronally advanced flap to subepithelial connective tissue placed under a coronally advanced flap in patients with recession type defects. METHODS Twenty patients with incisors or premolars presenting with a facial recession of > or = 4 mm in contralateral quadrants of the same jaw were treated; 17 patients completed the study. One tooth in each patient was randomized to receive either a coronally advanced flap with a subepithelial connective tissue graft (control) or a coronally advanced flap with EMD (test). Clinical parameters measured at baseline and at 6, 9, and 12 months included amount of recession; width at the coronal extent of the gingival defect; width of keratinized tissue; probing depth; clinical attachment level; inflammation score; plaque score; plaque index; alveolar bone level; tissue texture and color; and patient perception of pain, bleeding, swelling, and sensitivity. RESULTS Results for both the test and control groups were similar for all measured clinical parameters with the exception of early healing, self-reported discomfort, and the amount of keratinized tissue obtained. The coronally advanced flap with EMD was superior to the subepithelial connective tissue graft with regard to early healing and patient-reported discomfort, whereas the subepithelial connective tissue graft demonstrated greater amount of keratinized tissue during the 12-month evaluation period. However, both the test and control showed a significant increase in the amount of keratinized tissue at 9 and 12 months compared to baseline. No significant difference in the amount of root coverage was found between the test and control groups (n = 19; P = 0.82). On average, a gain of 4.5 mm (range 4 to 8 mm) tissue covering the previously exposed root surfaces was achieved with both treatment groups. The average percentages of root coverage for control and test groups were 93.8% and 95.1%, respectively. One hundred percent root coverage was obtained 89.5% of the time with the coronally advanced flap with EMD and 79% of the time with the subepithelial connective tissue graft. CONCLUSION Based on the results of this investigation, the addition of EMD to the coronally advanced flap resulted in root coverage similar to the subepithelial connective tissue graft but without the morbidity and potential clinical difficulties associated with the donor site surgery.
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Affiliation(s)
- Michael K McGuire
- Department of Periodontics, University of Texas, Dental Branch Houston and Health Science Center at San Antonio, TX, USA.
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McGuire MK, Cochran DL. Evaluation of Human Recession Defects Treated with Coronally Advanced Flaps and Either Enamel Matrix Derivative or Connective Tissue. Part 2: Histological Evaluation. J Periodontol 2003; 74:1126-35. [PMID: 14514225 DOI: 10.1902/jop.2003.74.8.1126] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A number of surgical procedures are effective in covering denuded root surfaces. The first paper in this series evaluated the subepithelial connective tissue graft and the coronally advanced flap with enamel matrix derivative (EMD). That paper revealed no significant difference in the percent of root coverage between the two treatments (P = 0.82). There is limited human histological evidence of the type of attachment achieved with these types of procedures. This paper presents a human case report detailing the histological nature of the attachment of these two treatments to the root surfaces previously exposed by recession. METHODS One patient presented with two hopeless teeth that were randomized to receive either a subepithelial connective tissue graft or a coronally advanced flap plus EMD. The surgery was accomplished in accordance to the protocol previously described. The teeth and a small collar of tissue were removed at 6 months and underwent histological analysis. RESULTS Histological evaluation of the subepithelial connective tissue graft revealed a connective tissue attachment between the tooth and graft, and no histological evidence of cementum, bone, or periodontal ligament (PDL) and, therefore, regeneration. In addition, there appeared to be some resorption of the dentin adjacent to the graft. Histological evaluation of the coronally advanced flap with EMD revealed new cementum, organizing PDL fibers and islands of condensing bone at a constant distance from the root surface. CONCLUSIONS The subepithelial connective tissue graft in this study was found to have adhered to the root surface primarily by a connective tissue attachment with some evidence of root resorption. The coronally advanced flap with EMD was found histologically to have all the tissues necessary for regeneration: new cementum, organizing PDL fibers, and islands of condensing bone. These histologic sections strongly suggest that enamel matrix derivative works in a biomimetic fashion by mimicking the natural process of tooth development.
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Affiliation(s)
- Michael K McGuire
- Department of Periodontics, University of Texas, Dental Branch Houston and Health Science Center at San Antonio, TX, USA.
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Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 2003; 29 Suppl 3:178-94; discussion 195-6. [PMID: 12787218 DOI: 10.1034/j.1600-051x.29.s3.11.x] [Citation(s) in RCA: 276] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The evidence for the efficacy of periodontal plastic surgery (PPS) in the treatment of recession defects has not yet been systematically evaluated. The objective of this review was to systematically review the efficacy of PPS in achieving root coverage in the treatment of localized gingival recession. The following surgical procedures have been considered in this review: guided tissue regeneration (GTR), free gingival graft (FGG), connective tissue graft (CTG), and coronally advanced flap (CAF). METHODS Randomized and controlled trials, as well as case series of at least 6 months' follow-up, were searched. Data sources included electronic databases and hand-searched journals. Screening, data abstraction and quality assessment were conducted independently and in duplicate. RESULTS Regarding recession reduction, a limited but statistically significant greater benefit was found for CTG compared with GTR (weighted mean difference: 0.43 mm, 95% CI: 0.62-0.23). No differences were found comparing either GTR with CAF or resorbable versus non-resorbable GTR barriers. Gain in attachment was also similar for each of the three comparisons. Analysis of single arms of trials and case series demonstrated that PPS can have a marked improvement on clinical parameters but heterogeneity was often high and only partly explained by initial defect depth. CONCLUSIONS Overall, PPS was effective in reducing gingival recessions with a concomitant improvement in attachment levels. Even though no single treatment can be considered superior to all the others, CTG was statistically significantly more effective than GTR in recession reduction. Further research is needed to identify the factors most associated with successful outcomes.
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Clauser C, Nieri M, Franceschi D, Pagliaro U, Pini-Prato G. Evidence-based mucogingival therapy. Part 2: Ordinary and individual patient data meta-analyses of surgical treatment of recession using complete root coverage as the outcome variable. J Periodontol 2003; 74:741-56. [PMID: 12816306 DOI: 10.1902/jop.2003.74.5.741] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The literature (1970-2000) on the outcome of surgical root coverage has been revised and summarized in a companion paper. The overall conclusion was that the various procedures are effective, but it was not possible to determine which procedure was best indicated in different clinical conditions. In this study, meta-analysis techniques were used to seek evidence for guiding clinical decisions when planning root coverage surgery. The aim of this study was to illustrate the differences between meta-analyses applied to summarized and individual patient data (IPD) and to present suggestions for reducing the costs of IPD meta-analysis. METHODS Only clinical trials and case series that included data on the number of teeth treated, baseline recession depth (BRD) and the proportions of postoperative complete root coverage (CRC) were considered. The first group of meta-analyses (the outcome of each procedure based on summarized data) covered 65 studies dealing with coronally advanced flap (CAF), epithelial free gingival graft (EFGG), connective tissue graft (CTG), and guided tissue regeneration (GTR) procedures. The second group of meta-analyses was done to determine the outcome of each procedure on the basis of 26 studies that reported IPD for at least baseline recession depth (BRD) and final CRC for each site. The third group of meta-analysis compared the outcomes of CTG and GTR in 5 randomized studies, 4 of which reported only summarized data. RESULTS The first analysis showed that CRC was achieved more often in non-randomized than in randomized studies. The heterogeneity tests revealed great variability of results in both the randomized and non-randomized studies, which makes it difficult to draw any definite conclusions. In the second analysis all the tested techniques revealed similar trends: greater baseline recession depths were always associated with a decreased CRC. The third analysis showed that CRC was achieved more frequently in the sites treated with CTG as opposed to GTR. The small sample size and the lack of IPD rendered the analyses inconclusive despite the randomized design. CONCLUSIONS Few studies reported individual patient data; they are a valuable contribution to clinical decision making, but IPD published in the literature are still insufficient to provide a reliable guide for clinical decision making. Therefore, decisive steps should be taken to facilitate the publication of IPD, in electronic format, whenever a clinical study is published in a leading journal.
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Affiliation(s)
- Carlo Clauser
- Accademia Toscana Ricerca Odontostomatologica (ATRO), Florence, Italy
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Pagliaro U, Nieri M, Franceschi D, Clauser C, Pini-Prato G. Evidence-based mucogingival therapy. Part 1: A critical review of the literature on root coverage procedures. J Periodontol 2003; 74:709-40. [PMID: 12816305 DOI: 10.1902/jop.2003.74.5.709] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Systematic reviews of the literature are an increasingly important tool for providing evidence-based guidance to the practitioner. This review article and a companion paper deal with the surgical coverage of exposed root surfaces, but their aim is to promote a more up-to-date way of writing and publishing scientific articles in this field. This article presents the published data about surgical root coverage in table form and its aim is to identify updated minimum standards for data presentation. METHODS Manual and computer-assisted searches were conducted to find the articles published on this topic during the 30-year period from 1970 to 2000. Articles that described the surgical procedure and reported at least the number of treated recessions and the duration of the follow-up, including case series, controlled studies, and randomized trials were selected and data were arranged in tables. RESULTS Only 90 of the 290 articles that dealt with root coverage met the entry criteria; 25 of these were found only through manual searching. The overall clinical outcomes of different techniques appear to be satisfactory, but the published evidence is of little help in deciding which procedure is best suited for each clinical situation. Only a more homogeneous way of collecting and reporting clinical data and especially outcome measures will allow for an effective reanalysis which could help in everyday clinical decision making. Perhaps studies should be carried out and presented keeping in mind that the published results of sound clinical studies will, sooner or later, be reviewed and compared with other studies. CONCLUSION A standard format with minimum requirements for data collection and presentation should be established and imposed by international journals in order to provide readers and researchers with more useful information.
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Lee YM, Kim JY, Seol YJ, Lee YK, Ku Y, Rhyu IC, Han SB, Choi SM, Chung CP. A 3-year longitudinal evaluation of subpedicle free connective tissue graft for gingival recession coverage. J Periodontol 2002; 73:1412-8. [PMID: 12546090 DOI: 10.1902/jop.2002.73.12.1412] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this study was to longitudinally evaluate, over a 3-year period, the reduction of gingival recession through use of a subepithelial free connective tissue graft placed under a coronally advanced partial-thickness pedicle flap. METHODS Twenty-one buccal recession defects (mean 3.67 mm; range 3 to 4.5 mm; Miller Class I, II, and III) in 15 patients were treated using this technique. Amount of gingival recession (GR), clinical attachment loss (CAL), and width of keratinized gingiva (WKG) were followed for 3 years after surgery. The measurements were performed at presurgery, and 1, 3, 6, 12, 18, 24, and 36 months postsurgery. RESULTS GR decreased from 3.67 +/- 0.58 mm at baseline to 0.33 +/- 0.43 mm at 36 months, representing a reduction of 3.33 mm, corresponding to 91.28% mean root coverage. CAL was significantly decreased at 36 months from 5.26 +/- 0.77 mm to 2.14 +/- 0.57 mm. At 36 months, 3.12 mm of attachment gain was obtained. WKG significantly increased after 36 months (1.95 mm). GR, CAL, and WKG had the most positive outcomes at 12 months and were maintained at stable levels throughout the 36-month observation period. CONCLUSIONS These results indicate that the connective tissue graft with a partial thickness coronal advancement pedicle is a predictable method for root coverage and, provided that optimal maintenance care is provided, the clinical outcomes gained by this technique can be well maintained.
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Affiliation(s)
- Yong-Moo Lee
- Department of Periodontology and BK21HLS, College of Dentistry, Seoul National University, Seoul, Korea
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Tal H, Moses O, Zohar R, Meir H, Nemcovsky C. Root coverage of advanced gingival recession: a comparative study between acellular dermal matrix allograft and subepithelial connective tissue grafts. J Periodontol 2002; 73:1405-11. [PMID: 12546089 DOI: 10.1902/jop.2002.73.12.1405] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acellular dermal matrix allograft (ADMA) has successfully been applied as a substitute for free connective tissue grafts (CTG) in various periodontal procedures, including root coverage. The purpose of this study was to clinically compare the efficiency of ADMA and CTG in the treatment of gingival recessions > or = 4 mm. METHODS Seven patients with bilateral recession lesions participated. Fourteen teeth presenting gingival recessions > or = 4 mm were randomly treated with ADMA or CTG covered by coronally advanced flaps. Recession, probing depth, and width of keratinized tissue were measured preoperatively and 12 months postoperatively. Changes in these clinical parameters were calculated within and compared between groups and analyzed statistically. RESULTS Baseline recession, probing depth, and keratinized tissue width were similar for both groups. At 12 months, root coverage gain was 4.57 mm (89.1%) versus 4.29 mm (88.7%) (P = NS), and keratinized tissue gain was 0.86 mm (36%) versus 2.14 mm (107%) (P < 0.05) for ADMA and CTG, respectively. Probing depth remained unchanged (0.22 mm/0 mm), with no difference between the groups. CONCLUSIONS Recession defects may be covered using ADMA or CTG, with no practical difference. However, CTG results in significantly greater gain of keratinized gingiva.
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Affiliation(s)
- Haim Tal
- Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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MAHN DOUGLASH. Esthetic Correction of Gingival Recession Using a Modified Tunnel Technique and an Acellular Dermal Connective Tissue Allograft. J ESTHET RESTOR DENT 2002. [DOI: 10.1111/j.1708-8240.2002.tb00143.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cordioli G, Mortarino C, Chierico A, Grusovin MG, Majzoub Z. Comparison of 2 techniques of subepithelial connective tissue graft in the treatment of gingival recessions. J Periodontol 2001; 72:1470-6. [PMID: 11759857 DOI: 10.1902/jop.2001.72.11.1470] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The clinical outcome of connective tissue grafts in the treatment of gingival recessions has been documented in numerous studies. However, no attempt has been made to correlate the postoperative mucogingival changes with the surgical parameters. The present retrospective clinical study was undertaken to 1) evaluate root coverage and mucogingival changes 1 to 1.5 years following treatment of Miller's Class I and II recession defects using 2 variants of the subepithelial connective tissue graft (SCTG) procedure, and 2) assess the effect of the surgical parameters on the postoperative gingival width. METHODS Thirty-one recessions in 10 patients treated with the envelope technique (E) and 31 recessions in 11 patients treated with coronally positioned flap combined with connective tissue graft (CP) were retrospectively analyzed to evaluate: 1) percentage of root coverage obtained with the 2 procedures and variations in width of keratinized tissue (KT) 1 to 1.5 years postsurgery, and 2) the effect of the surgical parameters on the postoperative gingival width. RESULTS Results showed a mean root coverage percentage of 89.6 +/- 15% for the E group and 94.7 +/- 11.4% for the CP group; the difference between groups was statistically insignificant (P = 0.1388). Mean KT increased significantly from 1.4 +/- 1.1 mm presurgery to 4.5 +/- 1.1 mm postsurgery for the E group while a minor increase in KT was observed in the CP group (2 +/- 1.5 mm presurgery versus 2.7 +/- 1.6 mm postsurgery). For both treatment groups, the mean postsurgical width of keratinized tissue (POSTKT) was found to be mathematically correlated with the mean presurgical width of keratinized tissue (PREKT) and the corono-apical height of the graft that remained exposed (GE) coronal to the flap margin in the recipient site. CONCLUSIONS Treatment of human gingival recession defects by the 2 variants of SCTG resulted in significant recession reduction. When SCTG is grafted beneath alveolar mucosa using the combined technique (CP), transformation of the mucosa into keratinized tissue does not seem to occur, at least within 1 to 1.5 years postsurgery. The treatment outcome in terms of keratinized tissue width seems to be correlated with the presurgical gingival dimensions and the height of the graft that remains exposed at the end of the surgical procedure.
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Affiliation(s)
- G Cordioli
- Department of Periodontology, University of Padova, Institute of Clinical Dentistry, Italy
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Affiliation(s)
- P Bouchard
- Department of Periodontology, Service d'Odontologie, Paris 7-Denis Diderot University, Paris, France
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Saletta D, Pini Prato G, Pagliaro U, Baldi C, Mauri M, Nieri M. Coronally advanced flap procedure: is the interdental papilla a prognostic factor for root coverage? J Periodontol 2001; 72:760-6. [PMID: 11453238 DOI: 10.1902/jop.2001.72.6.760] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study was designed to verify if the dimension of the interdental papilla may be a prognostic factor for the clinical outcome of the coronally advanced flap (CAF) in the treatment of gingival recessions. METHODS Thirty-three Miller Class I recessions were treated in 33 patients using the CAF procedure. Two types of measurements were performed: 1) clinical measurements (probing depth, recession depth, width of keratinized tissue, clinical attachment level) were recorded at baseline and 3 months after surgery and 2) all recessions were photographed and transformed into computer images. A specific software allowed recording of both linear and square measurements. The following digital measurements were recorded at baseline: 1) base, height, and area of the mesial and distal papillae adjacent to the involved tooth and 2) width/depth of the recession and the area of the exposed root surface of the involved tooth. The residual recession area, if any, was recorded 3 months after surgery. The digital measurements of the height and of the area of the papilla were used in statistical analysis (multiple linear regression and logistic regression) to evaluate a possible correlation with root coverage (mm2) and/or with complete root coverage. RESULTS Root coverage was not significantly correlated to the papilla area (P= 0.3692) or to papilla height (P= 0.0968). The complete root coverage was not correlated to the papilla area (P= 0.3181), but it was correlated to papilla height (P= 0.0499). CONCLUSIONS This study indicates that the root coverage following CAF procedure is not significantly correlated to papilla dimension. However, complete root coverage is significantly more frequent in sites with lower height of the adjacent papilla.
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Henderson RD, Greenwell H, Drisko C, Regennitter FJ, Lamb JW, Mehlbauer MJ, Goldsmith LJ, Rebitski G. Predictable multiple site root coverage using an acellular dermal matrix allograft. J Periodontol 2001; 72:571-82. [PMID: 11394391 DOI: 10.1902/jop.2001.72.5.571] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The primary aim of this randomized, controlled, blinded clinical investigation was to determine if orientation of an acellular dermal matrix (ADM) allograft, basement membrane side against the tooth or connective tissue side against the tooth, affected the percent root coverage. Additional aims were to: 1) compare results of this study with results obtained from other root coverage studies; 2) determine if multiple additional sites could be successfully covered with the same surgery; 3) determine the effect of the procedure on keratinized tissue; and 4) evaluate the amount of creeping attachment obtained. METHODS Ten patients with 2 Miller Class I or II buccal recession defects > or =3 mm were treated with a coronally positioned flap plus ADM and followed for 12 months. Test sites received ADM with the basement membrane side against the root (AB), while the control sites received the connective tissue side against the root (AC). Multiple additional recession sites were treated with the same flap procedure. RESULTS Mean baseline recession for the AB sites was 4.2 mm and for the AC sites, 3.7 mm. Mean root coverage of 95% was obtained for both AB and AC sites. Sixty-eight additional Class I or II AB and AC sites obtained about 93% root coverage. The mean increase in keratinized tissue for both treatments was 0.80 mm. No additional root coverage was gained due to creeping attachment between 2 and 12 months. CONCLUSIONS Treatment with ADM was an effective and predictable procedure for root coverage. The orientation of the material did not affect the treatment outcome for any of the parameters tested.
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Affiliation(s)
- R D Henderson
- School of Dentistry, University of Louisville, KY 40292, USA
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Modica F, Del Pizzo M, Roccuzzo M, Romagnoli R. Coronally advanced flap for the treatment of buccal gingival recessions with and without enamel matrix derivative. A split-mouth study. J Periodontol 2000; 71:1693-8. [PMID: 11128916 DOI: 10.1902/jop.2000.71.11.1693] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The coronally advanced flap (CAF) is a predictable method for achieving root coverage in buccal gingival recessions. The use of enamel matrix derivative (EMD) has already been tested in treating intrabony defects. No clinical comparative study has been published evaluating the CAF in combination with EMD in treating buccal gingival recessions. METHODS This split-mouth study was performed to assess the efficacy of EMD to improve the results of a root coverage procedure. Fourteen pairs of Miller Class I and II bilateral comparable defects were selected in 12 patients. In each patient, one site was randomly assigned to the test group and the contralateral site to the control group. The treatment consisted of a CAF procedure with (test) or without (control) EMD. Gingival recession (REC), clinical attachment level (CAL), probing depth (PD), and extension of keratinized tissue (KT) were recorded at baseline and 6 months postsurgery. RESULTS The average initial REC was 3.71 mm (SD +/- 1.68) for the test group, and 3.50 mm (SD +/- 1.56) for the control group. The 2 groups were statistically homogeneous. The mean root coverage was 3.36 mm (SD +/- 1.55), corresponding to a value of 91.2% for the test group, and 2.71 mm (SD +/- 1.20), equal to 80.9% for the control group. The differences between the 2 groups were not statistically significant. The mean CAL gain was 3.57 mm (SD +/- 1.55) for the test group and 2.79 mm (SD +/- 1.19) for the control group. No changes of PD and KT were found. CONCLUSIONS This study suggests that EMD does not seem to significantly improve the clinical outcomes of gingival recession treated by means of CAF, even though the test group showed slightly better results in terms of root coverage and CAL. Further studies with a larger number of teeth and higher statistical power are needed to support this conclusion.
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Affiliation(s)
- F Modica
- Department of Periodontology, School of Dental Medicine, University of Torino, Italy
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Boltchi FE, Allen EP, Hallmon WW. The use of a bioabsorbable barrier for regenerative management of marginal tissue recession. I. Report of 100 consecutively treated teeth. J Periodontol 2000; 71:1641-53. [PMID: 11063399 DOI: 10.1902/jop.2000.71.10.1641] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Periodontal plastic surgical procedures aimed at coverage of exposed root surfaces have evolved into routine treatment modalities. The present study was designed to assess the effectiveness and the predictability of a bioabsorbable barrier in the treatment of human recession defects utilizing a single-step surgical procedure. METHODS One hundred consecutive single and multiple adjacent Miller Class I, II, and III buccal recession defects in 41 patients were treated with a combination of a bioabsorbable barrier and coronally advanced flap technique. Clinical parameters were recorded immediately prior to surgery, at 3 months, and after a minimum of 6 months. RESULTS A highly significant reduction in recession depth from a mean value of 3.2 +/- 0.9 mm preoperatively to 0.3 +/- 0.5 mm postoperatively, corresponding to a mean root coverage of 92. 7% +/- 14.1%, was obtained. Complete (100%) root coverage was obtained in 75% of the sites. Factors adversely affecting root coverage were membrane exposure postoperatively and preoperative recession depth > or =4 mm. In addition, inferior results were achieved at mandibular incisor and maxillary molar sites. Factors having no effect on root coverage included maxillary versus mandibular sites and single versus multiple adjacent sites. CONCLUSIONS The use of guided tissue regeneration in periodontal plastic surgery is highly predictable, and highly esthetic root coverage can be gained without requiring a second surgical procedure or a second surgical site and is, therefore, an attractive alternative to conventional grafting techniques.
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Affiliation(s)
- F E Boltchi
- Department of Periodontics, Baylor College of Dentistry, Texas A&M University System, Dallas, USA.
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Tal H. Subgingival acellular dermal matrix allograft for the treatment of gingival recession: a case report. J Periodontol 1999; 70:1118-24. [PMID: 10505815 DOI: 10.1902/jop.1999.70.9.1118] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Root coverage procedures using subgingival soft tissue grafts or guided tissue regeneration have attracted much interest within the past 2 decades. Recently, acellular dermal matrix allograft (ADMA) has been introduced as a substitute for palatal donor tissue in gingival augmentation procedures. This study was undertaken to examine the potential of ADMA to be used as a substitute for autogenous connective tissue graft material in a root coverage procedure in a case with moderate gingival recession combined with reduced keratinized attached gingiva. After thorough root planing and conditioning of the root surface with a saturated solution of tetracycline-HCl, a trapezoidal mucoperiosteal flap was raised and the papillae were de-epithelialized. The exposed bone surrounding the exposed root surface was perforated with a No. 2 round drill, and the exposed root and surrounding bone were covered by ADMA. The allograft was stabilized by 5-0 vicryl sutures. The flap was coronally positioned to completely cover the ADMA. Healing was uneventful. Eight-month observations and measurements showed root coverage of more than 3.5 mm (>80%), a gingival margin that was harmonious with the neighboring teeth, and an increase of the zone of keratinized attached gingiva, from 1 to 3 mm. Within the limitations of these clinical observations, it is suggested that ADMA may be a possible substitute to free autogenous connective tissue grafts and/or bioabsorbable barrier membranes. Further clinical and histological studies are necessary to understand the healing process of this surgical wound.
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Affiliation(s)
- H Tal
- Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel
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Müller HP, Stahl M, Eger T. Root coverage employing an envelope technique or guided tissue regeneration with a bioabsorbable membrane. J Periodontol 1999; 70:743-51. [PMID: 10440635 DOI: 10.1902/jop.1999.70.7.743] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Different treatment modalities have been described for root coverage in cases of gingival recession. The aim of the present study was to evaluate the postsurgical outcome of 2 modes of surgical root coverage of predominantly shallow, Class I or II, gingival recessions. METHODS Fourteen buccal recession sites in 13 patients were treated with free connective tissue grafts employing a modified envelope technique; 14 sites in 9 patients were subjected to a coronally repositioned flap in combination with a bioabsorbable membrane. Immediately before surgery as well as after 6 months, gingival dimensions, i.e., width and thickness, as well as root coverage and attachment gain, were assessed to the next 0.1 mm employing a caliper, an ultrasonic device, and a pressure calibrated, computerized periodontal probe. RESULTS At the outset, mean recession depths amounted to 2.48+/-1.06 and 3.00+/-1.95 mm for patients treated with a free connective tissue graft and a bioabsorbable membrane, respectively. With the former technique, 80+/-24% root surface could be covered after 6 months, while the latter resulted in only 45+/-40% coverage. The contrast in reduction of recession width was even more pronounced (77+/-35% versus 18+/-37%). In both groups, an increase of gingival thickness of 0.6 to 0.7 mm was noticed. CONCLUSIONS Small recessions may be covered more predictably with the modified envelope technique. 751.
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Affiliation(s)
- H P Müller
- Department of Operative Dentistry and Periodontology, University of Heidelberg, Germany
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Abstract
Surgical treatment of gingival recession defects aims at obtaining soft tissue coverage of exposed root surfaces and/or augmentation of gingival tissue dimensions. A variety of protocols have been developed to manage these clinical problems. Since one goal of periodontal therapy is the regeneration of the lost attachment apparatus of the tooth, full restoration of defect should be accomplished following mucogingival procedures. This implies regeneration of all periodontal structures, including formation of new cementum with inserting connective tissue fibers, alveolar bone regeneration and recreation of a functional and aesthetic morphology of the mucogingival complex. Animal and human histological studies have shown that healing at gingiva-root interface following pedicle flaps or free soft tissue grafts generally includes a long junctional epithelium with varying amounts of a new connective tissue attachment in the most apical aspect of the covered root surface. Limited bone regeneration has been observed. Adjunctive use of root conditioning agents and cell excluding, wound-stabilizing devices may amplify regenerative outcomes. Changes in the amount of keratinized tissue, which can significantly affect the aesthetic outcome of treatment, have been shown to depend on the interactions among various tissues involved in the healing process and the selected surgical procedure.
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Affiliation(s)
- L Trombelli
- Department of Periodontology, School of Dentistry, University of Ferrara, Italy
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Jepsen K, Heinz B, Halben JH, Jepsen S. Treatment of gingival recession with titanium reinforced barrier membranes versus connective tissue grafts. J Periodontol 1998; 69:383-91. [PMID: 9579626 DOI: 10.1902/jop.1998.69.3.383] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
It was the aim of this study to compare barrier membrane therapy with connective tissue grafts in the treatment of recession defects. Fifteen patients with 2 paired vestibular recession defects participated in the study. After thorough scaling and root surface conditioning with tetracycline-HCl, defects were randomly assigned to 1 of 2 treatment modalities. In one of the defects, a trapezoidal mucoperiosteal flap was prepared, and a titanium reinforced expanded polytetrafluoroethylene membrane was adapted to the defect and secured by a sling suture. The membrane was subsequently covered by a coronally positioned flap secured with crown attached sutures. The other defect was treated with a connective tissue graft employing the "envelope technique." Twelve months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. Gingival recession decreased from 3.6+/-0.7 mm to 0.5+/-0.5 mm for membrane treated defects and from 3.6+/-1.0 mm to 0.5+/-0.5 mm following use of grafts, corresponding to mean root coverages of 87.1% and 86.9%, respectively. Mean gains of keratinized tissue of 1.5 mm (membrane) and 2.5 mm (graft) could be observed. Thus, the results of this study demonstrate that both titanium reinforced barrier membranes and connective tissue grafts can be successfully used to treat periodontal recession defects.
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Affiliation(s)
- K Jepsen
- Department of Periodontology, School of Dentistry, Kiel University, Germany
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Affiliation(s)
- J L Wennström
- Department of Periodontology, School of Dentistry, Uníversity of Göteborg. Sweden
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Jendresen MD, Allen EP, Bayne SC, Donovan TE, Hansson TL, Klooster J, Kois JC. Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 1994; 72:39-77. [PMID: 8083840 DOI: 10.1016/0022-3913(94)90214-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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