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Poornima R, Meena A. Contemporary minimally invasive VISTA approach for gingival recession coverage: a case series. GENERAL DENTISTRY 2021; 69:58-61. [PMID: 33350957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Gingival recession is a common problem that requires periodontal surgery to restore esthetics. The vestibular incision subperiosteal tunnel access (VISTA) technique is a minimally invasive recession coverage method that has gained popularity. This case series reviews the treatment outcomes in 10 patients with a total of 28 Miller Class I or Class II recession defects in the maxillary anterior region. The defects were treated with the VISTA technique alone without any grafting material. The clinical parameters measured at baseline and at 3- and 6-month follow-up examinations were probing depth, clinical attachment level, Gingival Index, width and thickness of attached gingiva, and height of gingival recession. Statistical analysis (repeated-measures analysis of variance with a post hoc Bonferroni test) revealed that all clinical parameters except probing depth and thickness of attached gingiva showed statistically significant improvement from baseline to the follow-up examinations (P < 0.001). A mean root coverage of 78.99% was achieved. Even when performed without any grafting material, the VISTA technique is a reliable method to obtain recession coverage in the maxillary anterior region.
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Post-Orthodontic Lower Incisors Recessions: Combined Periodontic and Orthodontic Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218060. [PMID: 33147692 PMCID: PMC7663667 DOI: 10.3390/ijerph17218060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022]
Abstract
The bonded lingual retainer (BLR) is considered a favorable choice for retaining lower incisors’ alignment post-orthodontic treatment; however, it may cause some unwanted effects such as inadvertent tooth movement and torque changes. These often result in gingival recession (Miller class III-type) with exposure of the root surface, which compromises the esthetics and hinders the comfort of the patient. Fifteen post-orthodontic patients presenting Miller class III-type recessions with BLR were examined. Two protocols were used: the first included the removal of the BLR prior to surgery and the second included only a surgical approach. All patients underwent the same surgery of a modified tunnel double papilla procedure for root coverage. The gingival recession was measured using a dental probe before, and three to six months post-surgery. The average improvement in recession depth was significantly greater (p = 0.008) for the protocol that included removal of the BLR (4.0 ± 0.83 mm) with an improvement of 87.2% as compared to the second protocol that showed an improvement of 43.8% (1.88 ± 1.29 mm). Removing the BLR prior to surgery is beneficial for predictable root coverage in post-orthodontic Miller class III recessions.
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Cosgarea R, Miron R, Bora R, Rosu A, Buduru S, Sculean A. Long-term results after treatment of multiple adjacent gingival recessions with the modified coronally advanced tunnel and a porcine acellular dermal matrix. QUINTESSENCE INTERNATIONAL (BERLIN, GERMANY : 1985) 2020; 52:32-44. [PMID: 32901241 DOI: 10.3290/j.qi.a45171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
<p>Objective: To evaluate the long-term clinical results after treatment of multiple adjacent recession type (RT) I and II gingival recessions treated with the modified coronally advanced tunnel (MCAT) in conjunction with a porcine acellular dermal matrix (PADM).<br /> Method and materials: Nine periodontally healthy nonsmoking patients (seven women, 37.5 ± 7.36 years old) with a total of 41 adjacent RT I (n = 23) and RT II (n = 18) gingival recessions exhibiting a minimum depth of 2 mm were treated by means of MCAT+PADM. Recession depth and width, width of attached and keratinized tissue, probing depths, and clinical attachment level were measured at baseline and at 1 and 4 years postsurgically. The primary outcome variable was complete root coverage (ie 100% root coverage), while secondary outcomes were mean root coverage and increase in keratinized tissue and attached gingiva widths.<br /> Results: At 1 and 4 years, statistically highly significant (P < .001) root coverage was obtained in all nine patients compared to baseline. Mean root coverage decreased in these nine patients from 72.05 ± 30.18% at 1 year to 56.79 ± 27.53% at 4 years. Complete root coverage was obtained in 18 gingival recessions at 1 year (baseline RT: 12 RT I, 6 RT II) and in seven gingival recessions (5 RT I, 2 RT II) at 4 years. Most root coverage occurred in the first year postsurgically, showing a statistically significant decrease between the first and fourth year (P = .003). Mean width of attached gingiva increased statistically significantly (P < .05) from 2.85 ± 1.08 mm to 3.14 ± 1.08 mm at 1 year with a statistically significant decrease at 4 years. At 1 year, 78.05% of gingival recessions showed a root coverage > 50%, and 68.29% still exhibited a root coverage > 50% at 4 years.<br /> Conclusion: The use of MCAT+PADM represents a valuable treatment option for multiple adjacent maxillary and mandibular RT I and II gingival recessions on a long-term basis.</p>.
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Wan W, Zhong H, Wang J. Creeping attachment: A literature review. J ESTHET RESTOR DENT 2020; 32:776-782. [PMID: 32896991 DOI: 10.1111/jerd.12648] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/06/2020] [Accepted: 08/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Mucogingival surgery has been widely applied in clinics. An interesting phenomenon after mucogingival surgery is the coronal migration of gingival margin, which is described as "creeping attachment." The goal of this review is to summarize the characteristics, significance, mechanism, and manifestation of the creeping attachment after mucogingival surgery and to describe the factors associated with its occurrence. OVERVIEW A total of 82 relevant articles were included in the literature review. The characteristics and significance of the creeping attachment after mucogingival surgery were analyzed. The mechanism of the creeping attachment was explored. Different manifestations of and factors associated with creeping attachment were summarized. CONCLUSIONS Creeping attachment may occur to obtain additional root coverage after the healing of various mucogingival surgeries. However, this coverage is not always complete nor entirely predictable. CLINICAL SIGNIFICANCE Creeping attachment plays an important role in the prognosis of mucogingival surgeries. This review will help clinicians get a thorough recognition and understanding of this phenomenon.
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Carranza N, Rojas MA. Bilaminar Palatal Connective Tissue Grafts Obtained With the Modified Double Blade Harvesting Technique: Technical Description and Case Series. Clin Adv Periodontics 2020; 10:186-194. [PMID: 32862553 DOI: 10.1002/cap.10124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/08/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The purpose of this case series is to present a technique to harvest palatal connective tissue grafts (CTGs) that concurrently provides several advantages over previously described techniques when applied to treat gingival recessions. CASE SERIES Twenty patients were treated with root coverage procedures using CTGs harvested with the modified double blade harvesting technique (MDBHT). A double blade knife with two surgical blades set 1 mm apart was used in this case series. The palatal connective tissue was accessed through a horizontal incision and an envelope flap that was closed by primary intention. The grafts were measured immediately after harvesting with a periodontal probe. The overall mean length was 28.8 ± 7.8 mm and graft thickness was homogeneous and near to 1 mm in all the cases. Graft mean apicocoronal height was 5.0 ± 0.8 mm and 5.3 ± 1 mm at the molar and premolar levels, respectively. Clinical wound healing was evaluated at 7 days post-surgically and showed a modified early-wound healing index mean value of 3.0 ± 1.0. CONCLUSIONS The introduced MDBHT consistently rendered grafts of uniform thickness and sufficient dimensions, while excluding epithelial tissue and the deeper aspects of the submucosa, thus avoiding rich fatty and glandular tissues. MDBHT allowed for donor site healing with minimal discomfort and without complications.
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Sharma H, Dureja D, Arora R. Re-invigoration of Pink Esthetics by a Novel Minimally Invasive Technique: A Report of Two Cases. Contemp Clin Dent 2020; 10:668-671. [PMID: 32792828 PMCID: PMC7390426 DOI: 10.4103/ccd.ccd_135_19] [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] [Indexed: 11/26/2022] Open
Abstract
The importance of pink esthetics as well as increased patient comfort has been gaining its pace in dentistry. Moreover, when it comes to the treatment of gingival recession, the ideologies of the periodontists have changed over time, i.e., from “extension to prevention;” it has now become “conserve to preserve.” Utilizing this same principle, pinhole technique was introduced comprising sutureless surgery with minimal surgical intervention, thus providing maximum comfort to the patient while undergoing treatment and postoperatively. This article presents a case report of two cases who were treated with a minimally invasive pinhole surgical technique, with complete root coverage and minimal complications.
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Tunnel/Pouch versus Coronally Advanced Flap Combined with a Connective Tissue Graft for the Treatment of Maxillary Gingival Recessions: Four-Year Follow-Up of a Randomized Controlled Trial. J Clin Med 2020; 9:jcm9082641. [PMID: 32823850 PMCID: PMC7466088 DOI: 10.3390/jcm9082641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/22/2020] [Accepted: 07/31/2020] [Indexed: 12/22/2022] Open
Abstract
Background: The long-term stability after soft tissue graft for covering gingival recession remains a pivotal goal for both patient and periodontist. Therefore, the aim of this study was to compare the four-year outcomes of the coronally advanced flap (CAF) versus the pouch/tunnel (POT) technique, both combined with connective tissue graft (CTG), for gingival recession treatment. Methods: Forty patients were initially randomly assigned to the control group (CAF + CTG; N = 20) and the test group (POT + CTG; N = 20). Clinical outcomes included mean root coverage (MRC) and complete root coverage (CRC), gingival thickness (GT), and keratinized tissue (KT) gain. Esthetic outcomes were also analyzed using the pink esthetic score (PES) and patient-reported outcome measures (PROMs). All outcomes initially assessed at six months were extended to four years post-surgery. Results: No significant differences were observed between the two patient groups in terms of MRC and CRC. At four years, significantly greater GT and KT gain were noted in the POT + CTG group, and tissue texture enhancement was also more prominent in the test group. Conclusions: The POT + CTG technique allows for long-term clinical coverage of gingival recessions comparable to that of the CAF + CTG technique, but it potentially improves gingival thickness, keratinized tissue and esthetic results.
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Holtzman LP, Blasi G, Rivera E, Herrero F, Downton K, Oates T. Gingival Thickness and Outcome of Periodontal Plastic Surgery Procedures: A Meta-regression Analysis. JDR Clin Trans Res 2020; 6:295-310. [PMID: 32718265 DOI: 10.1177/2380084420942171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the impact of soft tissue thickness (STT) on root coverage achieved with different periodontal plastic surgery procedures. BACKGROUND Gingival recession has been managed successfully through various surgical approaches, with great variability in outcomes. Anatomic characteristics of the recipient site and selected technique account in part for this variability. Gingival flap thickness is one of the most critical site-related characteristics. METHODS An electronic search was conducted on the major databases (PubMed, Embase, Web of Science). Human prospective studies with at least 6 mo of follow-up and with a numeric baseline measurement for gingival thickness were eligible. Only studies including nonsmoking patients were considered. Variables included surgical approach, participant characteristics, local anatomic factors, and follow-up time. Primary outcome was mean percentage root coverage (%RC) achieved, and complete root coverage was a secondary outcome. RESULTS A total of 42 studies were included (35 randomized controlled trials, 5 case series, 1 prospective cohort study, and 1 controlled clinical trial). Across studies, the pooled %RC was 81.9% (95% CI, 79.1% to 84.7%). The %RC was not significantly associated (P = 0.267) with baseline soft tissue thickness; however there was a significant (P = 0.031) inverse relationship between STT and %RC after 12-mo follow-up. Subgroup analysis showed that for no graft, there was a significant (P = 0.025) positive relationship between STT and %RC with the exclusion of the single outlier study based on STT. CONCLUSIONS STT plays a limited role in predicting root coverage across all approaches; when flaps are performed with no graft, the effect of STT is most critical. The length of time following surgery appears to influence outcomes, with 12-mo follow-up offering greater insight. KNOWLEDGE TRANSFER STATEMENT The results of this study can suggest to clinicians which periodontal plastic surgery technique to employ when treating challenging cases. In particular, it can be helpful when selecting the treatment approach to treat thin phenotype sites. This study could help clinicians provide a more appropriate treatment decision in such cases.
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Subbareddy BV, Gautami PS, Dwarakanath CD, Devi PK, Bhavana P, Radharani K. Vestibular Incision Subperiosteal Tunnel Access Technique with Platelet-Rich Fibrin Compared to Subepithelial Connective Tissue Graft for the Treatment of Multiple Gingival Recessions: A Randomized Controlled Clinical Trial. Contemp Clin Dent 2020; 11:249-255. [PMID: 33776351 PMCID: PMC7989760 DOI: 10.4103/ccd.ccd_405_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/16/2020] [Accepted: 05/28/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The aim of this study was to compare the effectiveness of root coverage through vestibular incision subperiosteal tunnel access (VISTA) technique using platelet rich fibrin (PRF) or subepithelial connective tissue graft (SCTG) in multiple gingival recessions. MATERIALS AND METHODS A total of 20 patients with multiple gingival recessions were included, and 10 subjects were randomly allocated to test group (VISTA with PRF) and 10 patients to control group (VISTA with SCTG). Clinical parameters were recorded at baseline, 3 months, and 6 months. Patient's response toward the treatment was also assessed by questionnaire. RESULTS All the clinical parameters in the study have showed better results in test group when compared to control group after a follow up period of 6 months with statistical significance. CONCLUSION The results of the present study suggested that multiple gingival recessions can be successfully treated with both procedures, but better root coverage and a greater increase in keratinized tissue were achieved with the VISTA technique with SCTG. All the patients in both groups felt it was worth undergoing the treatment.
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Barakat H, Dayoub S. Treatment of miller type I and II gingival recession defects using three-dimensional porcine collagen matrix with coronally advanced flap: A randomized clinical split-mouth trial (a 1-year follow-up). Indian J Dent Res 2020; 31:209-216. [PMID: 32436899 DOI: 10.4103/ijdr.ijdr_897_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The main goal of periodontal plastic surgery is obtaining complete root coverage (CRC) and an optimal appearance. Aim The aim of this study was to evaluate the effectiveness of a three-dimensional porcine collagen matrix (PCM) with coronally advanced flap (CAF) in treating of Miller type I and II gingival recession (GR). Materials and Methods Twenty patients were enrolled in this study, presenting 40 Miller type I and II GR. Patients were randomized into test group (PCM + CAF) and control group [connective tissue graft (CTG + CAF)]. Clinical parameters such as recession depth (RD), probing depth, clinical attachment level (CAL), and width of keratinized gingiva (WKG) were evaluated at baseline and 12 months later. Root coverage percentage (RC%) and CRC were assessed at 12 months post surgically. Statistical analysis was performed using independent t-test for intergroup comparison. Statistical significance was set at 0.05. Results The mean RD at 12 months was 0.20 mm for the test group and 0.12 mm for the control group, whereas the mean RC% was 94.22% for PCM + CAF and 96.48% for CTG + CAF. CRC was higher in CTG + CAF with 80%. CAL gain was 2.05 and 2.07 mm in the test and control sites, respectively. The gain of WKG was 1.35 and 1.30 mm in the test and control sites, respectively. Patient esthetic satisfaction at 12 months post surgically in both groups was equivalent. Conclusion Within the limits of this study, using of PCM + CAF in treating GR is a successful and effective treatment option and could serve as an alternative to CTGs.
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Joshi A, Suragimath G, Varma S, Zope SA, Pisal A. Is platelet rich fibrin a viable alternative to subepithelial connective tissue graft for gingival root coverage? Indian J Dent Res 2020; 31:67-72. [PMID: 32246685 DOI: 10.4103/ijdr.ijdr_434_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction One of the most common aesthetic concerns associated with the periodontal tissue is gingival recession. Covering the root surface exposed during the disease process with soft and hard tissue surgeries may decrease these problems. The aim of the study was to compare the clinical outcome of coronally advanced flap (CAF) procedure in root coverage with platelet-rich fibrin (PRF) or subepithelial connective tissue graft (SCTG) for the treatment of Miller's Class-I gingival recession. Materials and Methods The split mouth design consisted of 15 patients with a total of 30 sites with bilateral Miller's Class-I recession on anterior teeth. They were randomly assigned into PRF group (test) or SCTG group (control). Statistical Analysis The values obtained were tabulated and analyzed using Mann--Whitney U-test and repeated measure ANOVA test. All the statistical tests were carried out using SPSS software. Results It was observed that both the autogenous grafts healed without any complications and at the end of 6 months the grafts were stable and recession coverage between 88-100% was achieved. Conclusion CAF procedure with either PRF or SCTG were both effective in the treatment of Miller's Class-I gingival recessions. CAF with SCTG showed better root coverage than CAF with PRF. Use of PRF offered additional benefit of avoiding second surgical site. Therefore, PRF can be considered as a viable alternative to SCTG in certain cases.
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Balderrama ÍDF, Ferreira R, Rezende DRB, Nogueira ALRN, Greghi SLA, Zangrando MSR. Root coverage stability with acellular dermal matrix in multiple gingival recessions in esthetic zone: A clinical case report with 12-year follow-up. J Indian Soc Periodontol 2019; 23:584-588. [PMID: 31849407 PMCID: PMC6906899 DOI: 10.4103/jisp.jisp_582_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The importance of surgical intervention for the maintenance of long-term results by root coverage of multiple gingival recessions in an esthetic area treated with a tissue substitute (acellular dermal matrix [ADM]-Alloderm®) is widely required. The present case report highlights the effectiveness of the ADM for the treatment of multiple recession defects in a female patient with Class I and II gingival recession in relation to maxillary anterior associated with esthetics and dentin hypersensitivity demands. The root coverage rate for the anterior area showed greater value with 70% of coverage; at 90 days and 2 and 12 years of follow-up, it showed 70.5%, 79%, and 77%, respectively. Conversely, for the posterior area, these rates were 68.5%, 63%, and 57% for the same follow-up periods. Results regarding gain of keratinized tissue demonstrated superior values for the anterior area, namely 3.92, 3.34 and 3.22 mm at 90 days and 2 and 12 years. These values for the posterior area were 0.54 mm, 2.41, and 1.87 mm, respectively. These findings suggest that the tissue substitute Alloderm® showed excellent long-term results for areas of multiple recessions, providing root coverage and stability of keratinized tissue gain. After this long period of evaluation, some local factors associated with recurrence of gingival recessions were detected, and a lack of proper periodontal maintenance care was observed. However, esthetic and functional outcomes achieved with surgical procedure were maintained.
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Kroiss S, Rathe F, Sader R, Weigl P, Schlee M. Acellular dermal matrix allograft versus autogenous connective tissue grafts for thickening soft tissue and covering multiple gingival recessions: a 5-year preference clinical study. QUINTESSENCE INTERNATIONAL (BERLIN, GERMANY : 1985) 2019; 50:278-285. [PMID: 30887961 DOI: 10.3290/j.qi.a42160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The present preference clinical trial compared the long-term outcome of acellular dermal matrix allograft (ADMA) versus autogenous connective tissue graft (CTG) in the treatment of gingival recessions. METHOD AND MATERIALS Thirty-nine consecutive patients with 233 Miller Class I and II recessions were treated by one operator (MS) with coronally advanced flaps and in addition either ADMA or CTG harvested from their palate. Clinical parameters were measured by an independent and masked assessor at baseline, 6 months, and 5 years. RESULTS Thirty-two patients could be recruited for long-term examination (seven dropouts). At 6 months and 5 years, all clinical parameters showed significant improvements in both groups with slightly better but statistically not significant clinical results for CTGs. At 5 years, the CTG group revealed an additional gain of keratinized mucosa width (t6m-0: CTG 1.88 mm, ADMA 1.04 mm, P = .081; and t5y-0: CTG 3.98 mm, ADMA 3.06 mm, P = .01) compared to 6 months, whereas the mean for ADMAs remained stable (intergroup comparison statistically significant, P = .010). In all other parameters in both groups, slight but not statistically significant relapses were detected. Only one minor postoperative complication at one ADMA-treated site occurred. CONCLUSIONS Regarding the long-term results, ADMA could be an alternative treatment option to thicken soft tissue and to cover multiple gingival recessions. If the gain of keratinized mucosa width is considered as a main goal, CTG may have a slight advantage over ADMA.
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Ucak Turer O, Ozcan M, Alkaya B, Surmeli S, Seydaoglu G, Haytac MC. Clinical evaluation of injectable platelet-rich fibrin with connective tissue graft for the treatment of deep gingival recession defects: A controlled randomized clinical trial. J Clin Periodontol 2019; 47:72-80. [PMID: 31518440 DOI: 10.1111/jcpe.13193] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to determine whether the combined connective tissue graft (CTG) with injectable platelet-rich fibrin (i-PRF) with coronally advanced flap (CAF) improved root coverage of deep Miller Class I or II gingival recessions compared with CTG alone with CAF. MATERIAL AND METHODS Seventy-two patients with Miller class I and II gingival recessions were enrolled. Thirty-six patients were randomly assigned to the test group (CAF+CTG+i-PRF [700 rpm for 3 min]) or control group (CAF+CTG). Clinical evaluations were made at 6 months. RESULTS At 6 months, complete root coverage was obtained at 88% of the sites treated with CAF+CTG+i-PRF and 80% of the sites treated with CAF+CTG. Difference between the two groups was not statistically significant. At 6 months, the recession depth (RD) reduction and increase in keratinized tissue height (KTH) of the test sites were significantly better compared with the control sites. CONCLUSIONS According to the results, the addition of i-PRF to the CAF+CTG treatment showed further development in terms of increasing the KTH and decreasing RD. However, this single trial is not sufficient to advocate the true clinical effect of i-PRF on recession treatment with CAF+CTG and additional trials are needed.
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Mercado F, Hamlet S, Ivanovski S. Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of multiple Class III-IV recessions in lower anterior teeth: A 3-year randomized clinical trial. J Periodontol 2019; 91:473-483. [PMID: 31561272 DOI: 10.1002/jper.19-0058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study compared clinical and patient-centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of multiple Class III-IV Miller periodontal recession (REC) defects on mandibular anterior teeth. METHODS This randomized clinical study evaluated 41 patients at 3 years follow-up. One hundred and fifty-six teeth were divided into two groups: test (CTG-EMD, 79 teeth) and control (CTG only, 77 teeth). Clinical REC, keratinized tissue (KT) width, percentage of root coverage, patient-centered outcomes were compared between the two groups. RESULTS At 36 months follow-up, patient level analysis showed that REC in the test group reduced significantly (5.71 ± 0.58 mm to 1.57 ± 0.85 mm) compared with the control group (5.94 ± 0.46 mm to 2.51 ± 0.62 mm) (P < 0.001), while KT width increased in the test group (1.51 ± 0.26 mm to 4.18 ± 0.34 mm) and was significantly greater than the control group (1.65 ± 0.21 mm to 2.90 ± 0.20 mm) (P < 0.001). At 36 months, tooth level analysis (Class III and Class IV groups) found less residual REC and increased KT in the test group compared with the control group (P < 0.01). Significantly less pain was reported at 2, 7, and 14 days follow-up post-surgery in the test group (P < 0.001). CONCLUSIONS The addition of EMD to CTG results in improved root coverage outcomes and higher amounts of KT width 36 months after treatment of Class III-IV REC on mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days post-surgery.
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Agarwal MC, Rathore P, Gummaluri SS, Agarwal P, Kumari S. Vestibular Incision Subperiosteal Tunnel Access with Titanium-Prepared Platelet-Rich Fibrin - A Golden Approach for Treating Multiple Recession Defects in Esthetic Zone. Contemp Clin Dent 2019; 10:682-685. [PMID: 32792832 PMCID: PMC7390423 DOI: 10.4103/ccd.ccd_2_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Gingival recession is defined as apical migration of marginal gingival tissue causing the exposure of root surface. Abnormal brushing techniques, trauma, anatomical presence of tooth, caries, and improper oral hygiene measures are some of the problems leading to gingival recession. Several treatment modalities such as coronary advanced flaps and free gingival grafts have been used for the treatment of gingival recession defects and showed good results. However, while treating multiple gingival recessions, some new treatment modalities were introduced in literature. Vestibular incision subperiosteal tunnel access (VISTA) as a minimally invasive technique for root coverage was introduced with various advantages such as no secondary surgical site needed for harvestment of donor tissue and it provides excellent esthetic results with decreased patient morbidity. The present case report emphasizes on the treatment of multiple gingival recessions in the maxillary anterior teeth region using VISTA with titanium-prepared platelet-rich fibrin.
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Baghele ON. A detailed description and 16-year validation of a new suturing method for stabilizing connective tissue grafts at recipient sites for root coverage and gingival augmentation. Indian J Dent Res 2019; 30:243-248. [PMID: 31169157 DOI: 10.4103/ijdr.ijdr_614_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Which are the different ways of stabilizing connective tissue grafts (CTGs) for root coverage and gingival augmentation by means of placement of sutures? There are various defined and undefined ways of stabilizing CTGs depending on experience and personal preferences. Most of the techniques profess use of absorbable sutures in separate interrupted fashion (sutures at the corners of the graft wherever possible). Aim This paper describes a new suturing method, "the lingually-tied horizontal mattress contouring suture," for stabilization of CTGs with or without epithelialized collar at the recipient site, for use with papilla retention and sparing techniques to treat marginal tissue recessions. Methods and Material The suturing technique is described in detail. It can be indicated for good number of root coverage cases, with additional objectives of gingival augmentation, specifically developed for papilla sparing and papillary buccal de-epithelialization recipient site preparations. Results Over a period of last 16 years this suturing technique showed promising results in terms of graft stabilization and survival. The main advantage of this technique lies in the use of cost-effective nonabsorbable sutures that usually retain some amount of tension on the soft tissues longer. Conclusion The primary objective of the suturing technique, per se, is to stabilize the CTG firmly along the contours of the root surface and to expedite a very close adaptation to the interdental soft tissues as well. The secondary objective of the article or publication is to disseminate the knowledge acquired through long periods of performance and observation for the benefit of the periodontal community as whole. Further validation is advocated.
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Xu CM, Zhang JM, Wu YF, Zhao L. [Research progress on substitutes for autogenous soft tissue grafts in mucogingival surgery]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:208-213. [PMID: 31168989 DOI: 10.7518/hxkq.2019.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mucogingival surgery is a general term for periodontal surgeries that correct aberrant periodontal soft tissues. Conventional mucogingival surgeries with pedicle flap or autologous soft tissue graft for treatment of gingival recession and insufficient keratinized tissues are always related to disadvantages such as need for a second surgery site, limited supplies, and complaints for postoperative discomfort. In this regard, research and application of soft tissue substitutes have gained increasing attention. Various kinds of soft tissue substitutes, including acellular dermal matrix and xenogeneic collagen matrix, have been developed and applied to clinical treatment. This review aims to summarize advances in research of the characteristics and clinical effectiveness of several soft tissue substitutes and provide references for clinical application.
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Ferraz BFR, Stuani VT, Passanezi E, Damante CA, Greghi SLA, de Rezende MLR, Zangrando MSR, Arruda IKC, Sant'Ana ACP. Osteogenic cells transfer improving root coverage: A randomized clinical trial. J Periodontal Res 2019; 54:506-512. [PMID: 30865291 DOI: 10.1111/jre.12651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/03/2019] [Accepted: 02/06/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this interventional, parallel-assignment, single-blinded, randomized, efficacy study was to investigate the efficacy of the treatment of gingival recessions by osteogenic cell transfer. This is the first randomized clinical trial of this nature. MATERIAL AND METHODS Treatment of Miller class I or II gingival recessions >4 mm was randomly defined by casual sorting and performed by newly forming bone graft (NFBG) and coronally advanced flap (CAF) or subepithelial connective tissue graft (SCTG) and CAF (control). Clinical examinations were performed by a single blinded examiner at baseline and at 3, 6, and 9 months after surgery. Parameters investigated were recession height (REC), probing depth (PD), clinical attachment level, gingival bleeding index (GBI), plaque index (PlI), and keratinized gingiva width (KGW). RESULTS Both techniques achieved similar percentage of root coverage, but NFBG was more effective in pocket depth reduction, attachment level gain, and reduction of plaque accumulation and of bleeding on probing. CONCLUSIONS These findings suggest that the transfer of osteogenic cells by NFBG is able to improve clinical attachment level and to cover denuded roots. NFBG can be used as an alternative treatment of deep recessions (≥4 mm), where the restoration of lost periodontal tissues is intended.
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Yadav D, Singh S, Roy S. Periodontal microsurgery for management of multiple marginal tissue recession using Zucchelli's modification of coronally advanced flap and pericardium membrane in an esthetic zone. J Indian Soc Periodontol 2019; 23:284-289. [PMID: 31143012 PMCID: PMC6519094 DOI: 10.4103/jisp.jisp_107_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Marginal tissue recession (MTR) by definition is an apical shift of gingival margin, which leads to exposure of root surface. Patients affected with MTR often complain of sensitivity to cold on exposed root surfaces apart from esthetic concerns. In this article, a case of multiple Miller's class I MTR who presented with sensitivity to cold in relation to maxillary anterior teeth region was treated using Zucchelli's coronally advanced flap with pericardium membrane under operating microscope. The application of principles of periodontal microsurgery and guided tissue regeneration results in significant root coverage with reduction/elimination of sensitivity. Long-term success of root coverage procedures depends on the removal of etiology and maintenance therapy.
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Nemcovsky CE, Beitlitum I. Combination Therapy for Reconstructive Periodontal Treatment in the Lower Anterior Area: Clinical Evaluation of a Case Series. Dent J (Basel) 2018; 6:dj6040050. [PMID: 30275349 PMCID: PMC6313804 DOI: 10.3390/dj6040050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 11/24/2022] Open
Abstract
Clinically, periodontal regeneration may be achieved by the application of barrier membranes, grafts, wound-healing modifiers, and their combinations. Combination therapy refers to the simultaneous application of various periodontal reconstructive treatment alternatives to obtain additive effects. This approach may lead to assemblage of different regenerative principles, such as conductivity and inductivity, space provision and wound stability, matrix development and cell differentiation. The application of autogenous connective tissue grafts during periodontal regenerative treatment with enamel matrix proteins derivative (EMD) has been previously reported. The present case series present a modified approach for treatment of severe periodontally involved lower incisors presenting with thin gingival biotype, gingival recession, minimal attached and keratinized gingiva width and muscle and/or frenum pull. In all cases a combination therapy consisting of a single buccal access flap, root conditioning, EMD application on the denuded root surfaces and a free connective tissue graft was performed. Clinical and radiographic outcomes were consistently satisfactory, leading to probing depth reduction, clinical attachment gain, minimal gingival recession, increased attached and keratinizing gingival width, elimination of frenum and/or muscle pull together with radiographic bone fill of the defects. It may be concluded that the present combination therapy for reconstructive periodontal treatment in the lower anterior area is a valuable alternative for indicated cases.
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Dursun E, Güncü GN, Dursun CK, Kiremitçi A, Karabulut E, Akalın FA. Nanofilled and conventional resin-modified glass ionomer fillings combined with connective tissue grafts for treatment of gingival recessions with non-carious cervical lesions. J Oral Sci 2018; 60:344-351. [PMID: 30146534 DOI: 10.2334/josnusd.17-0190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The aim of this study was to evaluate the clinical root coverage results of subepithelial connective tissue grafts (SCTG) performed on teeth with gingival recessions and non-carious cervical lesions (NCCLs) that were restored with cervical fillings and compare the results of two different filling materials: resin-modified glass ionomer (RMGIC) and nano-ionomer cements (NIC). A total of 54 teeth with Miller Class I gingival recessions with or without NCCLs in 36 patients (28 females, 8 males) were treated with SCTGs. Cervical lesions were randomly treated with RMGIC or NIC restorations. Periodontal clinical parameters, height of gingival recession (HGR), width of gingival recession (WGR), height of keratinized tissue, and dentin sensitivity were measured at baseline and 3, 6, and 12 months postoperatively. HGR and WGR values were statistically significantly reduced at all time points when compared to baseline values in all groups. There were no statistically significant differences between the groups in any clinical periodontal parameter (P > 0.05). The percentage of root coverage at 12 months was 89.5%, 90.1%, and 96.2% in the RMGIC, NIC, and control groups, respectively. Successful root coverage with connective tissue grafts may be achieved on teeth restored with RMGIC or NIC cervical fillings.
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Rasperini G, Acunzo R, Pellegrini G, Pagni G, Tonetti M, Pini Prato GP, Cortellini P. Predictor factors for long-term outcomes stability of coronally advanced flap with or without connective tissue graft in the treatment of single maxillary gingival recessions: 9 years results of a randomized controlled clinical trial. J Clin Periodontol 2018. [PMID: 29777632 DOI: 10.1111/jcpe.12932.[online]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
AIM To assess the clinical outcomes 9 years after the surgical treatment of single maxillary gingival recessions and identify predictors for long-term gingival margin stability. MATERIALS AND METHODS Twenty-five gingival recessions (Miller Class I and II) were randomly treated with Coronally Advanced Flap (CAF) plus Connective Tissue Graft (CTG) or CAF alone. Outcomes included complete root coverage (CRC), recession reduction (REC), keratinized tissue (KT) gain and dentin hypersensitivity, and were evaluated at 6 months, 1 and 9 years. Multilevel analysis was performed to identify predictors for long-term gingival margin stability. RESULTS Baseline gingival recession was 2.4 ± 0.8 mm and 2.4 ± 1.0 mm in the CAF + CTG and in the CAF-treated sites, respectively (p = 0.693). The chance to gain and preserve CRC over time is equal to 70% in the CAF + CTG group (Relative Risk [RR] = 1.70, 95% CI [0.84-3.45]; adjusted RR = 1.48, 95% CI [0.61-3.62]). Using the CTG, an increase in KT was recorded 9 years after the surgery (p = 0.019). An OR of 0.12 (p = 0.022) of not achieving CRC was observed in cases with non-carious cervical lesions (NCCL) compared to cases without NCCL. CONCLUSION Both treatment modalities demonstrated stability over time. Additional use of CTG provided a greater increase in KT. The presence of NCCL negatively affected CRC and REC.
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Yadav AP, Kulloli A, Shetty S, Ligade SS, Martande SS, Gholkar MJ. Sub-epithelial connective tissue graft for the management of Miller's class I and class II isolated gingival recession defect: A systematic review of the factors influencing the outcome. JOURNAL OF INVESTIGATIVE AND CLINICAL DENTISTRY 2018; 9:e12325. [PMID: 29424485 DOI: 10.1111/jicd.12325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 12/24/2017] [Indexed: 06/08/2023]
Abstract
The aim of the present systematic review was to analyze the factors that affect the outcome of subepithelial connective tissue graft (SCTG) for managing Miller's class I and class II isolated gingival recession defect. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews were used. Quality assessments of selected articles were performed. Data on root surface condition, recession type defect, flap thickness, different flap designs, different harvesting techniques, presence/absence of the epithelial collar, graft thickness, flap tension, suturing techniques, and smoking-related outcomes on root coverage were assessed. The SCTG procedure provides the best root coverage outcomes for Miller's class I and class II recession. The critical threshold of flap thickness was found to be 1 mm. Maximum root coverage was achieved by envelope and modified tunnel technique. SCTG with the epithelial collar does not provide additional gains than SCTG without the epithelial collar. The thickness of SCTG for root coverage was found to be 1.5-2 mm. Greater flap tension and smoking adversely affect root coverage outcomes. Analysis of the factors discussed would be of key importance for technique selection, and a combined approach involving factors favoring outcomes of SCTG could be of clinical relevance in recession coverage.
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Reddy SSP. Pinhole Surgical Technique for treatment of marginal tissue recession: A case series. J Indian Soc Periodontol 2018; 21:507-511. [PMID: 29551873 PMCID: PMC5846251 DOI: 10.4103/jisp.jisp_138_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The field of periodontal plastic surgery is always a subject of fascination for periodontists, and the importance of pink esthetics is gaining its pace. Preservation of what is existing is more important than its replacement. The same principle also applies to soft-tissue esthetic procedures thereby the concept of minimal surgical invasion came into existence. This article presents a series of five cases with 18 recession sites which were treated with a minimally invasive Pinhole Surgical Technique which resulted in overall root coverage of 96.7% after 6-month follow-up with minimal complications.
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