Coronally advanced flap achieved higher esthetic outcomes without a connective tissue graft for the treatment of single gingival recessions: a 4-year randomized clinical trial

Gingival phenotype changes after different periodontal plastic surgical techniques: a single-masked randomized controlled clinical trial

ABSTRACT: OBJECTIVES: Aim of this clinical study was to evaluate the effects on gingival thickness of three surgical techniques for root coverage: the coronally advanced flap (CAF) alone, with a sub-epithelial connective tissue graft (SCTG) or with leukocyte- and platelet-rich fibrin (L-PRF) membranes.

METHODS

Sixty patients with RT1 single maxillary gingival recession were treated with CAF + L-PRF (20 patients), CAF + SCTG (20 patients) or CAF alone (20 patients). At baseline and 6-month after treatment, gingival thickness (GT), keratinized tissue width (KT), gingival recession (GR), clinical attachment level (CAL), probing depth (PD), PROMs, and the aesthetic outcome were recorded.

RESULTS

CAF + SCTG and CAF + L-PRF groups showed a significantly greater mean GT increase than CAF alone (0.31 ± 0.10 mm) with no significant differences between CAF + SCTG (0.99 ± 0.02 mm) and CAF + L-PRF (0.92 ± 0.52 mm) groups (p = 0.55). CAF + SCTG was associated with a significantly greater KT gain (3.85 ± 1.04 mm), while in CAF + L-PRF (2.03 ± 0.53 mm) and CAF (1.50 ± 0.69 mm) groups, KT was not significantly increased. Both GR and CAL showed a significant within groups' improvement, without among-groups differences. No significant among-groups difference for the aesthetic outcome but greater discomfort and pain-killer consumption in CAF + SCTG group was detected.

CONCLUSION

All investigated surgical techniques produced significant GR reduction and CAL gain. GT was similarly augmented by CAF + L-PRF and CAF + SCTG techniques; however, the CAF + SCTG technique produced a more predictable KT and GT increase.

CLINICAL RELEVANCE

The results of our study suggest that the CAF + SCTG technique represents the most predictable method for the clinician to improve the gingival phenotype, an important factor for long term gingival margin stability.

Clinical and Aesthetic Outcomes of Multiple Gingival Recessions Coverage with Modified Coronally Advanced Tunnel and Subepithelial Connective Tissue Graft in Maxilla and Mandible: A 2-Year Retrospective Study

Limited long-term data are available when analyzing gingival recession coverage between the maxillary and mandibular sites. Therefore, the aim of this study was to evaluate the influence of location (maxilla versus mandible) of multiple gingival recessions on 24 months clinical and aesthetic outcomes of modified coronally advanced tunnel with subepithelial connective tissue graft. Forty patients with multiple gingival recessions (GR) located at maxillary or mandibular teeth were treated between January 2018 and December 2019. Reduction in GR, average root coverage (ARC), complete root coverage (CRC), increase in keratinized tissue width (KTW), increase in gingival thickness (GT), and aesthetic evaluation with the root coverage esthetic score (RES) were evaluated after 24 months. Thirty patients with 270 recessions in the upper teeth and ten patients with 90 recessions in the lower teeth completed the 2-year recall. The differences between preoperative and postoperative clinical parameters showed statistical significance only within but not between groups. ARC at 2 years was 93.31% for maxillary teeth and 93.06% for mandibular teeth (p = 0.7906). Mean RES values were comparable for upper and lower teeth (9.25 versus 8.92, respectively, p = 0.6733). However, upper teeth achieved significantly higher scores for marginal tissue contour (MTC), muco-gingival junction alignment (MGJ), and gingival color (GC). Lower teeth had decreased chances of receiving better RES (OR = 0.49, CI 0.24-0.99, p = 0.0457) in regression analysis, when compared with upper teeth. MCAT + SCTG achieved comparably favorable 2-year outcomes for the treatment of multiple GR in upper and in lower teeth. However, the individual RES components were higher in maxillary teeth, and upper teeth had higher odds of receiving better RES.