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Ariceta A, Chambrone L, Stuhr S, Couso-Queiruga E. Effect of suturing in root coverage via coronally advanced flaps: A systematic review. Clin Adv Periodontics 2024. [PMID: 39276125 DOI: 10.1002/cap.10312] [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: 06/17/2024] [Revised: 08/07/2024] [Accepted: 08/07/2024] [Indexed: 09/16/2024]
Abstract
BACKGROUND To analyze the evidence about the influence of the suturing technique and material in terms of the percentage of mean root coverage (%MRC) following root coverage therapy in teeth diagnosed with single/localized gingival recession defects (GRD) via a monolaminar coronally advanced flap. METHODS The protocol of this systematic review was registered in PROSPERO (CRD42024514043). A literature search was conducted to identify investigations that fulfilled the eligibility criteria. Variables of interest were extracted, subsequently categorized, and qualitatively analyzed. RESULTS A total of 15 randomized clinical trials, including 301 localized GRD in non-molar sites classified as Miller class I-II/RT1, in 253 patients were included. The studies reporting the combination of sling and single interrupted sutures, or interrupted sutures alone showed an MRC of 70.2%±16.6%, and 74.1%±0.75%, respectively. The highest MRC was observed in the studies using polyglactin 910 with a pooled value of 76.6% ± 15.3%, and monofilament materials, with a pooled MRC of 74.8%±7.1%. When the suturing diameter was evaluated, the highest pooled MRC with values of 79.1%±9.8% was observed with the use of 5-0. CONCLUSIONS For the treatment of single/localized GRD in non-molar sites via a monolaminar coronally advanced flap, the use of a combination of sling and single interrupted sutures, or single interrupted sutures, polyglactin 910 or monofilament materials, and material diameter of 5-0 showed a higher MRC as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters. KEY POINTS There were no differences in the percentage of root coverage achieved between the use of sling and single interrupted, versus single interrupted sutures alone on the treatment of single/localized GRD in non-molar sites. Polyglactin 910 and monofilament sutures resulted in a higher percentage of root coverage achieved as compared to expanded polytetrafluoroethylene, and silk with/without dressing. The use of 5-0 material diameter showed the highest percentage of root coverage achieved. PLAIN LANGUAGE SUMMARY This study was primarily aimed at evaluating how different suturing techniques and materials could affect the percentage of root coverage in single/localized recession defects, without the use of soft tissue substitutes or autogenous soft tissue grafts. After the pooled analyses of 15 randomized clinical trials that fulfilled the inclusion criteria, we observed that the adequate selection of suturing techniques, materials, and size could lead to a higher percentage of root coverage. Specifically, the use of single interrupted with or without sling sutures at the most coronal portion, Polyglactin 910 or monofilament materials, and size of 5-0 showed a higher percentage of root coverage as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.
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Affiliation(s)
- Alina Ariceta
- Department of Periodontology, School of Dentistry, Catholic University of Uruguay, Montevideo, Uruguay
| | - Leandro Chambrone
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health & Science, Monte de Caparica, Caparica, Portugal
- Unit of Basic Oral Investigations (UIBO), School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Sandra Stuhr
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Emilio Couso-Queiruga
- Department of Oral Surgery and Stomatology, University of Bern School of Dental Medicine, Bern, Switzerland
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Balice G, Paolantonio M, Serroni M, De Ninis P, Rexhepi I, Frisone A, Di Gregorio S, Romano L, Sinjari B, Murmura G, Femminella B. Treatment of Multiple RT1 Gingival Recessions Using a Coronally Advanced Flap Associated with L-PRF or Subgingival Connective Tissue Graft from Maxillary Tuberosity: A Randomized, Controlled Clinical Trial. Dent J (Basel) 2024; 12:86. [PMID: 38667998 PMCID: PMC11049079 DOI: 10.3390/dj12040086] [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: 01/05/2024] [Revised: 02/27/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
The goal of plastic periodontal surgery is to obtain complete root coverage, increasing gingival thickness (GT), a positive prognostic factor for gingival margin stability over time. The aim of this study was to compare the effectiveness of the Coronally Advanced Flap (CAF) in RT1 (GR; gingival recession with no loss of interproximal attachment) when associated with a connective tissue graft from the maxillary tuberosity (tCTG) or with leukocyte and platelet-rich fibrin (L-PRF) membranes in obtaining root coverage and increasing the thickness and width of the keratinized tissue, along with aesthetic improvement, taking into account a number of patient-related outcomes. Thirty patients with two adjacent RT1 GRs (GRs with no loss of interproximal attachment) were each treated using CAF associated with tCTG (15 patients) or L-PRF. The main outcome was a GT increase; secondary outcomes were keratinized tissue width (KT), gingival recession (GR), probing depth (PD), clinical attachment level (CAL), root coverage percentage (RC%), complete root coverage (CRC), and root coverage esthetic score (RES). Patient-reported outcomes were discomfort (D), dentine hypersensitivity (DH), patient-related esthetic score (PRES), and overall treatment satisfaction (OTS). After 12 months, clinical and patient-reported parameters did not show significant differences between groups, with the only exception being a GT gain, which was significantly greater in the CAF + tCTG group. Our results showed that both techniques were effective in treating RT1 GRs, with comparable patient-related outcomes. However, the use of tCTG produces significantly thicker tissue, covering the exposed root surface.
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Affiliation(s)
- Giuseppe Balice
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Michele Paolantonio
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Matteo Serroni
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Paolo De Ninis
- “Luisa D’Annunzio” Institute for High Culture, Pescara, Italy;
| | - Imena Rexhepi
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Alessio Frisone
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Stefania Di Gregorio
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Luigi Romano
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Bruna Sinjari
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Giovanna Murmura
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Beatrice Femminella
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
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P MK, Nagate RR, Chaturvedi S, Al-Ahmari MMM, Al-Qarni MA, Gokhale ST, Ahmed AR, Bariqi AA, Cicciù M, Minervini G. Importance of periodontal phenotype in periodontics and restorative dentistry: a systematic review. BMC Oral Health 2024; 24:41. [PMID: 38191372 PMCID: PMC10773067 DOI: 10.1186/s12903-023-03777-3] [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: 09/28/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Periodontal phenotype is regarded to be one of the key factors influencing the efficacy of restorative therapies in dental practice. The objective of the systematic review was to explore the importance of thin and thick periodontal phenotypes and how they affect the outcome of periodontal and restorative therapies by looking at a number of academic publications from various online databases. METHODS Following the PRISMA guidelines (Preferred Reporting Items for Systematic Review standards), relevant data will be searched and retrieved from three significant scientific databases, including PubMed, EBSCO, and Scopus. The articles with full texts that matched the keywords and published in English between 2018 and 2023 were taken into consideration. RESULTS The majorities of these articles were based on the type of periodontal phenotype and their impact on periodontal and restorative treatment outcomes were selected. The initial search yielded a total of 530 articles. Only 273 were relevant to the review's objectives, and these were considered for determining eligibility. Only 20 publications were eligible for analysis. CONCLUSION Understanding these anatomical aspects of periodontal phenotype is crucial to both periodontology and restorative dentistry. The clinical outcome of restorative, prosthetic, orthodontic, surgical, and periodontal therapies is determined in large part by the periodontal phenotype, which also plays a significant role in clinical failure or success in dental treatments. TRIAL REGISTRATION This study protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) dated 16th June 2023 with the registration ID CRD42023432568.
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Affiliation(s)
- Mohan Kumar P
- Department of Periodontics and Implantology, Vishnu Dental College, West Godavari, Vishnupur, Bhimavaram, 534202, Andhra Pradesh, India.
| | - Raghavendra Reddy Nagate
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Saurabh Chaturvedi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia.
| | - Manae Musa Musleh Al-Ahmari
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Mohammed A Al-Qarni
- Consultant in Restorative Dentistry, College of Dentistry, King Khalid University, P.O.Box 3263, Abha, 61471, Saudi Arabia
| | - Shankar T Gokhale
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Abdul Razzaq Ahmed
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Ahmed Al Bariqi
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, 95123, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India.
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Caserta, 81100, Italy.
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Bezerra de Melo N, Sobreira Duarte LN, Maia Vieira Pereira C, da Silva Barbosa J, Matos Gonçalves da Silva A, de Souza Coelho Soares R, Meira Bento P. Thermographic examination of gingival phenotypes: correlation between morphological and thermal parameters. Clin Oral Investig 2023; 27:7705-7714. [PMID: 37924357 DOI: 10.1007/s00784-023-05361-z] [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: 07/20/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES To evaluate the clinical and thermographic aspects of the gingival phenotype (GP) in healthy subjects. MATERIALS AND METHODS The study sample examined 264 teeth, upper and lower incisors, comprising 132 central incisors (CI) and 132 lateral incisors (LI), in 33 healthy volunteers. Four periodontal parameters were recorded systematically: ratio of width to length of the dental crown (CW/CL), height of the gingival attachment (KGW), probing depth (PD), and gingival transparency (GT). The temperatures of the attached gingiva (KGW temp) and the free gingival margin (FGM Temp) were also recorded by way of infrared thermography (IRT). RESULTS The average age of the sample was 30.70 ± 7.65 years. Of the 264 teeth evaluated, 76.1% had a thin GP. There was a significant association between CW/CL (p < 0.001), KGW (p < 0.001), PD (p < 0.007), and FGM Temp (p < 0.006) with the tooth groups. The results show a significant and inversely proportional correlation between clinical parameters and gingival temperature (p < 0.05). A significant association was found between CW/CL (p < 0.026); KGW (p < 0.001); and GP. CONCLUSION CW/CL, KGW, PD, and FGM Temp vary according to tooth group. The majority of the sample presented with the thin GP, which was more prevalent in the lower LIs and CIs. No significant association could be observed between thermographic parameters and GP. CLINICAL RELEVANCE Knowledge of the temperature of the gingival tissues can be useful in helping to diagnose and plan periodontal treatments. Moreover, our findings will help future studies evaluate the use of IR as an auxiliary diagnostic method in dentistry, eliminating GP as a confounding factor, since it does not seem to influence the temperature of the gingival tissues.
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Affiliation(s)
- Niebla Bezerra de Melo
- Department of Dentistry, State University of Paraíba, R. Baraúnas, 351, Universitário, Campina Grande, PB, 58429-500, Brazil.
| | - Lígia Natália Sobreira Duarte
- Department of Dentistry, State University of Paraíba, R. Baraúnas, 351, Universitário, Campina Grande, PB, 58429-500, Brazil
| | - Camila Maia Vieira Pereira
- Department of Dentistry, State University of Paraíba, R. Baraúnas, 351, Universitário, Campina Grande, PB, 58429-500, Brazil
| | - Jussara da Silva Barbosa
- Department of Dentistry, State University of Paraíba, R. Baraúnas, 351, Universitário, Campina Grande, PB, 58429-500, Brazil
| | - Ariane Matos Gonçalves da Silva
- Department of Dentistry, State University of Paraíba, R. Baraúnas, 351, Universitário, Campina Grande, PB, 58429-500, Brazil
| | - Renata de Souza Coelho Soares
- Department of Dentistry, State University of Paraíba, R. Baraúnas, 351, Universitário, Campina Grande, PB, 58429-500, Brazil
| | - Patrícia Meira Bento
- Department of Dentistry, State University of Paraíba, R. Baraúnas, 351, Universitário, Campina Grande, PB, 58429-500, Brazil
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