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Özdemi R EÇN, Bozkurt E, Manav TY. Volumetric changes in free gingival graft and gingival unit graft treatments evaluated using an indirect digital method. Ann Anat 2024; 257:152329. [PMID: 39244109 DOI: 10.1016/j.aanat.2024.152329] [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: 03/24/2024] [Revised: 08/15/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND The aim of this study was to evaluate clinical one-dimensional changes such as root surface coverage, decrease seen in the amount of gingival recession and keratinised gingival width (KGW) obtained throughout a 6-month follow-up period following the treatment of Cairo class II gingival recession with free gingival graft (FGG) and gingival unit graft (GUG). Three-dimensional changes in gingival volume and thickness were also compared digitally using an indirect method. METHODS A total of 20 patients with localised Cairo class II gingival recession were randomly separated into two groups; 10 patients were treated with FGG and 10 patients treated with GUG. Preoperatively and at 6 months postoperatively, the initial position of the gingiva and KGW were recorded for all the patients and plaster models were formed from the obtained impressions with the traditional method. The plaster models were transferred to a digital environment by scanning with a model scanner. Using a software program, changes in gingival papillary height and gingival volume and thickness were compared between the groups and according to the baseline values from The Standard Tessellation Language (STL) files obtained. RESULTS Compared to the baseline values, a significant increase was determined in the KGW, and a significant decrease in pocket depth, clinical attachment level, and gingiva recession depth in all the groups (p<0.05). No statistically significant difference was determined between the groups in respect of the changes in mean gingiva thickness, gingiva volume, and mean vertical papillary height (p>0.05). CONCLUSION The study results showed that GUG treatment for Cairo class II localised gingival recession is an effective method in respect of increasing gingiva volume and thickness, increasing KGW, coverage of the root surface, and forming tissue contours that allow the patient to easily maintain oral hygiene. However, there was not seen to be any adventage of GUG and FGG over each other.
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Affiliation(s)
- Eda Çeti N Özdemi R
- Department of Periodontology, Faculty of Dentistry, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey.
| | - Esra Bozkurt
- Department of Periodontology, Faculty of Dentistry, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Taha Yaşar Manav
- Department of Prosthetic Dental Treatment, Faculty of Dentistry, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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Rascon AN, Lander B, Fiorellini JP, Neiva R. The wingspan suspension approach: A modified semilunar technique for multiple areas of recession. Clin Adv Periodontics 2024. [PMID: 38874320 DOI: 10.1002/cap.10296] [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: 07/06/2023] [Revised: 04/17/2024] [Accepted: 04/26/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Gingival recession can be considered an undesirable condition that results in the exposure of the root surface. There are many techniques that can be employed to address gingival recession; however, they frequently involve a second surgical site. Other approaches have been introduced in the past to address this concern, and this case study discusses the use of a modified technique to achieve root coverage. METHODS A patient presented to the periodontics clinic with concerns regarding gingival recession. A modification to the semilunar technique was employed to address the recession, whereas double sling sutures were utilized to maintain the coronal repositioning of the flap. RESULTS Maxillary central incisors initially presented with 2-3 mm of facial recession and root coverage was achieved by use of a modified surgical semilunar approach. No rebound noted over a 6-month period, newly established gingival margin deemed clinically stable. CONCLUSIONS This case study provides an alternative to addressing gingival recession in the maxillary anterior region, when <3 mm of recession is noted. Avoidance of a second surgical procedure and/or donor site is of particular benefit, as well as maintenance of the blood supply. KEY POINTS Why is this case new information? There is insufficient evidence on the use of a modified wingspan incision design Phenotype modification with elimination of a second surgical site is most ideal for the patient. What are the keys to successful management of this case? Comprehensive diagnosis and proper case selection Meticulous flap management and adequate release to allow for repositioning without tension Appropriate use ofsuture and suturing technique. What are the primary limitations to success in this case? Thin periodontal phenotype Poor oral hygiene and plaque accumulation postoperatively Loss to follow-up.
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Affiliation(s)
- Allison N Rascon
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bradley Lander
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph P Fiorellini
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rodrigo Neiva
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Pini Prato G, Di Gianfilippo R. Challenges and success in periodontal plastic surgery. J Clin Periodontol 2023; 50:1572-1581. [PMID: 37661329 DOI: 10.1111/jcpe.13869] [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: 05/25/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
To truly understand a field of study, one must delve into its past and examine the challenges and successes that have shaped its current practices. In the case of periodontal plastic surgery, recognizing how challenges induced changes over the last 70 years-from the 1950s to today-is essential to fully comprehend its evolution. This editorial provides a perspective on the field, highlighting the interrelationships between influential surgical techniques and advancements in research methodology. With each event building upon the last, the evolution of periodontal plastic surgery is a story of scientific progress and ongoing research, fostering a sense of community and shared knowledge.
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Affiliation(s)
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Bagde H, Pawar SK, Vasisth D, Vadvadgi VH, Laddha RB, Wagh PP. Comparison of Amnion Membrane and Hyaluronic Acid in Gingival Recession Coverage and Gain in Clinical Attachment Level following Coronally Advanced Flap Procedure-A Clinical Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S1104-S1107. [PMID: 37694043 PMCID: PMC10485441 DOI: 10.4103/jpbs.jpbs_202_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 09/12/2023] Open
Abstract
Background Gingival recession is defined as the apical migration of gingival margin to the cementoenamel junction. Recently, amnion membrane, the third-generation membrane which is a placental-derived tissue, has been introduced. Materials and Methods Study included 45 subjects with age group of 20-60 years of both genders. Patients with Miller's Class I and Class II gingival recession were selected for the study. The progress was assessed at baseline one, three, and six months observation interval through clinical parameters RD, RW, PD, and CAL at the end of six months. Results Recession depths in the first, third, and sixth month were 1.82 ± 0.442, 1.31 ± 0.47 mm, and 0.91 ± 0.29, respectively, which showed a significant reduction from the baseline. Recession widths in the first, second, and third weeks were 3.04 ± 0.442 mm, 1.31 ± 0.47 mm, and 1.49 ± 0.59 mm, respectively. There was a statistically significant reduction (P > 0.005) when compared to the baseline. Pocket depths in the first, third, and sixth month were 0.93 ± 0.447, 0.42 ± 0.50, and 0.24 ± 0.43 (P > 0.005) which is significant when compared to baseline. Clinical attachment levels in the first, third, and sixth month were 2.73 ± 0.751, 1.78 ± 0.70, and 1.18 ± 0.53 (P > 0.005) which is significant compared to six months. Conclusion Within the limitations of the present study, the data obtained by periodic assessment of the clinical parameters indicate the use of amnion membrane and hyaluronic acid, and proper technique may thus be the panacea for root coverage procedure.
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Affiliation(s)
- Hiroj Bagde
- Department of Periodontology, Rama Dental College, Kanpur, Uttar Pradesh, India
| | - Sangeeta K. Pawar
- Depertment of Oral Pathology, Dr. Hegdewar Smruti Rugna Seva Mandals Dental College and Hospital, Hingoli, Maharashtra, India
| | - Diwakar Vasisth
- Department of Dental and Maxillofacial Surgery at Lady Hardinge Medical College and Hospital, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Vinay H. Vadvadgi
- Department of Periodontology, Rural Dental College, Pravara Institute of Medical Sciences, Deemed to be University, Ahmednagar, Maharashtra, India
| | - Rashmi B. Laddha
- Department of Periodontology, Dr. Rajesh Ramdasji Kambe Dental College and Hospital, Akola, Maharashtra, India
| | - Pradnya P. Wagh
- Department of Periodontology, AECS Maaruti College of Dental Sciences and Research Center, Bengaluru, Karnataka, India
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Cairo F, Burkhardt R. Minimal invasiveness in gingival augmentation and root coverage procedures. Periodontol 2000 2023; 91:45-64. [PMID: 36694255 DOI: 10.1111/prd.12477] [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: 03/25/2022] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 01/26/2023]
Abstract
Minimally invasive surgical procedures aim at optimal wound healing, a reduction of postoperative morbidity and, thus, at increased patient satisfaction. The present article reviews the concept of minimal invasiveness in gingival augmentation and root coverage procedures, and critically discusses the influencing factors, technical and nontechnical ones, and relates them to the underlying biological mechanisms. Furthermore, the corresponding outcomes of the respective procedures are assessed and evaluated in relation to a possible impact of a minimized surgical invasiveness on the clinical, aesthetic, and patient-related results.
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Affiliation(s)
- Francesco Cairo
- Head Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rino Burkhardt
- Private Practice, Zurich, Switzerland.,Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, Hong Kong, SAR.,Department of Periodontics & Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Muacevic A, Adler JR, Alyahya LA, AlHarbi MN, Alazaz NN, AlKadi L, Albalawi F, Aboalela AA. The Posterior Extension of the Palatal Rugae as an Anatomical Constraint for Soft Tissue Grafts in a Saudi Arabian Population. Cureus 2022; 14:e32731. [PMID: 36686091 PMCID: PMC9851844 DOI: 10.7759/cureus.32731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Background The purpose of this study was to investigate the distal extension of the palatal rugae area as an anatomical constraint on the harvesting of palatal soft tissue grafts in a Saudi Arabian population. Additionally, factors that could affect or predict the extension were considered. Methods Three hundred seventy-four (374) dental casts from Saudi nationals currently residing in Riyadh (170 males and 204 females) were included. Two independent observers used a standardized probe to measure the posterior extent of the rugae on each stone cast bilaterally on a horizontal base. A sharp graphite pencil was used to mark the measurements from the origin of the rugae to their terminal ends on the cast, and a magnification lens was used to identify them. Using this technique, the most posterior extension of the rugae was marked and then analyzed. The normal approximation test for binomial distribution was used to determine the proportion of the subjects with rugael extensions beyond the mesial end of the upper second premolar, and logistic regression was used to see the association of this extension with other factors. Results The asymptotic chi-squared (p = 0.0002) McNemar tests revealed that the posterior distal extension of the rugae was not the same on both sides. A normal approximation test for the left side with 95% confidence intervals (CIs) with the "rugael extension proximal to the mesial end of the upper second premolar" category considered "success" found that the proportion of upper second premolars with rugael extensions proximal to the mesial end was not significantly different to the proportion of rugael extensions beyond the mesial end of the upper second premolars (95% CI: 48.69%-58.79%, p = 0.147). Conversely, the proportion of the upper second premolars with rugael extensions proximal to the mesial end was significantly lower than that beyond the mesial end on the right (95% CI: 35.92%-45.89%, p = 0.00004). Gender, age, and palatal shape did not significantly affect the posterior extension of palatal rugae. Conclusions The palatal rugae on the left side of a sample of the Saudi Arabian population do not considerably extend beyond the upper second premolar mesial aspect, which may provide reliable soft tissue grafts for esthetic mucogingival surgery.
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Hyaluronic Acid as an Adjunct to Coronally Advanced Flap Procedures for Gingival Recessions: A Systematic Review and Meta—Analysis of Randomized Clinical Trials. J Pers Med 2022; 12:jpm12091539. [PMID: 36143324 PMCID: PMC9501956 DOI: 10.3390/jpm12091539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 11/21/2022] Open
Abstract
Previous systematic reviews have reported that coronally advanced flap (CAF) + connective tissue graft (CTG) are the gold standard in root coverage procedures (RCP). Nevertheless, adjunctive treatment with hyaluronic acid (HA) has been proposed to aim at improving clinical outcomes and reducing patient morbidity. The aim of this systematic review and meta-analysis is to compare the use of HA as an adjunctive treatment to CAF procedures in Miller class I and II (recession type 1; RT1) gingival recession (GR) defects treatment with no adjunctive/other treatments. MEDLINE, The Cochrane Central Register of Controlled Trials, Web of Science, Scopus databases and gray literature were searched up to April 2022. The primary outcome variables were mean recession coverage (MRC) and reduction of the recession depth (RecRed). Weighted mean differences and 95% confidence intervals between treatments were estimated using a random-effect mode. From 264 titles identified, 3 RCTs reporting 90 GR defects in 60 patients were included. Overall analysis of MRC and RecRed were 0.27% (p = 0.01) and 0.40 mm (p = 0.45) in favor of CAF + HA compared to CAF alone/CAF + subepithelial connective tissue graft (SCTG), respectively, with a statistically significant difference only for MRC values. Nevertheless, due to the limited number and heterogeneity of the included studies, well-performed RCTs are needed to clarify a potential advantage of HA in RCPs in the future.
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De Santis D, Luciano U, Pancera P, Castegnaro G, Alberti C, Gelpi F. A New Matrix for Soft Tissue Management. J Clin Med 2022; 11:jcm11154486. [PMID: 35956103 PMCID: PMC9369623 DOI: 10.3390/jcm11154486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 12/10/2022] Open
Abstract
Gingival recession is a mucogingival defect defined as the apical shifting of the gingival margin in relation to the CEJ. The use of connective tissue autografts allows for the obtention of very satisfactory results but is associated with undoubted disadvantages. The aim of the present work is to carry out a systematic review of the literature using a meta-analysis to investigate the clinical efficacy of xenogeneic collagen matrix (XCM) in the treatment of gingival recessions. This revision was carried out strictly following the guidelines published in the Cochrane Handbook. Thus, a meta-analysis was performed to calculate relative risks and standardized mean differences for each of the variables considered. The results of the meta-analysis show that CAF + CTG was statistically better than CAF + XCM in almost all the variables analyzed: complete root coverage (RR 0.46), mean root coverage (SMD −0.89), recession reduction (SMD −0.98), clinical attachment level (SMD −0.63) and gingival thickness (SMD −1.68). Meanwhile, CAF + XCM was slightly better than CAF alone in regard to: mean root coverage (SMD 0.51), recession reduction (SMD 0.47) and gingival thickness (SMD 0.56). It is possible to conclude that CAF + CTG still remains the gold standard in radicular coverage.
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Toledano-Osorio M, Muñoz-Soto E, Toledano M, Vallecillo-Rivas M, Vallecillo C, Ramos-García P, Osorio R. Treating Gingival Recessions Using Coronally Advanced Flap or Tunnel Techniques with Autografts or Polymeric Substitutes: A Systematic Review and Meta-Analysis. Polymers (Basel) 2022; 14:polym14071453. [PMID: 35406326 PMCID: PMC9002830 DOI: 10.3390/polym14071453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 02/01/2023] Open
Abstract
Gingival recessions are a prevalent oral mucosa alteration. To solve this pathology, palatal mucosa or polymeric soft tissue substitutes are used when performing coronal advanced flap (CAF) or tunnel (TUN) surgical techniques. To evaluate which is the most successful approach, a literature review and meta-analysis were conducted. For the electronic search the National Library of Medicine, the Cochrane Oral Health Group Trials Register, EMBASE and WOS were used. Pooled data for the percentage of root coverage was collected and weighted means were calculated. Heterogeneity was determined using the Higgins (I2) statistic and a random-effects model was applied. Thirteen studies were included in the systematic review (12 randomized and 1 controlled clinical trials) in which both techniques (394 patients) were compared with a follow-up of 4 to 12 months. Galbraith and Baujat plots were used to control for the presence of potential outliers. After performing the meta-analysis (11 studies), the mean root coverage was similar when using the TUN or CAF techniques (p = 0.49). The only differences between the two were found for single recessions, where CAF offered a higher percentage of root coverage (mean difference = 4.98%; p = 0.006). There were no differences when applying an autograft or a polymeric substitute with either of the two tested surgical techniques (p = 0.445).
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Saxena A, Bhusari P, Singh A, Nagi R, Chaturvedi SS. Coronally advanced flap with and without hyaluronic acid (HYALOSS) for the treatment of gingival recession – a randomized clinical trial. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2022. [DOI: 10.1051/mbcb/2022034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: To compare and evaluate the surgical outcome of gingival recession treatment using CAF alone or in conjunction with hyaluronic acid (HA) on Miller's Class I and class II gingival recession defects. Materials and methods: After randomisation, the control group (15 patients) received CAF alone and the test group (15 patients) received HA as an adjunct to CAF technique for an isolated gingival recession accompanied by an adequate width of keratinized gingiva on maxillary canines and premolars. All patients were evaluated at 7, 15, 30, 60 and 90 days interval post-operatively. Data obtained was subjected to statistical analysis and p value <0.05 was considered as statistically significant. Results: At 90 days interval statistically highly significant root coverage was obtained with mean gain of 66.1% in control group and 86.6% in test group. Statistically significant reduction in depth of gingival recession and gain in clinical attachment level was found for control and the test groups, and intergroup comparison showed statistically significant differences for root coverage and clinical attachment level between the groups (p = 0.000), however no significant differences were found for width of attached gingiva, keratinized gingiva and gingival thickness between the groups at 90 days (p > 005). Conclusion: HA has proven to be beneficial in the field of regenerative therapy. Our analysis suggested that HA can be used as a promising adjunct with CAF for root coverage, however further studies are required to imply the results on larger population.
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Potharaju SP, Prathypaty SK, Chintala RK, Kumar DS, Bai YD, Bolla VL, Koppolu P, Barakat A, Lingam AS. Comparative efficacy of coronally advanced flap with and without guided tissue regeneration in the management of gingival recession defects: A split-mouth trial. Ann Afr Med 2022; 21:415-420. [PMID: 36412344 PMCID: PMC9850890 DOI: 10.4103/aam.aam_142_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The gingival recession causes tooth sensitivity, poor esthetics, and tooth mobility in severe cases. Scientific documentation revealed effective root coverage (RC) and increased keratinized tissue heights acquired with the coronally advanced flap (CAF) for multiple recession defects. Objectives This research evaluates and compares the efficacy of CAF procedures with and without Type I collagen bio-absorbable membrane in guided tissue regeneration (GTR) in the treatment of Miller's Class I and II gingival recession. Materials and Methods A total of 30 sites from 15 patients were selected for the study after fulfilling the presurgical phase of treatment. The chosen sites were randomly allocated into Group A CAF and Group B (CAF + Resorbable GTR membrane). The clinical variables such as plaque index, gingival index, recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), clinical attachment level (CAL), and surface area of the defect were recorded at the baseline and 6 months postoperatively. Results Both therapies resulted in a notable gain in RC with a mean of 73.13% and 71.60%, respectively, but it was not statistically significant when compared between the groups. Both the RD and RW were significantly reduced from baseline to 6 months postoperatively. Although there was a gain in WKG and CAL in both experimental sites, no significant difference was observed between both the groups. Conclusion Although there are several RC procedures, CAF furnishes a foreseeable, straightforward, and appropriate perspective for treating Miller's Class I and II recessions. Integrating this approach with placing a bio-absorbable membrane does not seem to improve the results following surgical treatment of such defects. However, both groups showed the potential advantage of achieving RC.
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Affiliation(s)
- Santhi Priya Potharaju
- Department of Periodontics, Government Dental College and Hospital, Hyderabad, Telangana, India,Address for correspondence: Dr. Santhi Priya Potharaju, Department of Periodontics, Government Dental College and Hospital, Hyderabad - 500 012, Telangana, India. E-mail:
| | | | | | | | - Y. Durga Bai
- Department of Periodontics, Government Dental College and Hospital, Hyderabad, Telangana, India
| | - Vijaya Lakshmi Bolla
- Department of Periodontics, Government Dental College and Hospital, Hyderabad, Telangana, India
| | - Pradeep Koppolu
- Department of Preventive Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Ali Barakat
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Amara Swapna Lingam
- Department of Surgical and Diagnostic Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
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Cosgarea R, Kantarci A, Stavropoulos A, Arweiler N, Sculean A. Soft Tissue Regeneration at Natural Teeth. Dent Clin North Am 2021; 66:87-101. [PMID: 34794556 DOI: 10.1016/j.cden.2021.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This article provides an overview of the best-documented surgical techniques for recession coverage and draws conclusions for the clinician. Use of a connective tissue graft with either coronally advanced flap (CAF) or tunnel is the most predictable technique for the treatment of single and multiple gingival recessions. Long-term results exist only for CAF with/without connective tissue graft providing evidence for long-term stability with only minor relapses. Soft tissue replacement materials and biologics may represent a valuable modality to additionally improve the clinical outcomes obtained with CAF alone or, in certain clinical situations, to serve as an alternative to autogenous tissue.
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Affiliation(s)
- Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Welschnonnenstr. 17, 53125 Bonn, Bonn, Germany; Department of Periodontology and Peri-Implant Diseases, Philipps University of Marburg, Georg-Voigt. Str. 3, Marburg 35039, Germany; Department of Prosthetic Dentistry, University Iuliu Hatieganu Cluj-Napoca, Str. Clinicilor nr 32, Cluj-Napoca 400056, Romania
| | | | - Andreas Stavropoulos
- Department of Periodontology, University of Malmö, Carl Gustafs väg 34, 214 21 Malmö, Sweden
| | - Nicole Arweiler
- Department of Periodontology and Peri-Implant Diseases, Philipps University of Marburg, Georg-Voigt. Str. 3, Marburg 35039, Germany
| | - Anton Sculean
- Department of Periodontology, University of Bern, Freiburgstrasse, 7, Bern CH-3010, Switzerland.
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Murugan T, Inbasekaran D, Murthykumar K. Enhanced Gingival Recession Coverage by Er,Cr:YSGG Laser Root Biomodification. Contemp Clin Dent 2021; 12:328-331. [PMID: 34759695 PMCID: PMC8525809 DOI: 10.4103/ccd.ccd_720_20] [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: 08/18/2020] [Revised: 10/10/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
Gingival recession predisposes to functional and aesthetic concerns, for which many surgical procedures are available. Among these, till now subepithelial connective graft is considered as the gold standard technique for its higher predictability of achieving recession coverage. However, it does not heal by new attachment, thus many techniques to promote new attachment such as root biomodification are done. This case enumerates the use of Er, Cr: YSGG laser for root biomodification to treat a wide and deep gingival recession defect by subpedicle connective tissue graft. Six months results show better recession coverage inspite of a wide and deeper defect. Thus, Er, Cr: YSGG laser can be an adjunctive tool to enhance the recession coverage.
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Affiliation(s)
- Thamaraiselvan Murugan
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Dipika Inbasekaran
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Karthikeyan Murthykumar
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
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Tunkel J, Hofmann F, de Stavola L. The multiple pedicle coronally advanced flap for multiple deep Miller-Class-II-recessions: A case report. Clin Adv Periodontics 2021; 11:176-182. [PMID: 34250744 DOI: 10.1002/cap.10177] [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: 05/19/2021] [Accepted: 06/26/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In recent years, several methods have been described for the treatment of deep Miller-Class-II-recessions. Most of these techniques concentrate on single recessions or one deep recession accompanied by just slight neighboring root denudations. A modified technique is presented for treating two or more deep recessions beyond the mucogingival margin combining a subepithelial connective tissue graft (SCTG), enamel matrix derivative, and a multiple pedicle coronally advanced flap. To the best of our knowledge, this is the first report to describe the treatment of multiple deep Miller-Class-II-recessions exceeding beyond the mucogingival junction using a pedicled advanced flap. CASE PRESENTATION A 29-year-old woman was referred to the periodontal practice of JT for the treatment of progressive deep Miller-Class-II-recessions. The root coverage procedure was performed by a modified multiple pedicle flap combined with a connective tissue graft harvested from the palate and enamel matrix derivative. The case was followed up for 2 years. CONCLUSIONS This modified technique of a multiple pedicled flap is a feasible and useful method for treating several deep neighboring recessions. Due to the improved incision techniques, scar tissue formation might be reduced not to interfere with the esthetic result.
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Ferreira CF, Wong D, Binkley LH. "Crawling Attachment" during Periodontally Accelerated Osteogenic Orthodontics Procedure. Contemp Clin Dent 2021; 12:179-183. [PMID: 34220160 PMCID: PMC8237815 DOI: 10.4103/ccd.ccd_376_20] [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: 05/06/2020] [Accepted: 07/21/2020] [Indexed: 12/04/2022] Open
Abstract
The present clinical case reports an increased zone of keratinized gingiva that was generated following surgical excision of the gingiva during periodontally accelerated osteogenic orthodontics. The present case consists of angle Class I with mal-aligned teeth and impacted #11. The patient was evaluated up to 2 years and 1 month (2.1) showing a stable increased zone of keratinized tissue. Possible causes for this event are discussed in this case report. Additional long-term clinical studies are necessary to support these results.
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Affiliation(s)
- Cimara Fortes Ferreira
- Department of Periodontology, University of Tennessee Health Sciences College of Dentistry, Memphis, TN, USA
| | - David Wong
- Private Practice, Post-Graduate Program in Periodontics, University of Tennessee Health Sciences College of Dentistry, Memphis, TN, USA
| | - Lesley H Binkley
- Department of Periodontology, University of Tennessee Health Sciences College of Dentistry, Memphis, TN, USA
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16
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Rimbert M, Barré R. New surgical approach for mandibular anterior root coverage by modified tunnel technique with simultaneous frenuloplasty: Technical description and 5-year recall case report. Clin Adv Periodontics 2021; 11:155-160. [PMID: 33913627 DOI: 10.1002/cap.10163] [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: 03/12/2021] [Accepted: 04/22/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Root coverage of gingival recessions in the anterior mandible has limited predictability. Mandibular incisors often offers a thin phenotype, a lack of keratinized tissue and moreover a shallow vestibule with high labial frenum attachment. These conditions induce tensions on the surgical site in conventional coronally advanced flap (CAF) procedures and may compromise the complete root coverage. The purpose of this case report is to present a novel surgical technique for deep labial recessions on mandibular incisors, based on a modified tunnel technique with subepithelial connective tissue graft (CTG) in combination with simultaneous frenuloplasty. CASE PRESENTATION A 20-year-old female patient was referred to the office for treatment of an isolated RT1 in Cairo classification buccal recession on #24 with a shallow vestibule. The design of the recipient site consisted of a full-thickness modified tunnel preparation extending 4 mm bilaterally to the recession and beyond the crestal bone. A CTG was harvested from the palate and properly adapted to the root surface. The graft and flap were secured with single-interrupted sutures and double-crossed sutures to achieve complete root coverage. Frenuloplasty was then performed with a single incision in the bottom of the vestibule and careful sectioning of frenum fibers to release vestibular tensions. Complete root coverage was maintained at 5 years with completely satisfactory esthetic outcomes. CONCLUSION Treatment of single deep mandibular anterior recessions with a combined tunneled CTG approach in addition to frenuloplasty appears to lead to complete long-term root coverage in one surgery with lasting esthetics results.
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Affiliation(s)
- Matthieu Rimbert
- Private practice, Toulouse, France.,Department of Periodontology, Paul Sabatier University, Toulouse, France
| | - Ronan Barré
- Private practice, Vic Fezensac, France.,Department of Periodontology, Paul Sabatier University, Toulouse, France
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17
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Said KN, Abu Khalid AS, Farook FF. Distal extension of palatal rugae as a limitation for donor soft tissue grafts in a Jordanian population: A cross-sectional study. BMC Oral Health 2021; 21:203. [PMID: 33892695 PMCID: PMC8066888 DOI: 10.1186/s12903-021-01561-9] [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: 06/14/2020] [Accepted: 04/12/2021] [Indexed: 11/11/2022] Open
Abstract
Background The purpose of the cross sectional study was to investigate the distal extension of the rugae area in a Jordanian (Middle Eastern) population, as an anatomical limitation influencing the surgical decision of harvesting a palatal soft tissue graft. Factors that may influence or predict the extension were also assessed. Methods Sixty periodontally healthy participants (29 males and 31 females) were included. Maxillary alginate impressions were made and casts were poured. The measurements were highlighted from the origin of the rugae (near mid palatine raphe) to the terminal end with a sharp graphite pencil on the cast and a magnification lens was used for identification. The most posterior extension of the rugae were marked on the casts and determined by a standardized periodontal probe. The normal approximation test for binomial distribution was used to determine the proportion of the subjects with rugael extensions beyond the mesial end of the upper second premolar and fisher’s exact test for the purpose of analysis of the association of this extension with other factors. Results In almost half (41.7%) of the sample, the rugae extended distal to the upper second premolar, 23.3% extended to the mid-palatal of the upper second premolar, and 11.7% extended to the mesial of the upper second premolar. The implication is that 90.0% of the rugae reached the upper second premolar and 78.3% extended beyond its mesial aspect. The normal approximation test performed with 95% CI with the "rugael extension proximal to the mesial end of the upper 2nd premolar" considered to be the "success" category revealed that the proportion of the subjects with rugael extensions proximal to the mesial end of the upper second premolar was significantly lower than the proportion beyond the mesial end of the upper second premolar (95% CI of 11.2–32.0%, p = .00001). There was no significant difference between gender, smoking status, gingival phenotype and palatal shape with the posterior extension of palatal rugae. Conclusions Palatal rugae in a sample of a Jordanian population extends beyond the mesial aspect of the upper second premolar which may cause a substantial limitation for graft harvesting from the palate. The hard palate of Jordanian patients may not be a reliable source of soft tissue grafts required for aesthetic mucogingival surgery. No significant association existed between the most posterior extent of palatal rugae and gender, gingival phenotype or palatal shape. Other possible sources should be explored.
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Affiliation(s)
- Khalid Nazmi Said
- Department of Dentistry, Oral Health Institute, Hamad Medical Corporation, Doha, Qatar
| | - Areej Sulaiman Abu Khalid
- Department of Dental and Oral Health, Prince Sultan Military College of Health Sciences, Dhahran, Kingdom of Saudi Arabia
| | - Fathima Fazrina Farook
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 11426, Saudi Arabia. .,King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
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18
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Fernández-Jiménez A, García-De-La-Fuente AM, Estefanía-Fresco R, Marichalar-Mendia X, Aguirre-Urizar JM, Aguirre-Zorzano LA. Complete root coverage in the treatment of Miller class III or RT2 gingival recessions: a systematic review and meta-analysis. BMC Oral Health 2021; 21:145. [PMID: 33752657 PMCID: PMC7986294 DOI: 10.1186/s12903-021-01494-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background The primary objective of this systematic review and meta-analysis was to assess the evidence on complete root coverage (CRC) achieved by periodontal plastic techniques in the treatment of Miller class III/RT2 gingival recessions, comparing techniques developed along the twentieth century (pre-twenty-first) versus surgical approaches of the twenty-first century (21st). Methods An electronic bibliographic search was carried out in four databases up to December 2019, focusing on studies that reported CRC results in Miller class III or RT2 recessions treatment with at least a six-month follow-up. In addition, a random-effects models’ meta-analysis was performed for the CRC, comparing pre-twenty-first versus twenty-first century techniques at 6 months, 12 months and more than 12 months. Results Thirty-seven publications were included. A total of 933 gingival recessions were treated, 298 with pre-twenty-first century surgical techniques and 635 with techniques from the twenty-first century. CRC was achieved at 6 months on half of the recessions (pre-twenty-first: 57.60% vs. 21st: 51.11%), but decreased markedly for twenty-first century techniques at 12 months (pre-twenty-first: 63.82% vs. 21st: 32.87%). Thereafter, this difference was the other way around (> 12 months: pre-twenty-first: 5.26% vs. 21st: 19.65%). The meta-analysis showed a high heterogeneity, with no significant differences amongst the techniques. Conclusions Although CRC might be achievable by treating Miller class III or RT2 recessions with any of the described techniques, its long-term stability is not predictable. More randomized clinical trials with longer follow-ups and several visits, are needed. In addition, the patient’s satisfaction should also be assessed. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01494-3.
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Affiliation(s)
- Aitziber Fernández-Jiménez
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - Ana-María García-De-La-Fuente
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain.
| | - Ruth Estefanía-Fresco
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - Xabier Marichalar-Mendia
- Department of Nursing I, University of the Basque Country (UPV/EHU), Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - José-Manuel Aguirre-Urizar
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - Luis-Antonio Aguirre-Zorzano
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
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19
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Dias JJ, Panwar M, Kosala M. Management of inadequate keratinized gingiva and millers class III or IV gingival recession using two-stage free gingival graft procedure. J Indian Soc Periodontol 2020; 24:554-559. [PMID: 33424173 PMCID: PMC7781245 DOI: 10.4103/jisp.jisp_531_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 07/16/2020] [Accepted: 08/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Prognosis in the management of Millers Class III or IV gingival recession is often fair to poor, which is further decreased by factors such as inadequate keratinized gingiva. Very few modalities show long-term success in the management of gingival recession with inadequate keratinized gingiva, free gingival graft (FGG) being one such technique. Materials and Methods: Ten individuals with Millers Class III or IV recession and inadequate keratinized gingiva were recruited for the study. The first surgical procedure involved the FGG procedure to increase the width of keratinized gingiva (WOKG). Patients were recalled after 3 months for the second surgical procedure, where the flap was coronally advanced. They were recalled 9 months after the second surgery. WOKG was examined at baseline and 3 months (before the second surgical procedure). Recession depth (RD) and clinical attachment level (CAL) was examined at baseline, at 3 months (before the second surgical procedure) and at 12 months (9 months after the second surgical procedure). The percentage of root coverage was measured at 12 months from baseline. Results: Significant increase in WOKG was seen at 3 months. Significant decrease in RD and CAL was observed at 12 months from baseline. The percentage of root coverage was 76.4%. Conclusion: Two-stage FGG procedure can be a successful modality in the management of Millers Class III or IV recession with inadequate keratinized gingiva. This technique improves the prognosis of such compromised cases.
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Affiliation(s)
| | - Mohinder Panwar
- Department of Dental Surgery and Oral Health Sciences, AFMC, Pune, Maharashtra, India
| | - Manab Kosala
- Department of Dental Surgery and Oral Health Sciences, AFMC, Pune, Maharashtra, India
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20
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A Modified Bilaminar Technique with the Use of a Fibrin-Fibronectin System for a Single Gingival Recession: A Case Report with a Follow-Up of 3 Years. Case Rep Dent 2020; 2020:3892753. [PMID: 33062343 PMCID: PMC7545419 DOI: 10.1155/2020/3892753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022] Open
Abstract
This case report described a modified bilaminar technique for treating a single gingival recession. Patient presented a gingival recession in a maxillary canine. Tooth was in a buccally prominent position and soft keratinized tissue apical to the recession was reduced but still present. A split-full-split thickness trapezoidal flap was designed. Root's surface was prepared with curettes. Epithelial-connective tissue graft was harvested from the palate with reduced dimension. After deepithelialization, the graft was placed with a fibrin-fibronectin system at the maximum root coverage level, and the flap coronally advanced and sutured. At 3-year follow-up control, the free gingival margin was still stable at the postsurgery position, with a thicker biotype corresponding to the grafted area, with no probing and a suitable aesthetic result.
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21
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Deeb JG, Deeb GR. Oral Soft Tissue Grafting. Oral Maxillofac Surg Clin North Am 2020; 32:611-630. [PMID: 32912774 DOI: 10.1016/j.coms.2020.07.006] [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: 10/23/2022]
Abstract
The presence of healthy soft tissue at the tooth and implant interface correlates to long-term success and stability in function and esthetics. Grafting procedures utilizing various techniques can be performed during any stage of the implant or restorative therapy. Materials of autogenous, allogeneic, and xenogeneic sources are available for oral soft tissue grafting. This article describes the classifications of soft tissue defects, treatment modalities, and materials used to enhance soft tissue quality and quantity and to achieve optimal esthetics and function around teeth and implants.
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Affiliation(s)
- Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, 521 North 11th Street, Richmond, VA 23298, USA
| | - George R Deeb
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, 521 North 11th Street, Richmond, VA 23298, USA.
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22
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Chambrone L, Avila-Ortiz G. An evidence-based system for the classification and clinical management of non-proximal gingival recession defects. J Periodontol 2020; 92:327-335. [PMID: 32738056 DOI: 10.1002/jper.20-0149] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/08/2020] [Accepted: 05/19/2020] [Indexed: 11/11/2022]
Abstract
Gingival recession defect (GRD) may be defined as an apical migration of the gingival margin respective to the cementoenamel junction resulting in partial exposure of the root surface to the oral cavity, which may have important esthetic, functional, and periodontal health implications. A novel system for the classification and management of non-proximal GRDs is proposed in this article. This evidence-based system consists of two essential components: (1) Establishment of the GRD type based on the midbuccal/midlingual attachment level respective to the interproximal bone level, and (2) Assessment of the gingival phenotype according to the width of attached gingiva and gingival thickness. Each category of this new classification system is linked with treatment recommendations substantiated by relevant literature pertaining to the outcomes of validated root coverage procedures in specific scenarios, which can be used as a guide for clinical decision-making in daily practice.
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Affiliation(s)
- Leandro Chambrone
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA.,MSc Dentistry Program, Ibirapuera University School of Dentistry, São Paulo, Brazil.,Unit of Basic Oral Investigations (UIBO), Universidad El Bosque, School of Dentistry, Bogotá, Colombia
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
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23
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Salem S, Salhi L, Seidel L, Lecloux G, Rompen E, Lambert F. 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:E2641. [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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Affiliation(s)
- Souheil Salem
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, 4000 Liege, Belgium; (S.S.); (L.S.); (G.L.); (E.R.)
| | - Leila Salhi
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, 4000 Liege, Belgium; (S.S.); (L.S.); (G.L.); (E.R.)
| | - Laurence Seidel
- Biostatistics and Medico-Economic Information, University Hospital of Liège, 4000 Liège, Belgium;
| | - Geoffrey Lecloux
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, 4000 Liege, Belgium; (S.S.); (L.S.); (G.L.); (E.R.)
| | - Eric Rompen
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, 4000 Liege, Belgium; (S.S.); (L.S.); (G.L.); (E.R.)
| | - France Lambert
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, 4000 Liege, Belgium; (S.S.); (L.S.); (G.L.); (E.R.)
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24
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Monika K, Sunkala L, Sandeep N, Keerthi K, Bharathi BV, Madhav GV. Evaluation of root coverage with pedicled buccal fat pad in class III and class IV gingival recession defects. J Family Med Prim Care 2020; 9:1656-1661. [PMID: 32509667 PMCID: PMC7266237 DOI: 10.4103/jfmpc.jfmpc_1104_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: 12/04/2019] [Revised: 02/05/2020] [Accepted: 02/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Gingival recession (GR) is a common clinical feature of periodontal disease and is an undesirable condition. More than 50% of the population has one or more sites with GR ≥ 1 mm. Material and Methods: In this study 15 subjects were subjected to initial periodontal therapy such as ultrasonic scaling and root planning with hand instruments and curettes. Patient is motivated for home care. The buccal fat pad is harvested and sutured in the gingival recession area and followed up for 6 months and root coverage was calculated. Results: At baseline mean recession of 5.60 ± 1.18 mm, probing depth of 0.73 ± 0.59 mm, clinical attachment loss of 6.40 ± 1.18 mm were recorded. At the end of 6 months, the mean recession was reduced from 5.60 ± 1.18 mm to 2.87 ± 0.74 mm, probing depth was increased from 0.73 ± 0.59 mm to 1.73 ± 0.70 mm and clinical attachment loss was decreased from 6.40 ± 1.18 mm to 4.53 ± 0.83 mm.The difference between baseline score and six months score for all three parameters are statistically significant. Conclusion: Buccal fat pad is a predictable procedure to cover Miller's class III and class IV gingival recession defects. There was a definitive improvement in clinical parameters (reduction in gingival recession, increased probing depth, gain in clinical attachment) after 6 months. There was 46.78% improvement in root coverage which was statistically significant.
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Affiliation(s)
- K Monika
- Private Practitioner, Department of Periodontics, Panineeniya Institute of Dental Sciences, Hyderabad, India
| | - Lokesh Sunkala
- Department of Prosthodontics Crown and Bridge, Army College of Dental Sciences, Secunderabad, Telangana, India
| | - N Sandeep
- Private Practitioner, Department of Periodontics, Panineeniya Institute of Dental Sciences, Hyderabad, India
| | - K Keerthi
- Private Practitioner, General Dentistry, Hyderabad, India
| | - B Vimal Bharathi
- Department of Prosthodontics Crown and Bridge, Panineeniya Institute of Dental Sciences, Hyderabad, India
| | - Gajula Venu Madhav
- Department of Prosthodontics Crown and Bridge, Army College of Dental Sciences, Secunderabad, Telangana, India
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25
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Tavelli L, Barootchi S, Di Gianfilippo R, Modarressi M, Cairo F, Rasperini G, Wang HL. Acellular dermal matrix and coronally advanced flap or tunnel technique in the treatment of multiple adjacent gingival recessions. A 12-year follow-up from a randomized clinical trial. J Clin Periodontol 2019; 46:937-948. [PMID: 31242333 DOI: 10.1111/jcpe.13163] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/15/2019] [Accepted: 06/23/2019] [Indexed: 11/25/2022]
Abstract
AIM To evaluate the long-term outcomes of Acellular Dermal Matrix (ADM) with Coronally Advanced Flap (CAF) or Tunnel technique (TUN) in the treatment of multiple adjacent gingival recessions (MAGRs). MATERIAL AND METHODS Nineteen of the original 24 patients contributing to a total number of 33 sites for CAF and 34 for TUN were available for the 12 years follow-up examination. Recession depth, mean root coverage (mRC), keratinized tissue width (KTW), gingival thickness (GT) were evaluated and compared with baseline values and 6-months results. Regression analysis was performed to identify factors related to the stability of the gingival margin. RESULTS A highly significant drop in mRC was observed for both groups from the 6 months timepoint to the 12 years recall (p < .001). While there were no statistically significant differences between the two groups in terms of Clinical Attachment Level (CAL), KTW, GT changes and Root Coverage Esthetic Score at each timepoint (p > .05). KTW ≥ 2 mm and GT ≥ 1.2 mm at 6-months were two predictors for stability of the gingival margin (p = .03 and p = .01, respectively). CONCLUSIONS A significant relapse of the gingival margin of MAGRs treated with CAF or TUN + ADM was observed after 12 years.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Riccardo Di Gianfilippo
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Marmar Modarressi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Private Practice, Chicago, IL, USA
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Surgery and Translational Medicine, University of Florence, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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26
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Zucchelli G, Tavelli L, Barootchi S, Stefanini M, Rasperini G, Valles C, Nart J, Wang H. The influence of tooth location on the outcomes of multiple adjacent gingival recessions treated with coronally advanced flap: A multicenter re‐analysis study. J Periodontol 2019; 90:1244-1251. [DOI: 10.1002/jper.18-0732] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/05/2019] [Accepted: 02/25/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Giovanni Zucchelli
- Department of Biomedical and Neuromotor SciencesUniversity of Bologna Bologna Italy
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
| | - Lorenzo Tavelli
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
| | - Shayan Barootchi
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor SciencesUniversity of Bologna Bologna Italy
| | - Giulio Rasperini
- Department of BiomedicalSurgical and Dental SciencesFoundation IRCCS Ca’ Granda PolyclinicUniversity of Milan Milan Italy
| | - Cristina Valles
- Department of PeriodontologySchool of Dentistry, UniversitatInternational de Catalunya Barcelona SC Spain
| | - José Nart
- Department of PeriodontologySchool of Dentistry, UniversitatInternational de Catalunya Barcelona SC Spain
| | - Hom‐Lay Wang
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
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27
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Moisa DH, Connolly JA, Cheng B, Lalla E. Impact of connective tissue graft thickness on surgical outcomes: A pilot randomized clinical trial. J Periodontol 2019; 90:966-972. [PMID: 31020642 DOI: 10.1002/jper.18-0741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/25/2019] [Accepted: 02/15/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to compare thick versus thin connective tissue grafts (CTG) for the treatment of gingival recession, over a 3-month period. METHODS Forty-two CTG procedures were performed on single tooth Miller Class I or II recession defects at either premolar or anterior sites in 30 individuals. Procedures were randomized (1:1 ratio) to CTG thickness of 1 or 2 mm (parallel group design). Primary outcomes were the change in the width of the zone of keratinized tissue and the amount of root coverage achieved 3 months postoperatively at the recipient site. Secondary outcomes included change in the thickness of keratinized tissue at 3 months and patient-reported outcomes, such as pain, bleeding, and swelling at both the recipient and donor sites at 1 week, 2 weeks, 1 month, and 3 months. RESULTS No significant differences were found between the two groups for any of the primary or secondary outcomes. Mean root coverage achieved was 2.1 ± 0.2 mm in the 1-mm thick group and 2.5 ± 0.2 mm in the 2-mm thick group (P = 0.33). Keratinized tissue width was increased by 2.2 ± 0.2 mm in the 1-mm thick group and by 2.7 ± 0.3 mm in the 2-mm thick group (P = 0.18). Keratinized tissue thickness was increased by 1.0 ± 0.1 mm and by 1.2 ± 0.1 mm in the 1- and 2-mm thick groups, respectively (P = 0.09). CONCLUSION Within the current study limitations, our results suggest that similar root coverage and increase in the width and thickness of keratinized tissue can be achieved at 3 months whether a 1- or 2-mm thick CTG is used.
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Affiliation(s)
- David H Moisa
- Division of Periodontics, College of Dental Medicine, Columbia University, New York, NY
| | - Julie A Connolly
- Division of Periodontics, College of Dental Medicine, Columbia University, New York, NY
| | - Bin Cheng
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Evanthia Lalla
- Division of Periodontics, College of Dental Medicine, Columbia University, New York, NY
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Chambrone L, Castro Pinto RCN, Chambrone LA. The concepts of evidence‐based periodontal plastic surgery: Application of the principles of evidence‐based dentistry for the treatment of recession‐type defects. Periodontol 2000 2019; 79:81-106. [DOI: 10.1111/prd.12248] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Leandro Chambrone
- M.Sc. Dentistry Program Ibirapuera University Sao Paulo SP Brazil
- Unit of Basic Oral Investigation (UIBO) School of Dentistry El Bosque University Bogota Colombia
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Goyal L, Gupta ND, Gupta N, Chawla K. Free Gingival Graft as a Single Step Procedure for Treatment of Mandibular Miller Class I and II Recession Defects. World J Plast Surg 2019; 8:12-17. [PMID: 30873357 PMCID: PMC6409142 DOI: 10.29252/wjps.8.1.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gingival recession is a frequent issue encountered by both the clinician and the patient. This study was aimed to assess the predictability of the free gingival graft as a single step procedure in terms of root coverage and aesthetics in Miller Class I and II mandibular gingival recession. METHODS Ten patients (4 males, 6 females) aged 25-30 years with a total of 12 mandibular sites having Miller class I and II recession were selected. All recession sites were treated with single step free gingival graft procedure. Clinical parameters like recession depth, recession width, width of attached gingiva, probing depth and clinical attachment level were recorded at baseline, 6 and 9 months. Visual analog score at 1, 6 and 9 months postoperatively was provided. RESULTS There was a reduction in mean recession depth from 3.66±1.20 to 0.91±0.99 mm suggesting coverage of 82% over a period of 9 months. There was statistically significant gain in clinical attachment level and width of attached gingiva. Aesthetically, it was acceptable by patients as measured by visual analog scores. CONCLUSION Free gingival graft as a single step procedure is acceptable in terms of root coverage and aesthetics.
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Affiliation(s)
- Lata Goyal
- Department of Dentistry, All India Institute of Medical Sciences, Rishikesh, India
- Corresponding Author: Lata Goyal, MDS; Senior Research Associate, Department of Dentistry, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, 249201 India. E-mail:
| | - Narender Dev Gupta
- Department of Periodontics and Community Dentistry, Dr. Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh India
| | - Namita Gupta
- Department of Periodontics and Community Dentistry, Dr. Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh India
| | - Kirti Chawla
- Department of Periodontology, Jamia Millia Islamia, New Delhi, India
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Chambrone L, Salinas Ortega MA, Sukekava F, Rotundo R, Kalemaj Z, Buti J, Pini Prato GP. Root coverage procedures for treating localised and multiple recession-type defects. Cochrane Database Syst Rev 2018; 10:CD007161. [PMID: 30277568 PMCID: PMC6517255 DOI: 10.1002/14651858.cd007161.pub3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable root coverage periodontal plastic surgery (RCPPS) procedures. This review is an update of the original version that was published in 2009. OBJECTIVES To evaluate the efficacy of different root coverage procedures in the treatment of single and multiple recession-type defects. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 12) in the Cochrane Library (searched 15 January 2018), MEDLINE Ovid (1946 to 15 January 2018), and Embase Ovid (1980 to 15 January 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 January 2018). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) only of at least 6 months' duration evaluating recession areas (Miller's Class I or II ≥ 3 mm) and treated by means of RCPPS procedures. DATA COLLECTION AND ANALYSIS Screening of eligible studies, data extraction and risk of bias assessment were conducted independently and in duplicate. Authors were contacted for any missing information. We expressed results as random-effects models using mean differences (MD) for continuous outcomes and odds ratios (OR) for dichotomous outcomes with 95% confidence intervals (CI). We used GRADE methods to assess the quality of the body of evidence of our main comparisons. MAIN RESULTS We included 48 RCTs in the review. Of these, we assessed one as at low risk of bias, 12 as at high risk of bias and 35 as at unclear risk of bias. The results indicated a greater reduction in gingival recession for subepithelial connective tissue grafts (SCTG) + coronally advanced flap (CAF) compared to guided tissue regeneration with resorbable membranes (GTR rm) + CAF (MD -0.37 mm; 95% CI -0.60 to -0.13, P = 0.002; 3 studies; 98 participants; low-quality evidence). There was insufficient evidence of a difference in gingival recession reduction between acellular dermal matrix grafts (ADMG) + CAF and SCTG + CAF or between enamel matrix protein (EMP) + CAF and SCTG + CAF. Regarding clinical attachment level changes, GTR rm + CAF promoted additional gains compared to SCTG + CAF (MD 0.35; 95% CI 0.06 to 0.63, P = 0.02; 3 studies; 98 participants; low-quality evidence) but there was insufficient evidence of a difference between ADMG + CAF and SCTG + CAF or between EMP + CAF and SCTG + CAF. Greater gains in the keratinized tissue were found for SCTG + CAF when compared to EMP + CAF (MD -1.06 mm; 95% CI -1.36 to -0.76, P < 0.00001; 2 studies; 62 participants; low-quality evidence), and SCTG + CAF when compared to GTR rm + CAF (MD -1.77 mm; 95% CI -2.66 to -0.89, P < 0.0001; 3 studies; 98 participants; very low-quality evidence). There was insufficient evidence of a difference in keratinized tissue gain between ADMG + CAF and SCTG + CAF. Few data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure. AUTHORS' CONCLUSIONS Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for treating localised or multiple recession-type defects. The available evidence base indicates that in cases where both root coverage and gain in the width of keratinized tissue are expected, the use of subepithelial connective tissue grafts shows a slight improvement in outcome. There is also some weak evidence suggesting that acellular dermal matrix grafts appear as the soft tissue substitute that may provide the most similar outcomes to those achieved by subepithelial connective tissue grafts. RCTs are necessary to identify possible factors associated with the prognosis of each RCPPS procedure. The potential impact of bias on these outcomes is unclear.
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Affiliation(s)
| | | | | | | | | | - Jacopo Buti
- UCL Eastman Dental InstituteUnit of PeriodontologyLondonUK
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Clementini M, Discepoli N, Danesi C, de Sanctis M. Biologically guided flap stability: the role of flap thickness including periosteum retention on the performance of the coronally advanced flap-A double-blind randomized clinical trial. J Clin Periodontol 2018; 45:1238-1246. [DOI: 10.1111/jcpe.12998] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/02/2018] [Accepted: 08/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Marco Clementini
- Department of Periodontology; Università Vita-Salute San Raffaele; Milan Italy
| | - Nicola Discepoli
- Department of Medical Biotechnologies; Unit of Periodontics; Università degli Studi di Siena; Siena Italy
| | - Carlotta Danesi
- Department of Periodontology; Università Vita-Salute San Raffaele; Milan Italy
| | - Massimo de Sanctis
- Department of Periodontology; Università Vita-Salute San Raffaele; Milan Italy
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Chambrone L, Pini Prato GP. Clinical insights about the evolution of root coverage procedures: The flap, the graft, and the surgery. J Periodontol 2018; 90:9-15. [DOI: 10.1002/jper.18-0281] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/13/2018] [Accepted: 06/27/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Leandro Chambrone
- School of Dentistry; Ibirapuera University (Unib); São Paulo Brazil
- Unit of Basic Oral Investigation (UIBO); School of Dentistry; El Bosque University; Bogota Colombia
- Department of Periodontics; College of Dentistry and Dental Clinics; The University of Iowa; Iowa City IA
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Zucchelli G, Tavelli L, Ravidà A, Stefanini M, Suárez-López del Amo F, Wang HL. Influence of tooth location on coronally advanced flap procedures for root coverage. J Periodontol 2018; 89:1428-1441. [DOI: 10.1002/jper.18-0201] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/20/2018] [Accepted: 05/27/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI
| | - Andrea Ravidà
- Department of Periodontics & Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | | | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI
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Shkreta M, Atanasovska-Stojanovska A, Dollaku B, Belazelkoska Z. Exploring the Gingival Recession Surgical Treatment Modalities: A Literature Review. Open Access Maced J Med Sci 2018; 6:698-708. [PMID: 29731944 PMCID: PMC5927507 DOI: 10.3889/oamjms.2018.185] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 12/01/2022] Open
Abstract
Gingival recessions present complex soft tissue pathology, with a multiple aetiology and a high prevalence which increases with age. They are defined as an exposure of the root surface of the teeth as a result of the apical migration of the gingival margin beyond the cementum-enamel junction, causing functional and aesthetic disturbances to the affected individuals. Aiming to ensure complete root coverage and satisfying aesthetic outcomes, a wide range of surgical techniques have been proposed through the decades for the treatment of the gingival recessions. The following literature review attempts to provide a comprehensive, structured and up-to-date summary of the relevant literature regarding these surgical techniques, aiming to emphasise for each technique its indications, its long-term success and predictability, its advantages and disadvantages about each other.
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Affiliation(s)
- Mirsad Shkreta
- Department of Oral Pathology and Periodontology, Dental Clinical Center, Faculty of Stomatology, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Aneta Atanasovska-Stojanovska
- Department of Oral Pathology and Periodontology, Dental Clinical Center, Faculty of Stomatology, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Blerta Dollaku
- Department of Restorative Dentistry and Endodontics, Faculty of Dentistry, University “Hasan Prishtina”, Prishtina, Kosovo
| | - Zlatanka Belazelkoska
- Department of Oral Pathology and Periodontology, Dental Clinical Center, Faculty of Stomatology, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Stefanini M, Marzadori M, Aroca S, Felice P, Sangiorgi M, Zucchelli G. Decision making in root-coverage procedures for the esthetic outcome. Periodontol 2000 2018; 77:54-64. [DOI: 10.1111/prd.12205] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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36
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Cairo F. Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontol 2000 2017; 75:296-316. [DOI: 10.1111/prd.12186] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lingeshwaran S, Theyagarajan R, Namasivayam A. Staged Approach for Advanced Gingival Recession: Free Gingival Autograft Followed by Coronally Advanced Flap with PRF Membrane. J Clin Diagn Res 2017; 11:ZJ01-ZJ02. [PMID: 28658928 DOI: 10.7860/jcdr/2017/25458.9768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/01/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Sowmiya Lingeshwaran
- Senior Lecturer, Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Ramakrishnan Theyagarajan
- Professor and Head, Department of Periodontics, Adhiparasakthi Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Ambalavanan Namasivayam
- Professor and Head, Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
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Jenabian N, Khanjani N, Bijani A. The comparison of modified semilunar technique in conjunction with connective tissue and subepithelial connective tissue graft for root coverage: a randomized controlled trial. Electron Physician 2017; 9:3699-3705. [PMID: 28465795 PMCID: PMC5410894 DOI: 10.19082/3699] [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: 04/27/2016] [Accepted: 08/21/2016] [Indexed: 11/24/2022] Open
Abstract
Background Gingival recession may result in aesthetically unfavourable effects, difficulty in plaque control, increased susceptibility to root caries, and dentin hypersensitivity. Objective The aim of this study was to compare the use of modified semilunar techniques with connective tissue and subepithelial connective tissue grafts (Langer) for denuded root surface coverage. Methods In this randomized clinical trial, fourteen localized recessions of Miller class I to II were treated in 5 subjects. Recessions were randomly treated with modified semilunar techniques (test group) and a subepithelial connective tissue graft (control group). Clinical parameters such as clinical attachment level (CAL), keratinized tissue width (KTW), probing pocket depth (PPD), vertical recession depth (VRD) and recession width (RW)were recorded at base line, 1, 3 and 6 months after surgery and healing index and the subject’s satisfaction was evaluated. The repeated measure test and paired-sample t-test were used for statistical analyses by SPSS. Results Both methods showed significant improvement in clinical parameters. The healing index (HI) in the test group was a slightly more than the control group in Day 10. Aesthetic VAS (Visual Analogue Scale) levels in the test group were more than the control group in 1, 3 and 6 months (test group, in 1 month 6.57±1.13, in 3 month 7.86±1.07, in 6 month 8.00±0.81. control group in 1 month 5.57±1.13, in 3 month 7.00±1.00, in 6 month 7.14±0.90). The KTW, CAL, VRD and RW level’s difference in the test and control group was significant in 6 month compared to the base line (p=0.000). Conclusions The present study shows that treatment of Miller Class I and II gingival recession by the modified semilunar technique is acceptable. Clinical trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT201512021760N43. Date registered: December 27, 2015. Funding The authors received no financial support for the research, authorship, and/or publication of this article.
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Affiliation(s)
- Niloofar Jenabian
- Specialist in Periodontology, Associate Professor, Department of Periodontology, Faculty of Dentistry, Babol University of Medical Science, Babol, Iran
| | - Nafiseh Khanjani
- Postgraduate Student in Periodontology, Department of Periodontology, Faculty of Dentistry, Babol University of Medical Science, Babol, Iran
| | - Ali Bijani
- M.D., Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Science, Babol, Iran
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Santos FR, Storrer CLM, Cunha EJ, Ulbrich LM, Lopez CAV, Deliberador TM. Comparison of conventional and semilunar coronally positioned flap techniques for root coverage in teeth with cervical abrasion restored with pink resin. Clin Cosmet Investig Dent 2017; 9:7-11. [PMID: 28331369 PMCID: PMC5352164 DOI: 10.2147/ccide.s119040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gingival recession is the most common mucogingival defect, characterized by apical migration of the gingival margin from the cementoenamel junction and root exposure. Several surgical techniques are reported for the treatment of gingival recession. Here we present a comparison of the conventional (coronally advanced flap) and semilunar coronally positioned flap techniques for root coverage in teeth with cervical abrasion restored with pink resin that mimics the color of the gingiva. Although the conventional technique is more predictable, we found that both techniques were effective in achieving satisfactory and esthetic root coverage.
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Affiliation(s)
| | | | | | - Lucienne M Ulbrich
- Department of Dentistry, Universidade Positivo, Curitiba, Paraná, Brazil
| | - Camilo Andress Villabona Lopez
- Department of Dentistry, University of Santo Tomás, Bucaramanga, Santander, Colombia; Department of Implantology, Federal University of Santa Cataria, Florianópolis, Brazil
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Ridge Preservation Comparing a Nonresorbable PTFE Membrane to a Resorbable Collagen Membrane: A Clinical and Histologic Study in Humans. IMPLANT DENT 2017; 25:128-34. [PMID: 26655097 DOI: 10.1097/id.0000000000000370] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The primary aim of this randomized, controlled, blinded clinical trial was to compare the effect of a resorbable collagen membrane (CM group) versus a nonresorbable high-density polytetrafluoroethylene membrane (PTFE group) on the clinical and histologic outcomes of a ridge preservation procedure. MATERIALS AND METHODS All 24 sites received an intrasocket cancellous allograft and a buccal overlay bovine derived xenograft. RESULTS The change in horizontal crestal ridge width was -1.4 ± 1.2 mm for the CM group, whereas the PTFE group lost -2.2 ± 1.5 mm, which was not statistically significant between groups (P > 0.05). Vertical ridge height change was -1.2 ± 1.5 for the CM group, whereas the PTFE group lost -0.5 ± 1.6, which was not significantly different between groups (P > 0.05). The percent vital bone was similar and not significantly different between groups. Primary closure was not obtained and the exposed membrane portion over the socket opening healed with keratinized tissue. CONCLUSION The choice of a resorbable versus a nonresorbable barrier membrane did not affect the clinical or the histologic outcome of ridge preservation treatment.
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Bertl K, Melchard M, Pandis N, Müller-Kern M, Stavropoulos A. Soft tissue substitutes in non-root coverage procedures: a systematic review and meta-analysis. Clin Oral Investig 2017; 21:505-518. [PMID: 28108833 PMCID: PMC5318480 DOI: 10.1007/s00784-016-2044-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/22/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The present systematic review compared the effectiveness of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) in non-root-coverage procedures to increase keratinized tissue (KT) width around teeth. MATERIALS AND METHODS Included studies fulfilled the following main eligibility criteria: (a) preclinical in vivo or human controlled trials using FGG as control, (b) non-root-coverage procedures, and (c) assessment of KT width. Meta-analysis was performed on the gain in KT width (primary outcome variable) and several secondary variables. RESULTS Eight human trials with short observation time evaluating five different STSs were identified. FGG yielded consistently significantly (p < 0.001) larger increase in KT width irrespective whether the comparison regarded an acellular matrix or a tissue-engineered STS. Further, FGG yielded consistently ≥2 mm KT width postoperatively, while use of STS did not, in the few studies reporting on this outcome. On the other hand, STSs resulted in significantly better aesthetic outcomes and received greater patient preference (p < 0.001). CONCLUSIONS Based on relatively limited evidence, in non-root-coverage procedures, FGG (1) resulted consistently in significantly larger increase in KT width compared to STS and (2) yielded consistently ≥2 mm KT width postoperatively, while STSs did not. STSs yielded significantly better aesthetic outcomes, received greater patient preference, and appeared safe. CLINICAL RELEVANCE Larger and more predictable increase in KT width is achieved with FGG, but STSs may be considered when aesthetics is important. Clinical studies reporting relevant posttreatment outcomes, e.g., postop KT width ≥2 mm, on the long-term (>6 months) are warranted.
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Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Carl Gustafs väg 34, 20506, Malmö, Sweden.,Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Maximilian Melchard
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Bern, Switzerland
| | - Michael Müller-Kern
- Division of Conservative Dentistry and Periodontology, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Carl Gustafs väg 34, 20506, Malmö, Sweden.
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Mufti S, Dadawala SM, Patel P, Shah M, Dave DH. Comparative Evaluation of Platelet-Rich Fibrin with Connective Tissue Grafts in the Treatment of Miller's Class I Gingival Recessions. Contemp Clin Dent 2017; 8:531-537. [PMID: 29326502 PMCID: PMC5754972 DOI: 10.4103/ccd.ccd_325_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: One of the most common aesthetic problem encountered in the field of periodontology is gingival recession, which is, perceived by the patients as increase in length of teeth. The treatment of buccal gingival recession is a common requirement due to aesthetic concern or root sensitivity. This study was planned to evaluate the efficacy of PRF membrane compared to that of CTG in Miller's class I gingival recessions. Materials and Methods: 32 sites with Miller's Class I gingival recessions, out of which 16 sites received PRF (test) and 16 sites received CTG (control). Each patient had undergone an initial periodontal treatment, including oral hygiene instructions, plaque control, and scaling and root planing, followed by re-evaluation. All clinical recordings; recession height, recession width, clinical attachment level, height of keratinized tissue, thickness of keratinized tissue, healing index and pain perception, were performed immediately before surgery (baseline) and after 6 months interval following periodontal surgery. Results: In the test group, significant improvement was seen in terms CAL, REC-HT, REC-WD, HKT and TKT from baseline to 6 months. In the control group, only significant improvement seen was in REC-HT and TKT from baseline to 6 months. Comparison of both Healing Index and VAS score was done and it showed no significant difference between test and the control group except VAS at 1 week. Conclusion: Though CTG is a gold standard procedure, PRF can be used as an alternative procedure by keeping patient's comfort and recognition in mind.
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Affiliation(s)
- Sonam Mufti
- Department of Periodontology, Vaidik Dental College and Research Center, Daman, India
| | - Sarvagna Mayank Dadawala
- Department of Periodontology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Phoram Patel
- Department of Periodontology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Monali Shah
- Department of Periodontology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Deepak Harish Dave
- Department of Periodontology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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Henriques PSG, Okajima LS, Nunes MP, Montalli VAM. Coverage Root after Removing Peripheral Ossifying Fibroma: 5-Year Follow-Up Case Report. Case Rep Dent 2016; 2016:6874235. [PMID: 27891263 PMCID: PMC5116516 DOI: 10.1155/2016/6874235] [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: 09/19/2016] [Accepted: 10/30/2016] [Indexed: 11/23/2022] Open
Abstract
When lesions in soft tissue reach the gingival margin, they can produce aesthetic defects during its permanence and after its removal. Periodontal plastic surgery allows the correction of the gingival contour using different techniques. This paper is a case report of a peripheral ossifying fibroma removal in the interproximal area of teeth 21 and 22 in addition to root coverage of the affected area through two surgical phases: keratinized gingival tissue augmentation surgery with free gingival graft concurrent with removal of the lesion and, in a second stage, root coverage by performing coronally advanced flap technique with a follow-up of five years. The initial results achieved, which were root coverage of 100% after 6 months, promoted an adequate gingival contour and prevented the development of a mucogingival defect or a root exposure with its functional and aesthetic consequences. After five years, the results showed long term success of the techniques, where the margin remained stable with complete root coverage and tissues were stable and harmonic in color.
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Affiliation(s)
- Paulo S. G. Henriques
- Department of Periodontology, São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
| | - Luciana S. Okajima
- Department of Periodontology, São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
| | - Marcelo P. Nunes
- Department of Periodontology, São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
| | - Victor A. M. Montalli
- Department of Oral Pathology, São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
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Moreno Rodriguez JA, Caffesse RG. Coverage of Buccal Tissue Dehiscences on Endosseous Implants: Decision-Making Process and Case Report. Clin Adv Periodontics 2016; 6:195-202. [PMID: 31535478 DOI: 10.1902/cap.2016.160004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/08/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Dehiscences on facial aspects of implants are an esthetic concern and, just as importantly, may make maintaining adequate home-care measures and implant health more difficult, especially when bordered by inadequate and mobile soft tissue margins. CASE PRESENTATION This report describes a new approach, the laterally rotated flap, and a tunnel subepithelial connective tissue graft, used to correct soft tissue dehiscences and gain keratinized mucosa on endosseous implants. Soft tissues were maintained in a stable condition 3 years after treatment. CONCLUSIONS Although there are few controlled clinical studies that support any surgical technique for covering dehiscences on implants, some results show a tendency for improvement. The techniques presented in this case report provided promising results.
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Affiliation(s)
| | - Raúl G Caffesse
- Department of Postgraduate Periodontics, Complutense University of Madrid, Spain
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Chopra A, Sivaraman K, Bhat SG. "United Pedicle Flap" for management of multiple gingival recessions. J Indian Soc Periodontol 2016; 20:344-8. [PMID: 27563212 PMCID: PMC4976559 DOI: 10.4103/0972-124x.183100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Numerous surgical procedures have evolved and are being modified with time to treat gingival recession by manipulating gingival or mucosal tissues in various ways. However, the decision to choose the most appropriate technique for a given recession site still remains a challenging task for clinicians. Mucogingival deformities such as shallow vestibule, frenal pull, or inadequate attached gingiva complicate the decision and limit the treatment options to an invasive procedure involving soft tissue grafts. The situation is further comprised if there is a nonavailability of adequate donor tissue and patients' unwillingness for procedures involving a second surgical site. In such situations, the recession either remains untreated or has poor treatment outcomes. This case report presents a modified pedicle graft technique for treatment of multiple gingival recessions with shallow vestibule and inadequate attached gingiva. The technique is a promising therapeutic alternative to invasive surgical procedures such as soft tissue grafts for treatment of multiple gingival recessions.
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Affiliation(s)
- Aditi Chopra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| | - Karthik Sivaraman
- Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| | - Subraya Giliyar Bhat
- Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
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Two-Stage Mucogingival Surgery with Free Gingival Autograft and Biomend Membrane and Coronally Advanced Flap in Treatment of Class III Millers Recession. Case Rep Dent 2016; 2016:9289634. [PMID: 27525131 PMCID: PMC4976187 DOI: 10.1155/2016/9289634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/16/2016] [Accepted: 06/22/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. Gingival recession is an apical shift of the gingival margin with exposure of the root surface. This migration of the marginal tissue leads to esthetic concerns, dentin hypersensitivity, root caries, and cervical wear. It is, paradoxically, a common finding in patients with a high standard of oral hygiene, as well as in periodontally untreated populations with poor oral hygiene. Changing the topography of the marginal soft tissue in order to facilitate plaque control is a common indication for root coverage procedures and forms a major aspect of periodontal plastic surgeries. The regeneration of a new connective tissue attachment to denuded root surface is by allowing the selective coronal regrowth of periodontal ligament cells while excluding the gingival tissues from the root during wound healing by means of a barrier membrane. Case Presentation. This case reports a two-stage surgical technique for treatment of Miller's class III defect using free gingival autograft and type I absorbable collagen membrane (BioMend®, Zimmer Dental, USA)§. Conclusions. The 6-month follow-up of the case showed a significant increase in attached gingiva suggesting it as a predictable alternative in the treatment of Millers class III defects.
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Bellver-Fernández R, Martínez-Rodriguez AM, Gioia-Palavecino C, Caffesse RG, Peñarrocha M. Surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft. Med Oral Patol Oral Cir Bucal 2016; 21:e222-8. [PMID: 26595836 PMCID: PMC4788803 DOI: 10.4317/medoral.21043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/09/2015] [Indexed: 12/03/2022] Open
Abstract
Background A coronally advanced flap with subepithelial connective tissue graft is the gold standard surgical treatment of gingival recessions, since it offers a higher probability of achieving complete root coverage compared with other techniques. However, optimum short- and middle-term clinical results have also been obtained with coronally advanced flaps alone. The aim of the present study was to evaluate the results obtained by the surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft. Material and Methods The reduction of recession height was assessed, together with the gain in gingival attachment apical to the recession, and total reduction of recession, in a comparative study of two techniques. Twenty-two gingival recessions were operated upon: 13 in the control group (coronally advanced flap) and 9 in the test group (coronally advanced flap associated to subepithelial connective tissue graft). Results After 18 months, the mean reduction of recession height was 2.2 ± 0.8 mm in the control group and 2.3 ± 0.7 mm in the test group, with a mean gain in gingival attachment of 1.3 ± 0.9 mm and 2.3 ± 1.3 mm, respectively. In percentage terms, the mean reduction of recession height was 84.6 ± 19.6% in the control group and 81.7 ± 17.8% in the test group, with a mean gain in gingival attachment of 20.5 ± 37.4% and 184.4 ± 135.5%, respectively. Conclusions Significant reduction of gingival recession was achieved with both techniques, though the mean gain in gingival attachment (in mm and as a %) was greater in test group. Key words:Gingival recession, coronally advanced flap, subepthelial connective tissue graft.
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Thakare P, Baliga V, Bhongade ML. Comparative evaluation of the effectiveness of acellular dermal matrix allograft and subepithelial connective tissue to coronally advanced flap alone in the treatment of multiple gingival recessions: A clinical study. J Indian Soc Periodontol 2015; 19:537-44. [PMID: 26644721 PMCID: PMC4645541 DOI: 10.4103/0972-124x.156877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Obtaining predictable and esthetic root coverage has become an important part of periodontal therapy. Several techniques have been developed to achieve these goals with variable outcomes. The aim of this study was to appraise the effectiveness of acellular dermal matrix allograft (ADMA) and subepithelial connective tissue graft (SCTG) compared to coronally advanced flap (CAF) in the treatment of multiple gingival recessions. Materials and Methods: A total of 30 patients aged between 18 and 50 years, with multiple Miller's Class I and II recessions on labial or buccal surfaces of teeth were selected for this study. The patients were randomly assigned to CAF + ADMA, CAF + SCTG and CAF groups with 10 patients in each group. The clinical parameters assessed were probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), width of keratinized tissue, plaque index and papilla bleeding index at base line and 6 months after surgery. Results: Statistical analysis using One-way ANOVA suggested that the root coverage obtained was greater in the ADMA + CAF (89.83 ± 15.29%), when compared to SCTG + CAF (87.73 ± 17.63%) and CAF (63.77 ± 27.12%) groups. The predictability for coverage of >90% was greater in CAF + ADMA (65%) when compared with SCTG + CAF (61.66%) and CAF (31.17%). Improvements in the clinical parameters from baseline were found in all the three groups treated. Conclusion: It was concluded that all three techniques could provide root coverage in Miller's class I and II gingival recessions; but greater % root coverage and predictability for coverage of >90% could be expected with CAF + ADMA and CAF + SCTG groups when compared with CAF alone.
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Affiliation(s)
- Pallavi Thakare
- Department of Periodontics, Vidarbha Youth Welfare Society Dental College and Hospital, Amravati, Maharashtra, India
| | - Vidya Baliga
- Department of Periodontics, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India
| | - Manohar Laxman Bhongade
- Department of Periodontics, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India
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Srinivas BVV, Rupa N, Halini Kumari KV, Rajender A, Reddy MN. Treatment of gingival recession using free gingival graft with fibrin fibronectin sealing system: A novel approach. J Pharm Bioallied Sci 2015; 7:S734-9. [PMID: 26538956 PMCID: PMC4606698 DOI: 10.4103/0975-7406.163524] [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] [Indexed: 11/19/2022] Open
Abstract
Periodontal plastic surgery is the branch of periodontology that is focused mainly on the correction or elimination of mucogingival problems associated with lack of attached gingiva, a shallow vestibule and aberrant frenum. Various mucogingival surgical procedures are used to halt the progression of the gingival recession and to correct poor esthetic appearance. Free gingival autograft is one of the most common techniques used for a gingival recession in areas of inadequate attached gingiva in the mandibular anterior region. Fibrin sealants are human plasma derivatives that mimic the final stages of blood coagulation, forming a fibrin clot. Fibrin Sealants enhances the overall outcome of surgical intervention because of their hemostatic, adhesive, and healing properties. These properties of fibrin sealants may reduce operating time, prevent complications, and enhance the overall outcome of many surgical interventions. Hence, this case report aims to investigate the clinical effectiveness of free gingival graft along with the commercially available fibrin-fibronectin sealing system (Tissucol®) in the treatment of Miller's class II gingival recession.
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Affiliation(s)
- B V V Srinivas
- Department of Periodontics, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India
| | - N Rupa
- Department of Dentistry, Rajiv Gandhi Institute of Medical Sciences, Srikakulam, Andhra Pradesh, India
| | - K V Halini Kumari
- Department of Periodontics, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India
| | - A Rajender
- Department of Periodontics, Aditya Dental College, Beed, Maharashtra, India
| | - M Narendra Reddy
- Department of Periodontics, Best Dental Science College and Hospital, Madurai, Tamil Nadu, India
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Skurska A, Dolińska E, Sulewska M, Milewski R, Pietruski J, Sobaniec S, Pietruska M. The assessment of the influence of vertical incisions on the aesthetic outcome of the Miller class I and II recession treatment: a split-mouth study. J Clin Periodontol 2015; 42:756-763. [DOI: 10.1111/jcpe.12440] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Skurska
- Department of Periodontal and Oral Mucosa Diseases; Medical University of Białystok; Białystok Poland
- Dental Practice; Białystok Poland
| | - Ewa Dolińska
- Department of Periodontal and Oral Mucosa Diseases; Medical University of Białystok; Białystok Poland
| | - Magdalena Sulewska
- Department of Periodontal and Oral Mucosa Diseases; Medical University of Białystok; Białystok Poland
| | - Robert Milewski
- Department of Statistics and Medical Informatics; Medical University of Białystok; Białystok Poland
| | | | - Stefan Sobaniec
- Department of Periodontal and Oral Mucosa Diseases; Medical University of Białystok; Białystok Poland
| | - Małgorzata Pietruska
- Department of Periodontal and Oral Mucosa Diseases; Medical University of Białystok; Białystok Poland
- Dental Practice; Białystok Poland
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