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Rodriguez AB, Chan HL, Velasquez D. Anatomy-driven complexity classification for soft-tissue tunneling procedures. Clin Adv Periodontics 2024; 14:113-120. [PMID: 37812141 DOI: 10.1002/cap.10267] [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: 04/23/2023] [Revised: 08/01/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The tunnel technique (TUN) preserves the integrity of the papilla by creating envelope flaps that allow for the insertion of a connective tissue graft, and/or biomaterials. METHODS (1) A comprehensive overview of tunneling flap procedures in the treatment of gingival recessions (GRs) for soft tissue coverage is presented and (2) A classification system for soft and hard tissue anatomy of GR sites which may aid the clinician in determining the surgical complexity is being introduced. RESULTS A novel clinical classification system is proposed to illustrate complexity levels determined by soft and hard tissue anatomy of GR sites such as the mucogingival junction proximity to the gingival margin, bone morphotype, and mucosal margin thickness. CONCLUSIONS TUN is highly effective in treating single/multiple GRs. Its limitations are related to variability in surgical site anatomy and operator expertise. A classification system based on anatomical soft and hard tissue variations has been proposed to help identify complexity levels encountered during tunneling procedures. KEY POINTS Site-related factors directly impact the surgical variables related to tissue trauma, flap tension, soft tissue management, muscle pull, and wound stability during the healing of gingival recessions (GRs). The achievement of expedited and favorable wound healing is crucial to obtaining quantitative and qualitative success in the treatment of GR and the long-term stability of root coverage. A classification system based on anatomical soft and hard tissue variations has been proposed to facilitate tunneling procedures while respecting surgical principles.
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Affiliation(s)
- Amanda B Rodriguez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Diego Velasquez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Seven Lakes Periodontics, Private Practice, Fenton, Michigan, USA
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2
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Skierska I, Górski B, Fus Ł. Tunnel technique and subepithelial connective tissue graft, with or without cross-linked hyaluronic acid, in the treatment of multiple gingival recessions: 12-month outcomes of a randomized clinical trial. J Periodontol 2024. [PMID: 38808976 DOI: 10.1002/jper.24-0093] [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: 02/07/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND This study evaluated the influence of the adjunctive application of a cross-linked hyaluronic acid (HA) in the treatment of multiple gingival recessions, using a modified coronally advanced tunnel (MCAT) technique and subepithelial connective tissue graft (SCTG) (MCAT+SCTG±HA). METHODS A randomized, split-mouth, double-masked comparison of the effects of MCAT+HA+SCTG (test) versus MCAT+SCTG (control) in the treatment of multiple, contralateral gingival recessions with clinical, esthetic, and histological evaluations was carried out. All samples were stained with hematoxylin and eosin, Masson's trichrome, Verhoeff-Van Gieson, and Alcian blue stain for semiquantitative evaluation. The primary outcome variable was 12-month mean root coverage (MRC). RESULTS Twenty-four patients with 266 gingival recessions received both control and test treatments (133 recessions per group). 12-month MRC of the MCAT+HA+SCTG group was not significantly different from the MCAT+SCTG group with 84.32%± 34.46% and 85.71%± 36.43%, respectively (p = 0.991). Both treatment modes produced favorable esthetic outcomes (root coverage esthetic score [RES] 9.51± 1.01 tests vs. 9.26± 1.10 controls, p = 0.7292). However, the application of HA improved soft tissue texture (p = 0.0091). The remaining end point measures did not differ significantly between groups. Histological evaluation showed a significantly greater number of elastic fibers and a moderate increase in collagen fiber density in biopsy samples taken from the test sides when compared to the control sides (p = 0.0419 and p = 0.300, respectively). CONCLUSIONS MCAT+SCTG is an effective procedure in the treatment of multiple recession Type 1 (RT1) and RT2 recessions. There were no statistically significant differences in evaluated clinical treatment outcomes in the MCAT+HA+SCTG group compared to the MCAT+SCTG group within a period of 12 months. The application of HA increased collagen and elastic fiber density.
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Affiliation(s)
- Izabela Skierska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Bartłomiej Górski
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Fus
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
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Devina AA, Halim FC, Sulijaya B, Sumaringsih PR, Dewi RS. Simultaneous Implant and Guided Bone Regeneration Using Bovine-Derived Xenograft and Acellular Dermal Matrix in Aesthetic Zone. Dent J (Basel) 2024; 12:52. [PMID: 38534276 DOI: 10.3390/dj12030052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Implant placement in the maxillary anterior area requires sufficient quantity and quality of both soft and hard tissue. In cases where soft and hard tissues are insufficient, additional regeneration using biomaterials is recommended. Treatment using bovine-derived xenograft and acellular dermal matrix (ADM) may increase bone volume and soft tissue thickness. Case and management: A 65-year-old woman sought help for discomfort and aesthetic issues with her denture, reporting missing teeth (11, 12, 13, 14, and 21) and bone volume shrinkage due to disuse atrophy. Intraoral examination revealed 1 mm gingival thickness. CBCT showed labio-palatal bone thickness of 6.0 mm, 5.8 mm, and 4.7 mm for teeth 21, 12 and 14, respectively. Implant planning and surgical guide fabrication were carried out before the surgery. Surgery included the placement of implants 3.3 mm in diameter and 12 mm in length, with the use of xenograft and ADM. Three months post-op, improvements in soft and hard tissues were observed, with a final prosthesis being a long-span implant-supported bridge. CONCLUSIONS Disuse alveolar atrophy causes soft and hard tissue deficiency. The use of xenograft and ADM show favourable results even on a geriatric patient.
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Affiliation(s)
- Anggun Alfreda Devina
- Periodontology Specialist Program, Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Felita Clarissa Halim
- Periodontology Specialist Program, Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Benso Sulijaya
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Patricia Rinanti Sumaringsih
- Prosthodontics Specialist Program, Department of Prosthodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Ratna Sari Dewi
- Department of Prosthodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia
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Parlak HM, Yilmaz BT, Durmaz MH, Toz H, Keceli HG. The effects of vertically coronally advanced flap and free gingival graft techniques on shallow vestibule: a randomized comparative prospective trial. Clin Oral Investig 2023; 27:7425-7436. [PMID: 37855920 DOI: 10.1007/s00784-023-05332-4] [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: 08/23/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES The present study aimed to compare the influence of vertically coronally advanced flap (V-CAF) and free gingival graft (FGG) techniques on shallow vestibule depth (VD). MATERIALS AND METHODS Parallel-arm randomized clinical trial was conducted on 38 sites treated with either FGG or V-CAF. Periodontal variables (VD, recession depth and width, probing depth, clinical attachment level, keratinized tissue height (KTH), and tissue thickness (TT)), clinician- and patient-based subjective variables were assessed. RESULTS All periodontal variables showed significant improvements in both groups at all follow-up intervals compared to baseline (p < 0.05). Both groups increased VD compared to baseline. RC and CRC were similar after treatment for both techniques. FGG provided a greater increase in KTH (p < 0.001) and VD (VD1, p = 0.02 and VD2, p < 0.001) while V-CAF exhibited more TT gain (p = 0.002). Except overall tissue appearance that was better in V-CAF (p < 0.001), no inter-group significant difference existed in patient-based variables. CONCLUSIONS Both techniques were significantly effective in VD increasing. While both techniques were equally successful in RC, V-CAF provided higher TT gain and better tissue appearance. V-CAF can be chosen instead of FGG in the treatment of recessions with shallow VD. CLINICAL RELEVANCE It can be recommended to prefer V-CAF instead of FGG in the treatment of shallow vestibule. TRIAL REGISTRATION NUMBER NCT05777811 (clinicaltrials.gov).
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Affiliation(s)
- Hanife Merva Parlak
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| | - Birtan Tolga Yilmaz
- Private Practice, İzmir, Turkey
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Dental Biomaterials, Institute of Health Science, Dokuz Eylul University, İzmir, Turkey
| | - Murat Haktan Durmaz
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| | - Havanur Toz
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| | - H Gencay Keceli
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
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Tavelli L, Kripfgans OD, Chan HL, Vera Rodriguez M, Sabri H, Mancini L, Wang HL, Giannobile WV, Barootchi S. Doppler ultrasonographic evaluation of tissue revascularization following connective tissue graft at implant sites. J Clin Periodontol 2023. [PMID: 37861110 DOI: 10.1111/jcpe.13889] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023]
Abstract
AIM To assess the Doppler ultrasonographic tissue perfusion at dental implant sites augmented with connective tissue graft (CTG) using coronally advanced flap (CAF) or tunnel technique (TUN). MATERIALS AND METHODS Twenty-eight patients presenting with isolated healthy peri-implant soft-tissue dehiscence (PSTD) were included in this randomized clinical trial. PSTDs were treated with either CAF + CTG or TUN + CTG. Ultrasound scans were taken at baseline, 1 week, 1 month, 6 months and 12 months. Tissue perfusion at the mid-facial, mesial and distal aspects of the implant sites was assessed by colour Doppler velocity (CDV) and power Doppler imaging (PDI). Early vascularization of the graft and the flap at 1 week and at 1 month were evaluated via dynamic tissue perfusion measurements (DTPMs), including flow intensity (FI), mean perfusion relief intensity (pRI) and mean perfused area (pA). RESULTS Regression analysis did not reveal significant differences in terms of mid-facial CDV and PDI changes between CAF and TUN over 12 months (p > .05), while significant differences between the two groups were observed at the interproximal areas (p < .001 for both CDV and PDI changes). Higher early DTPMs were observed at the TUN-treated sites in terms of mean FI of the graft (p = .027) and mean FI (p = .024) and pRI of the flap (p = .031) compared with CAF-treated sites at 1 week. Assessment of the FI direction showed that CTG perfusion at 1 week and at 1 month mainly occurred from the flap towards the implant/bone. Early tissue perfusion outcomes were found to be associated with the 12-month mean PSTD coverage and mucosal thickness gain. CONCLUSIONS Doppler ultrasonography shows tissue perfusion changes occurring at implant sites augmented with CTG. The main differences in tissue perfusion between CAF and TUN were observed at the interproximal sites, with early perfusion associated with clinical and volumetric outcomes at 12 months.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA
| | - Oliver D Kripfgans
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Maria Vera Rodriguez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Postgraduate Periodontics, Division of Periodontics, Columbia University College of Dental Medicine, New York City, New York, USA
| | - Hamoun Sabri
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Leonardo Mancini
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - William V Giannobile
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA
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Chen Z, Zhong J, Xie Y, Fan K, Zhou S, Ouyang X. Does vestibular incision improve the outcomes of vestibular incision subperiosteal tunnel technique: A randomized clinical trial for treatment of multiple adjacent type 1 gingival recession. J ESTHET RESTOR DENT 2023; 35:1131-1138. [PMID: 37078417 DOI: 10.1111/jerd.13051] [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: 01/04/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the clinical outcomes of vestibular incision subperiosteal tunnel technique (VISTA) and tunnel approach combined with connective tissue graft (CTG) for treatment of type 1 (RT1) multiple gingival recession. MATERIALS AND METHODS Twenty-four patients with a total of 59 nonmolar recession teeth were randomly allocated to VISTA + CTG or Tunnel + CTG group. Recession depth and width, probing depth, clinical attachment level, width of keratinized tissue, gingival thickness, flap tension, mean root coverage (MRC), complete root coverage (CRC), patient-centered, and esthetic outcomes (root coverage esthetic scores, RES) were assessed at baseline and 12 months after surgery. RESULTS At 12 months, MRC of 91.13 ± 16.96% and 91.40 ± 13.53%, CRC of 70.97% and 67.86% were observed for VISTA + CTG and Tunnel + CTG group respectively, with no significant difference between the two groups (p > 0.05). High RES of 8.52 ± 1.46 and 8.82 ± 1.44 was obtained in VISTA + CTG and Tunnel + CTG group respectively, without showing a significant difference (p = 0.245), while less scar formation was observed in Tunnel + CTG group (p < 0.01). CONCLUSIONS Both procedures were effective for root coverage in RT1 multiple gingival recession at 12 months. Better esthetic result with less scar formation was obtained in tunnel approach combined with CTG without vestibular incision. (Registration number: ChiCTR-INR-16007845, registered on 19/12/2015, http://www.chictr.org.cn). CLINICAL SIGNIFICANCE VISTA + CTG and Tunnel + CTG were both effective for root coverage in RT1 multiple gingival recession, with satisfying esthetic outcomes. However, it is suggested in critical esthetic areas, treatment options of making vertical incisions should be carefully considered.
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Affiliation(s)
- Ziyuan Chen
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Second Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Jinsheng Zhong
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Ying Xie
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Keang Fan
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Third Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Shuangying Zhou
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Xiangying Ouyang
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
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Guimarães DM, de Andrade PF, Rebollal J, Neves AMD, Granjeiro JM. A modified tunnel technique to treat multiple gingival recessions: Case Series. Braz Dent J 2023; 34:136-145. [PMID: 37466521 PMCID: PMC10355267 DOI: 10.1590/0103-6440202305502] [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: 03/29/2023] [Accepted: 05/22/2023] [Indexed: 07/20/2023] Open
Abstract
This case series reports a modified tunnel technique with connective tissue graft for the root coverage of multiple Miller Class I, II, and III gingival recessions. The modified approach presents an innovative suture technique to improve the stability and position of the graft. Ten patients with multiple gingival recessions (n=85 teeth) received surgical root coverage treatment. The gingival recession height and width were measured and presented as median, minimum, and maximum values. The percentage of the root coverage after at least 12 months expressed the treatment effectiveness. The Shapiro-Wilk test evaluated the normality; pared Wilcoxon test determined the exact P-value for the differences in the height of the gingival recession before and after surgical treatment (α = 0.05). An average of 97.9% (± 5.6%, p < 0.0001) root coverage after treatment occurred, and 73 out of 85 recessions presented complete root coverage after 12 months. Treatment of Miller class I and II gingival recessions resulted in root coverage higher than 99 and class III higher than 95% (p < 0.0001). The presented case series report the efficacy of a modified surgical technique promoting more than 95% of root coverage after 12 months in multiple Miller Class I, II, and III gingival recessions. Well-designed blind randomized controlled trials are needed to validate the proposed technique.
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Affiliation(s)
- Dennis Malta Guimarães
- Latin American Institute of Dental Research and Education (ILAPEO),
Department of Implantology, Curitiba, Paraná, Brazil
| | | | - Julio Rebollal
- Latin American Institute of Dental Research and Education (ILAPEO),
Department of Implantology, Curitiba, Paraná, Brazil
| | - André Martins das Neves
- School of Dentistry, Federal University of Minas Gerais, Belo
Horizonte, Minas Gerias, Brazil
| | - José Mauro Granjeiro
- Latin American Institute of Dental Research and Education (ILAPEO),
Department of Implantology, Curitiba, Paraná, Brazil
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Tunnel technique with cross-linked hyaluronic acid in addition to subepithelial connective tissue graft, compared with connective tissue graft alone, for the treatment of multiple gingival recessions: 6-month outcomes of a randomized clinical trial. Clin Oral Investig 2023; 27:2395-2406. [PMID: 36735090 DOI: 10.1007/s00784-023-04887-6] [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: 11/29/2022] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of this study was to investigate differences in clinical and esthetic outcomes in the treatment of multiple gingival recession types 1 and 2, using the modified coronally advanced tunnel technique (MCAT) combined with subepithelial connective tissue graft (SCTG), with or without cross-linked hyaluronic acid (HA). MATERIALS AND METHODS A total of 24 patients with 266 multiple gingival recessions (GR) were enrolled in the study (133 recessions per group). MCAT was combined with SCTG and HA on the test side, while MCAT with SCTG was used on the control side. Clinical parameters were measured at baseline and 6 months post-operatively. Visual analogue scales (VAS) and questionnaires were used to assess patient-rated outcomes, and the root coverage esthetic score (RES) was used for professional esthetic evaluation. RESULTS No significant improvement in root coverage was observed as a result of adding HA. After 6 months, mean root coverage (MRC) was 85% for SCTG + HA group and 83% for SCTG group (p = 0.9819). Complete root coverage (CRC) was observed in 91% (test) and 93% (control) of the cases (p = 0.9001). Professional assessment of soft tissue texture (STT) using RES showed a significant difference (0.94 versus 0.69, p = 0.0219) in favor of the experimental group. CONCLUSIONS Both treatments were similarly effective in treating multiple GRs and led to comparable improvements in clinical parameters. However, application of HA improved the appearance of soft tissue texture. CLINICAL RELEVANCE Adjunctive application of HA in the MCAT + SCTG procedure may improve STT results.
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Mayta-Tovalino F, Barboza JJ, Pasupuleti V, Hernandez AV. Efficacy of Tunnel Technique (TUN) versus Coronally Advanced Flap (CAF) in the Management of Multiple Gingival Recession Defects: A Meta-Analysis. Int J Dent 2023; 2023:8671484. [PMID: 37063452 PMCID: PMC10101741 DOI: 10.1155/2023/8671484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/06/2022] [Accepted: 03/22/2023] [Indexed: 04/18/2023] Open
Abstract
Objective We systematically assessed the efficacy of tunnel technique (TUN) vs. coronally advanced flap (CAF) in the management of multiple gingival recession defects in adults. Methods Five databases were searched until September 2021 for randomized controlled trials (RCTs) assessing TUN vs. CAF; grafts of interest were acellular dermal matrix (ADM) and connective tissue graft (CTG). Primary outcomes were root coverage (RC) and complete root coverage (CRC). Secondary outcomes were clinical attachment level (CAL), keratinized tissue width (KTW), probing depth (PD), and recession coverage (REC). Effect measures were risk ratio (RR) or mean difference (MD) with their confidence intervals (95% CI). Inverse variance methods and random-effects model meta-analyses were used. Subgroup analyses by the type of graft were performed. Quality of evidence was assessed using GRADE methodology. Results Five RCTs (n = 173) were included, with a follow-up of 6 months for all outcomes. In comparison to CAF, TUN did not significantly reduce CRC (RR 0.65; 95% CI 0.002-176.7; p = 0.51) and did not increase RC (MD 0.99%; 95% CI -6.7 to 8.6; p = 0.80). In comparison to CAF, TUN showed no significant reduction of secondary outcomes. Subgroup analyses by type of graft showed no differences in comparison to primary analyses for primary and secondary outcomes. Three RCTs had a high risk of bias, and five RCTs had very low quality of evidence for all outcomes. Conclusions In adults with gingival recessions, TUN had similar primary and secondary outcomes in comparison with CAF. Subgroup analyses by the type of graft did not affect main conclusions. More RCTs with better design are needed to further characterize the effects of TUN vs. CAF in the treatment of multiple gingival recession defects.
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Affiliation(s)
- Frank Mayta-Tovalino
- Unidad de Revisiones Sistemáticas y Meta-Análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | | | | | - Adrian V. Hernandez
- Unidad de Revisiones Sistemáticas y Meta-Análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
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Tavelli L, Barootchi S, Rodriguez MV, Mancini L, Majzoub J, Travan S, Sugai J, Chan H, Kripfgans O, Wang H, Giannobile WV. Recombinant human platelet-derived growth factor improves root coverage of a collagen matrix for multiple adjacent gingival recessions: A triple-blinded, randomized, placebo-controlled trial. J Clin Periodontol 2022; 49:1169-1184. [PMID: 35871600 PMCID: PMC9796054 DOI: 10.1111/jcpe.13706] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 07/10/2022] [Accepted: 07/16/2022] [Indexed: 12/30/2022]
Abstract
AIM To evaluate the efficacy of recombinant human platelet-derived growth factor (rhPDGF)-BB combined with a cross-linked collagen matrix (CCM) for the treatment of multiple adjacent gingival recession type 1 defects (MAGRs) in combination with the coronally advanced flap (CAF). MATERIALS AND METHODS Thirty patients were enrolled in this triple-blind, randomized, placebo-controlled trial and treated with either CAF + CCM + rhPDGF, or CAF + CCM + saline. The primary outcome was mean root coverage (mRC) at 6 months. Complete root coverage, gain in gingival thickness (GT), keratinized tissue width, volumetric and ultrasonographic changes, and patient-reported outcome measures were also assessed. Mixed-modelling regression analyses were used for statistical comparisons. RESULTS At 6 months, the mRC of the CCM + rhPDGF and CCM alone groups were 88.25% and 77.72%, respectively (p = .02). A significant gain in GT was consistently observed for both treatment arms, and more so for the patients receiving the matrix containing rhPDGF through time (0.51 vs. 0.80 mm, on average, p = .01). The rhPDGF + CCM treated patients presented greater volume gain, higher soft tissue thickness, and a superior aesthetic score. CONCLUSION rhPDGF enhances the clinical, volumetric, and aesthetic outcomes of MAGRs above the results achieved with CAF + CCM alone (ClinicalTrials.gov NCT04462237).
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of PeriodontologyHarvard School of Dental MedicineBostonMassachusettsUSA,Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION)BostonMassachusettsUSA
| | - Shayan Barootchi
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION)BostonMassachusettsUSA
| | - Maria Vera Rodriguez
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA,Postgraduate Periodontics, Division of PeriodonticsColumbia University College of Dental MedicineNew YorkNew YorkUSA
| | - Leonardo Mancini
- Department of Life, Health and Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Jad Majzoub
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Suncica Travan
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Jim Sugai
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Hsun‐Liang Chan
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Oliver Kripfgans
- Biointerfaces Institute and Department of Biomedical EngineeringCollege of EngineeringAnn ArborMichiganUSA,Department of RadiologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Hom‐Lay Wang
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - William V. Giannobile
- Department of Oral Medicine, Infection, and Immunity, Division of PeriodontologyHarvard School of Dental MedicineBostonMassachusettsUSA,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION)BostonMassachusettsUSA
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11
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Modified coronally advanced tunnel versus epithelialized free gingival graft technique in gingival phenotype modification: a comparative randomized controlled clinical trial. Clin Oral Investig 2022; 26:6283-6293. [PMID: 35708779 DOI: 10.1007/s00784-022-04580-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The gingival thickness (GT) and keratinized tissue (KT) height are defined as the gingival phenotype. Both the modified coronally advanced tunnel technique (MCAT) and free gingival grafts (FGG) are used in modifying the gingival phenotype. This study aims to compare MCAT and FGG in gingival phenotype modification. MATERIALS AND METHODS One hundred and forty recessions in 50 patients with thin and insufficient keratinized tissue at the anterior mandible were treated with either MCAT or FGG. GT, KT height, recession depth, recession width, probing depth, and clinical attachment level were evaluated at baseline and 6 weeks, 6 months, and 12 months. GT change, KT change, root coverage (RC), clinical attachment gain, and complete root coverage (CRC) were calculated. The wound healing index, tissue appearance, patient expectations, aesthetic, and dentin hypersensitivity were assessed at baseline and 6 months. RESULTS All periodontal variables showed significant change from baseline to 12 months in both groups (p < 0.05). While FGG resulted in more KT change (p < 0.001), all MCAT sites showed at least 2 mm KT change in 12 months. MCAT resulted in greater GT change (p < 0.05) and RC (p < 0.003). In contrast, there was no significant inter-group CRC difference (p = 0.523). All patient-based variables were favorable to MCAT (p < 0.05), except dentin hypersensitivity (p = 0.225). CONCLUSIONS Both techniques were successful in terms of gingival phenotype modification in the anterior mandible. Additional GT increase, RC, and patient-based outcomes favored MCAT, though KT change proved greater with FGG. CLINICAL RELEVANCE Clinicians may choose MCAT for higher GT increase whereas FGG for more KTC. TRIAL REGISTRATION NUMBER NCT04690140 and date: 12/26/2020.
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12
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Miguel MMV, Ferraz LFF, Rossato A, Cintra TMF, Mathias-Santamaria IF, Santamaria MP. Comparison between connective tissue graft and xenogeneic acellular dermal matrix to treat single gingival recession: A data reanalysis of randomized clinical trials. J ESTHET RESTOR DENT 2022; 34:1156-1165. [PMID: 35670134 DOI: 10.1111/jerd.12936] [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: 03/13/2022] [Revised: 05/05/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There are few studies comparing xenogeneic acellular dermal matrixes (XDMs) with connective tissue graft (CTG) to treat single gingival recession (GR). The present study involved a reanalysis of previous studies and comparison of CTG or XDM to treat single RT1/GR. MATERIALS AND METHODS Fifty patients from three previous randomized clinical trials treated either by CTG (n = 25) or XDM (n = 25) were evaluated after 6-month. Clinical, patient-centered, and esthetic parameters were assessed. Pearson's correlation and regression analyses were also performed. RESULTS Greater recession reduction (RecRed), percentage of root coverage (%RC), and complete root coverage (CRC) were observed in the CTG group (p ≤ 0.02). Gingival thickness (GT) and keratinized tissue width (KTW) gains were higher in the CTG group. The CTG group showed better esthetic at 6-month. Logistic analyses reported that GT([OR] = 1.6473 ) and papilla height (PH) (OR = 8.20) are predictors of CRC. GT*XDM interaction was a negative predictor of CRC (OR = 7.105-5 ). GT at baseline acted as a predictor of RecRed in both groups (p = 0.03). The XDM graft impacted RecRed and %RC negatively. Baseline PH was a predictor of %RC for both grafts. CONCLUSION CTG was superior for treating RT1/GR, providing better root coverage outcomes and tissue gains over time. GT, PH, and graft type were classified as predictors of CRC. CLINICAL SIGNIFICANCE CTG presented better outcomes to treat single RT1 gingival recession when compared to the XDM.
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Affiliation(s)
- Manuela Maria Viana Miguel
- Division of Periodontics, Institute of Science and Technology, São Paulo State University (UNESP), São Paulo, Brazil
| | - Laís Fernanda Ferreira Ferraz
- Division of Periodontics, Institute of Science and Technology, São Paulo State University (UNESP), São Paulo, Brazil
| | - Amanda Rossato
- Division of Periodontics, Institute of Science and Technology, São Paulo State University (UNESP), São Paulo, Brazil
| | - Tuana Mendonça Faria Cintra
- Division of Periodontics, Institute of Science and Technology, São Paulo State University (UNESP), São Paulo, Brazil
| | | | - Mauro Pedrine Santamaria
- Division of Periodontics, Institute of Science and Technology, São Paulo State University (UNESP), São Paulo, Brazil.,University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
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13
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Antezack A, Ohanessian R, Sadowski C, Faure-Brac M, Brincat A, Etchecopar-Etchart D, Monnet-Corti V. Effectiveness of surgical root coverage on dentin hypersensitivity: A systematic review and meta-analysis. J Clin Periodontol 2022; 49:840-851. [PMID: 35634650 DOI: 10.1111/jcpe.13664] [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: 03/21/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
AIM To assess the effect of surgical root coverage (RC) on dentin hypersensitivity (DH) associated with gingival recession. MATERIALS AND METHODS Two independent reviewers conducted electronic literature searches in MEDLINE (PubMed), EMBASE, Cochrane Library, Web Of Science, Dentistry & Oral Sciences Source, ScienceDirect, and ClinicalTrials.gov databases as well as a manual search to identify eligible clinical studies from January 2000 to March 2022. Randomized controlled trials (RCTs) comparing two surgical RC techniques or a surgical RC technique with or without adjuvant were included. Meta-analyses were performed on data provided by RCTs. RESULTS Thirteen RCTs with a total of 701 patients (1086 recessions) were included. The percentage of DH suppression was 70.8% (95% confidence interval [CI] [64.4-76.6]; I2 = 39.2% [3.5-61.8], Q-test = 0.02) after surgical RC. Recession reduction and percentage of RC were both statistically significantly associated with DH suppression (estimate = 0.66 [0.10-1.23], p = .022, R2 = 14.45% and estimate = 0.04 [0.01-0.08], p = .012, R2 = 29.54%, respectively). Coronally advanced flap (CAF) + connective tissue graft showed results statistically more effective than CAF + xenogeneic collagen matrix in DH suppression (73.3% [65.6-79.8] and 61.4% [51.7-70.3], respectively; p = .048). CONCLUSIONS Success of surgical RC is associated with DH suppression.
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Affiliation(s)
- Angéline Antezack
- Faculté des Sciences Médicales et Paramédicales, Ecole de Médecine Dentaire, Aix-Marseille Université, Provence-Alpes-Côte D'azur, Marseille, France.,Assistance Publique-Hopitaux de Marseille (AP-HM), Hopital Timone, Provence-Alpes-Côte D'azur, Marseille, France.,UMR D-258 Microbes Evolution Phylogénie et Infection (MEPHI), Institut de Recherche Pour Le Développement (IRD), Aix-Marseille Université, Provence-Alpes-Côte D'azur, Marseille, France
| | - Romain Ohanessian
- Faculté des Sciences Médicales et Paramédicales, Ecole de Médecine Dentaire, Aix-Marseille Université, Provence-Alpes-Côte D'azur, Marseille, France.,Assistance Publique-Hopitaux de Marseille (AP-HM), Hopital Timone, Provence-Alpes-Côte D'azur, Marseille, France
| | - Camille Sadowski
- Faculté des Sciences Médicales et Paramédicales, Ecole de Médecine Dentaire, Aix-Marseille Université, Provence-Alpes-Côte D'azur, Marseille, France.,Assistance Publique-Hopitaux de Marseille (AP-HM), Hopital Timone, Provence-Alpes-Côte D'azur, Marseille, France
| | - Mathias Faure-Brac
- Faculté des Sciences Médicales et Paramédicales, Ecole de Médecine Dentaire, Aix-Marseille Université, Provence-Alpes-Côte D'azur, Marseille, France.,Assistance Publique-Hopitaux de Marseille (AP-HM), Hopital Timone, Provence-Alpes-Côte D'azur, Marseille, France
| | - Arthur Brincat
- Faculté des Sciences Médicales et Paramédicales, Ecole de Médecine Dentaire, Aix-Marseille Université, Provence-Alpes-Côte D'azur, Marseille, France.,Assistance Publique-Hopitaux de Marseille (AP-HM), Hopital Timone, Provence-Alpes-Côte D'azur, Marseille, France
| | - Damien Etchecopar-Etchart
- EA 3279: CEREeSS-Health Service Research and Quality of Life Center, Aix-Marseille Université, Département de Psychiatrie, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, Provence-Alpes-Côte D'azur, France
| | - Virginie Monnet-Corti
- Faculté des Sciences Médicales et Paramédicales, Ecole de Médecine Dentaire, Aix-Marseille Université, Provence-Alpes-Côte D'azur, Marseille, France.,Assistance Publique-Hopitaux de Marseille (AP-HM), Hopital Timone, Provence-Alpes-Côte D'azur, Marseille, France.,UMR D-258 Microbes Evolution Phylogénie et Infection (MEPHI), Institut de Recherche Pour Le Développement (IRD), Aix-Marseille Université, Provence-Alpes-Côte D'azur, Marseille, France
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14
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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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15
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Effect of Root Surface Biomodification on Multiple Recession Coverage with Modified Coronally Advanced Tunnel Technique and Subepithelial Connective Tissue Graft: A Retrospective Analysis. Gels 2022; 8:gels8010031. [PMID: 35049566 PMCID: PMC8775041 DOI: 10.3390/gels8010031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/23/2021] [Accepted: 01/02/2022] [Indexed: 01/22/2023] Open
Abstract
To improve treatment efficacy of gingival recessions (GR), chemical preparation of the exposed root surface was advocated. The aim of this study was to compare the additional influence of root biomodifications with 24% ethylenediaminetetraacetic acid (EDTA) alone or with enamel matrix derivative (EMD) on the 12 month outcomes of modified coronally advanced tunnel (MCAT) with subepithelial connective tissue graft in the treatment of multiple GR. Average root coverage (ARC), complete root coverage (CRC), reduction in GR, reduction in recession width (RW), gain in clinical attachment level (CAL), increase in gingival thickness (GT), increase in keratinized tissue width (KTW) and changes in root coverage esthetic score (RES) were evaluated. A total of 60 patients with 215 GR were enrolled. In 70, GR root surfaces were treated with EDTA + EMD, in other 72, with EDTA, while in the remaining 73 saline solution was applied. ARC was 94%, 89%, and 91% in the EDTA + EMD, the EDTA and the saline groups, respectively (p = 0.8871). Gains in clinical attachment level (CAL; 2.1 ± 1.1 mm) and RES values (9.6 ± 0.9) were significantly higher in the EDTA + EMD group, when compared with two other groups. The differences between other preoperative and postoperative parameters showed statistical significance only within but not between groups. MCAT outcomes may benefit from adjunctive use of EDTA + EMD regarding 12 month CAL gain and professionally assessed esthetics using RES following treatment of GR.
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16
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Panda S, Khijmatgar S, Arbildo-Vega H, Das AC, Kumar M, Das M, Mancini L, Del Fabbro M. Stability of biomaterials used in adjunct to coronally advanced flap: A systematic review and network meta-analysis. Clin Exp Dent Res 2021; 8:421-438. [PMID: 34845864 PMCID: PMC8874057 DOI: 10.1002/cre2.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 12/26/2022] Open
Abstract
AIM The objective of this network meta-analysis was to rank different biomaterials used in adjunct to coronally advanced flap (CAF), based on their performance in root-coverage for Miller's Class I and II gingival recessions. MATERIALS AND METHODS An electronic database search was carried out in PUBMED, CENTRAL, SCOPUS, and EMBASE to identify the eligible articles and compiled into the citation manager to remove the duplicates. The primary outcome was keratinized gingival tissue width (KGW) and percentage of root coverage (%RC). The treatment effect of different biomaterials was estimated using predictive interval plots and ranked based on biomaterials performance, using multidimensional scale ranking. RESULTS CAF + connective tissue graft (CTG), CAF + platelet concentrate matrix (PCM) and acellular dermal matrix (ADM) ranked at the top positions in performance in improving KGW. The highest ranked materials in improving percentage of root coverage in gingival recession were CAF + collagen matrix (CM) + gingival fibroblasts (GF), CAF + ADM + platelet rich plasma (PRP) and CAF + ADM, as compared to CAF alone. CONCLUSION CTG, ADM, platelet concentrates, and CM + GFs, when used in adjunct to CAF, showed improved stability over ≥12 months of follow-up, better percentage of root coverage, and improved keratinized gingival width.
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Affiliation(s)
- Sourav Panda
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Oral Biology and Genomic Studies, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, India
| | - Heber Arbildo-Vega
- Department of General Dentistry, Dentistry School, Universidad San Martín de Porres, Chiclayo, Peru
| | - Abhaya Chandra Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Manoj Kumar
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Mohit Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Leonardo Mancini
- Department of life health and environmental sciences, University of L'Aquila, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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17
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Santamaria MP, Rossato A, Miguel MMV, Fonseca MB, Bautista CRG, de Marco AC, Mathias-Santamaria IF, Ferreira Ferraz LF. Comparison of two types of xenogeneic matrices to treat single gingival recessions: A randomized clinical trial. J Periodontol 2021; 93:709-720. [PMID: 34598314 DOI: 10.1002/jper.21-0212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/10/2021] [Accepted: 09/26/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Xenogeneic matrices (XMs) have been increasingly used for root coverage procedures. This study compared the use of two types of XM (collagen matrix [CM] and xenogeneic acellular dermal matrix [XDM]) associated with the coronally advanced flap technique (CAF) to treat single gingival recessions. METHODS Seventy-five patients presenting single RT1 gingival recession were treated by CAF (control group, n = 25), CAF+CM (test group 1, n = 25), or CAF+XDM (test group 2, n = 25) and completed 6-month follow-up. Clinical, patient-centered, and esthetic assessments were performed and intra- and intergroup differences were analyzed. RESULTS At 6 months, the mean recession reduction for CAF, CAF+CM, and CAF+XDM was 2.4 ± 0.8 mm, 2.4 ± 0.9 mm and 2.1 ± 0.8 mm, respectively (P > 0.05). The corresponding mean percentage of root coverage was 78.9% ± 26.2% for CAF, 78.0% ± 28.5% for CAF+CM, and 65.6% ± 26.9% for CAF+XDM (P > 0.05). Dentin hypersensitivity and esthetic conditions showed significantly improvements in all groups. Test groups presented significant gains in gingival thickness (GT; CAF+CM: 0.4 ± 0.3 mm; CAF+XDM: 0.4 ± 0.2 mm) compared to the control group (CAF: 0.0 ± 0.1 mm; P < 0.05). CONCLUSION The CAF, CAF+CM, and CAF+XDM treatments each provided similar results in the treatment of single gingival recessions. The addition of either CM or XDM to CAF increases the GT.
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Affiliation(s)
- Mauro Pedrine Santamaria
- Division of Periodontics, Institute of Science and Technology, São José dos Campos, São Paulo State University (Unesp), São Paulo, Brazil.,College of Dentistry-Lexington, University of Kentucky, Lexington, Kentucky, USA
| | - Amanda Rossato
- Division of Periodontics, Institute of Science and Technology, São José dos Campos, São Paulo State University (Unesp), São Paulo, Brazil
| | - Manuela Maria Viana Miguel
- Division of Periodontics, Institute of Science and Technology, São José dos Campos, São Paulo State University (Unesp), São Paulo, Brazil
| | - Manuela Bafini Fonseca
- Division of Periodontics, Institute of Science and Technology, São José dos Campos, São Paulo State University (Unesp), São Paulo, Brazil
| | - Cristhian Reynaldo Gomez Bautista
- Division of Periodontics, Institute of Science and Technology, São José dos Campos, São Paulo State University (Unesp), São Paulo, Brazil
| | - Andrea Carvalho de Marco
- Division of Periodontics, Institute of Science and Technology, São José dos Campos, São Paulo State University (Unesp), São Paulo, Brazil
| | - Ingrid Fernandes Mathias-Santamaria
- Division of Periodontics, Institute of Science and Technology, São José dos Campos, São Paulo State University (Unesp), São Paulo, Brazil.,Division of Operative Dentistry, Department of General Dentistry, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Laís Fernanda Ferreira Ferraz
- Division of Periodontics, Institute of Science and Technology, São José dos Campos, São Paulo State University (Unesp), São Paulo, Brazil
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18
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Comparative Evaluation of Connective Tissue Graft with Pouch/Tunnel Technique versus Connective Tissue Graft with Coronally Advanced Tunnel Flap for the Treatment of Maxillary Recession Cases in Severe Periodontitis. Tissue Eng Regen Med 2021; 18:1001-1007. [PMID: 34480732 DOI: 10.1007/s13770-021-00375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/03/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The long-term stability for both the patient and periodontist remains an important priority after connective tissue graft to manage the gingival recession cases. The goal of this analysis was to assess and compare the connective tissue graft with Pouch/Tunnel technique versus connective tissue graft with coronally advanced tunnel flap for the treatment of maxillary recession cases in severe periodontitis. METHODS The total sample size was comprised of 200 subjects. The control group, coronally advanced flap along with connective tissue graft (CTG) was comprised of 100 samples and test group, pouch/tunnel technique with connective tissue graft (POT + CTG) was also comprised of 100 samples. The clinical findings included medium root coverage (MRC) and absolute root (CRC) coverage, gingival (GT) distribution and keratinized tissue (KT) gain. Esthetic findings were also evaluated. All findings analyzed initially after 6th months and have been expanded to 4 years. RESULTS There were no major variations between the MRC and CRC patient classes with non significant values. In the POT + CTG category, GT and KT improvements were slightly greater at 4 years, with a substantial improvement in texture in control group. CONCLUSION Pouch/Tunnel technique along with connective tissue graft allows for the clinical coverage of gingival recessions that is equivalent to Coronally advanced flap with CTG, however this may improves the gingival thickness, KT and esthetic performance.
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19
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Górski B, Szerszeń M, Kaczyński T. Effect of 24% EDTA root conditioning on the outcome of modified coronally advanced tunnel technique with subepithelial connective tissue graft for the treatment of multiple gingival recessions: a randomized clinical trial. Clin Oral Investig 2021; 26:1761-1772. [PMID: 34431001 PMCID: PMC8816759 DOI: 10.1007/s00784-021-04151-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate effects of root conditioning with 24% ethylenediaminetetraacetic acid (EDTA) on the 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG). MATERIALS AND METHODS Twenty patients with 142 GR were treated (72 test sites: SCTG + EDTA and 70 control sites: SCTG). Average and complete root coverage (ARC, CRC), gain in keratinized tissue width (KTW), gain in gingival thickness (GT), root esthetic coverage score (RES), and patient-reported outcome measures (PROMs) were evaluated at 12 months post-operatively. RESULTS Differences between pre- and post-operative values were statistically significant only within but not between treatment modalities. At 12 months, ARC was 86.0% for SCTG + EDTA-treated and 84.6 for SCTG-treated defects (p = 0.6636). CRC was observed in 90.2% (tests) and 91.4% (controls) of all cases (p = 0.9903). Professional assessment of esthetic outcomes using RES showed highly positive results reaching the value of 8.9 in case of test sites and 8.7 for control sites (p = 0.3358). Severity of pain and swelling did not differ between sites, regardless of whether EDTA was used. CONCLUSIONS Test and control sites presented similarly positive outcomes related to root coverage, periodontal and esthetic parameters, and patient satisfaction and self-reported morbidity with no statistical differences between them 12 months after surgery. No significant differences in evaluated variables were observed between sites treated with and without 24% EDTA. Clinical relevance Considering the limitations of the present study, the use of 24% EDTA for root conditioning did not improve 12-month outcomes after treatment of multiple RT1 and RT2 gingival recessions with MCAT and SCTG. Trial registration ClinicalTrials.gov identifier: NCT03354104.
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Affiliation(s)
- Bartłomiej Górski
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland.
| | - Marcin Szerszeń
- Department of Dental Prosthetics, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
| | - Tomasz Kaczyński
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
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20
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Mathias-Santamaria IF, Silveira CA, Rossato A, Sampaio de Melo MA, Bresciani E, Santamaria MP. Single gingival recession associated with non-carious cervical lesion treated by partial restoration and coronally advanced flap with or without xenogenous collagen matrix: A randomized clinical trial evaluating the coverage procedures and restorative protocol. J Periodontol 2021; 93:504-514. [PMID: 34310715 DOI: 10.1002/jper.21-0358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluate the use of collagen matrix (CM) as adjunctive to coronally advanced flap (CAF versus CAF + CM) to treat gingival recession (GR) associated with non-carious cervical lesion-combined defects (CDs). METHODS Sixty-two patients presenting 62 CDs (RT1 GR and non-carious cervical lesion (NCCLs) were randomly allocated to either CAF group (n = 31): partial restoration of the NCCL and CAF; or to CAF + CM group (n = 31): partial restoration of the NCCL and CAF associated with CM. Clinical, esthetic, patient-centered outcomes, and restorative parameters were assessed. RESULTS After 12 months, CD coverage were 55.2% for CAF and 54.4% for CAF + CM (P = 0.8). Recession reduction were 1.9 ± 0.8 mm for CAF and 2.0 ± 0.7 mm for CAF + CM (P = 0.6). CAF+CM resulted in higher increase in keratinized tissue (KT) width (CAF: 0.3 ± 0.7 mm; CAF + CM: 0.9 ± 0.8 mm; P = 0.004) and KT thickness gain (CAF: 0.1 ± 0.3 mm; CAF + CM: 0.7 ± 0.2 mm; P = 0.001). Both treatments presented low postoperative pain and resulted in esthetics improvements. In addition, no restoration was lost, 27.4% showed a reduction of the superficial polishing, and 8% showed marginal staining, but still clinically acceptable. CONCLUSION Partial resin composite restoration (with the apical limit up to 1 mm of the estimated CEJ) and CAF alone or combined with CM are suitable for treating CDs. The use of CM provided additional benefits in terms of KT width and thickness gain. (NCT03341598).
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Affiliation(s)
- Ingrid Fernandes Mathias-Santamaria
- UNESP Sao Paulo State University, Division of Periodontology, College of Dentistry, Sao Paulo, Brazil.,Division of Operative Dentistry, Department of General Dentistry, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Camila Augusto Silveira
- UNESP Sao Paulo State University, Division of Periodontology, College of Dentistry, Sao Paulo, Brazil
| | - Amanda Rossato
- UNESP Sao Paulo State University, Division of Periodontology, College of Dentistry, Sao Paulo, Brazil
| | - Mary Anne Sampaio de Melo
- Division of Operative Dentistry, Department of General Dentistry, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Eduardo Bresciani
- UNESP Sao Paulo State University, Division of Operative Dentistry, College of Dentistry, Sao Paulo, Brazil
| | - Mauro Pedrine Santamaria
- UNESP Sao Paulo State University, Division of Periodontology, College of Dentistry, Sao Paulo, Brazil.,College of Dentistry-Lexington, University of Kentucky, Lexington, Kentucky, USA
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21
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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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22
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Korkmaz B, Balli U. Clinical evaluation of the treatment of multiple gingival recessions with connective tissue graft or concentrated growth factor using tunnel technique: a randomized controlled clinical trial. Clin Oral Investig 2021; 25:6347-6356. [PMID: 33830339 DOI: 10.1007/s00784-021-03935-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the effectiveness of the combination of tunnel technique (TT) and concentrated growth factor (CGF) for root coverage in treating multiple gingival recessions (GR) and compare with the connective tissue graft (CTG). MATERIALS AND METHODS Forty patients with Miller Class I and II maxillary or mandibular GR were randomly divided into two groups as follows: TT + CTG and TT + CGF. The results at baseline and 6 months were evaluated for the following clinical parameters: complete root coverage (CRC), mean root coverage (MRC), gingival thickness (GT), gingival recession width (RW), gingival recession depth (RD), and keratinized tissue width (KTW). RESULTS At 6 months, a statistically significant difference was found in RD, RW, MRC, CRC, KTW, and GT compared with the baseline (p < 0.05). MRC was determined 89.52±16.36% in the TT + CTG and 76.60±24.10% in the TT + CGF (p < 0.05). CRC was achieved in 66.7% of the TT + CTG and 47.4% of the TT + CGF (p < 0.05). The increase in KTW and GT was significantly better in the TT + CTG group compared to the TT + CGF (p < 0.05). CONCLUSIONS The study showed that TT + CGF did not improve the results as much as TT + CTG in the treatment of Miller Class I and II GR. However, this finding is not sufficient to advocate the true clinical effects of CGF on GR treatment with TT. CLINICAL RELEVANCE CGF could not serve as a direct alternative biomaterial to the gold standard CTG. TRIAL REGISTRATION ClinicalTrials.gov Identification Number: NCT04561947.
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Affiliation(s)
- Birsen Korkmaz
- Department of Periodontology, Faculty of Dentistry, Bulent Ecevit University, Zonguldak, Turkey.
| | - Umut Balli
- Department of Periodontology, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
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23
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Durán JC, Alarcón C, De la Jara D, Pino R, Lanis A. Multidisciplinary Treatment of Deep Non-Carious Cervical Lesion With a CAD/CAM Chairside Restoration in Combination With Periodontal Surgery: A 60-Month Follow-Up Technique Report. Clin Adv Periodontics 2021; 11:87-92. [PMID: 33569921 DOI: 10.1002/cap.10152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/01/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Restoring function and esthetics are essential aspects of periodontology and restorative dentistry. Depending on their extension and the tissues involved, the treatment of non-carious cervical lesions (NCCLs) associated with gingival recessions may require a multidisciplinary approach, and different periodontal and restorative techniques have been described. CASE PRESENTATION This case report presents an innovative approach to treat a deep NCCL combined with a gingival recession in a canine region of a female patient. A Computer Aided Design - Computer Aided Manufacturing (CAD/CAM) chairside ceramic restoration in combination with mucogingival surgery procedures is described. A comprehensive analysis of the selected approach and its clinical implications is presented based on a 60-month follow-up. Conclusions After 60-month follow-up, clinical condition maintained stable, and a successful esthetic outcome was accomplished. Complete root coverage was achieved and kept throughout the whole period of tracing.
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Affiliation(s)
- Juan C Durán
- School of Dentistry, Universidad del Desarrollo, Santiago, Chile.,Department of Prosthodontics, School of Dentistry, Universidad del Desarrollo, Santiago, Chile
| | - Carolina Alarcón
- Department of Prosthodontics, School of Dentistry, Universidad del Desarrollo, Santiago, Chile
| | - Dolores De la Jara
- Department of Prosthodontics, School of Dentistry, Universidad del Desarrollo, Santiago, Chile
| | - Rodrigo Pino
- Department of Prosthodontics, School of Dentistry, Universidad del Desarrollo, Santiago, Chile
| | - Alejandro Lanis
- Department of Prosthodontics, School of Dentistry, Universidad del Desarrollo, Santiago, Chile.,Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Indiana, USA
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24
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Abstract
Gingival recession is a common finding in daily clinical practice. Several issues may be associated with the apical shift of the gingival margin such as dentine hypersensitivity, root caries, non-carious cervical lesions (NCCLs), and compromised aesthetics. The first step in an effective management and prevention program is to identify susceptibility factors and modifiable conditions associated with gingival recession. Non-surgical treatment options for gingival recession defects include establishment of optimal plaque control, removal of overhanging subgingival restorations, behaviour change interventions, and use of desensitising agents. In cases where a surgical approach is indicated, coronally advanced flap and tunnelling procedures combined with a connective tissue graft are considered the most predictable treatment options for single and multiple recession defects. If there is a contraindication for harvesting a connective tissue graft from the palate or the patient wants to avoid a donor site surgery, adjunctive use of acellular dermal matrices, collagen matrices, and/or enamel matrix derivatives can be a valuable treatment alternative. For gingival recession defects associated with NCCLs a combined restorative-surgical approach can provide favourable clinical outcomes. If a patient refuses a surgical intervention or there are other contraindications for an invasive approach, gingival conditions should be maintained with preventive measures. This paper gives a concise review on when and how to treat gingival recession defects.
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Affiliation(s)
- Jean-Claude Imber
- Department of Periodontology and Operative Dentistry, University of Mainz, Mainz, Germany; Department of Periodontology, University of Bern, Bern, Switzerland
| | - Adrian Kasaj
- Department of Periodontology and Operative Dentistry, University of Mainz, Mainz, Germany.
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25
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Cairo F, Barootchi S, Tavelli L, Barbato L, Wang HL, Rasperini G, Graziani F, Tonetti M. Aesthetic-And patient-related outcomes following root coverage procedures: A systematic review and network meta-analysis. J Clin Periodontol 2020; 47:1403-1415. [PMID: 32654220 DOI: 10.1111/jcpe.13346] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self-reported morbidity (post-operative pain/discomfort). MATERIAL AND METHODS A comprehensive literature search was performed. A mixed-modelling approach to network meta-analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient-reported satisfaction and post-operative pain/discomfort (visual analogue scale (VAS) of 100). RESULTS Twenty-six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p = .005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p = .01) and CAF + Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p = .04)) were significantly associated with higher RES than CAF. No significant difference between CAF + CTG and TUN + CTG was detected (0.09 (95% CI [-0.54, 0.72], p = .77)). Addition of CTG resulted in less natural tissue texture (-0.21 (95% CI [-0.34, -0.08]), p = .003) and gingival colour (-0.06 (95% CI [-0.12, -0.03], p = .03)) than CAF. CTG techniques were associated with increased morbidity. CONCLUSIONS Connective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG-based techniques were also correlated with a greater patient satisfaction and morbidity.
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Affiliation(s)
- Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Giulio Rasperini
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical Surgical and Dental Sciences Foundation IRCCS Ca' Granda Policlinic, University of Milan, Milan, Italy
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Maurizio Tonetti
- European Research Group on Periodontology (ERGOPERIO), Genova, Italy.,Division of Periodontology, Faculty of Dentistry, Hong Kong University, Hong Kong, China.,Department of Oral and Maxillo-Facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Stomatology, Shanghai Ninth People Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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26
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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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27
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Neves FLDS, Augusto Silveira C, Mathias-Santamaria IF, Miguel MMV, Ferraz LFF, Casarin RCV, Sallum EA, Tatakis DN, Santamaria MP. Randomized clinical trial evaluating single maxillary gingival recession treatment with connective tissue graft and tunnel or trapezoidal flap: 2-year follow-up. J Periodontol 2020; 91:1018-1026. [PMID: 31867724 DOI: 10.1002/jper.19-0436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/04/2019] [Accepted: 11/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND The literature lacks long-term evidence regarding outcomes of the coronally advanced tunnel flap (TUN) combined with connective tissue graft (CTG) when compared to the trapezoidal coronally advanced flap (CAF) and CTG combination. This study presents 2-year results of a randomized clinical trial comparing CTG combined with either CAF or TUN in the treatment of single maxillary gingival recession (GR) defects. METHODS Thirty-nine patients, each contributing a single Miller Class I or II GR defect, were treated by CAF+CTG (control; n = 19) or TUN+CTG (test; n = 20) and completed the 2-year follow up. Clinical, patient centered, and esthetic evaluations were performed and differences among groups were analyzed. RESULTS At 2 years, mean root coverage for control and test group was 89.5% ± 14.6% and 87.7% ± 18.4%, respectively (P = 0.5). The corresponding complete root coverage prevalence was 68.4% and 50% (P = 0.4). Dentin hypersensitivity significantly decreased for both groups. The two groups showed improvement in esthetics, as assessed by both professionals and patients, without significant intergroup differences (P > 0.5). TUN+CTG sites were much more likely to present improvement in root coverage between 6 months and 2 years, exhibiting creeping attachment of 0.7 ± 0.6 mm. CONCLUSIONS At 2 years of follow up, both CAF+CTG and TUN+CTG resulted in significant clinical and esthetic improvements and provided similar results in the treatment of single maxillary GRs.
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Affiliation(s)
- Felipe Lucas da Silva Neves
- UNESP - São Paulo State University, Division of Periodontology, College of Dentistry, São José dos Campos, Brazil
| | - Camila Augusto Silveira
- UNESP - São Paulo State University, Division of Periodontology, College of Dentistry, São José dos Campos, Brazil
| | | | - Manuela Maria Viana Miguel
- UNESP - São Paulo State University, Division of Periodontology, College of Dentistry, São José dos Campos, Brazil
| | | | - Renato Correa Viana Casarin
- Department of Prosthodontics and Periodontics, Periodontics Division, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Enilson Antônio Sallum
- Department of Prosthodontics and Periodontics, Periodontics Division, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
| | - Mauro Pedrine Santamaria
- UNESP - São Paulo State University, Division of Periodontology, College of Dentistry, São José dos Campos, Brazil
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28
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Barootchi S, Tavelli L, Zucchelli G, Giannobile WV, Wang H. Gingival phenotype modification therapies on natural teeth: A network meta‐analysis. J Periodontol 2020; 91:1386-1399. [DOI: 10.1002/jper.19-0715] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 03/15/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Shayan Barootchi
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
| | - William V. Giannobile
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
- Department of Biomedical Engineering & Biointerfaces Institute College of Engineering University of Michigan Ann Arbor MI USA
| | - Hom‐Lay Wang
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
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29
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Tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: a randomized clinical trial. Clin Oral Investig 2020; 24:4475-4486. [PMID: 32382922 PMCID: PMC7666664 DOI: 10.1007/s00784-020-03312-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/23/2020] [Indexed: 01/04/2023]
Abstract
Objectives The aim of this study was to compare outcomes of the modified coronally advanced tunnel technique (MCAT) combined with subepithelial connective tissue graft (SCTG) with or without enamel matrix derivative (EMD), in the treatment of gingival recession types 1 and 2. Materials and methods A total of 20 patients with 150 multiple gingival recessions (GR) were included in the study. On one side, MCAT was combined with SCTG and EMD (tests), whereas MCAT with SCTG was applied on the contralateral side (controls). Clinical parameters were measured at baseline and 6 months after surgery. Visual analog scales (VAS) and questionnaires were used to assess patient-reported outcomes and the root coverage esthetic score (RES) for professional esthetic evaluation. Results MCAT+SCTG+EMD was not superior with regard to root coverage. At 6 months, average root coverage (ARC) was 87.4% for SCTG+EMD-treated and 90.9% for SCTG-treated defects (p = 0.4170). Complete root coverage (CRC) was observed in 86.7% (tests) and 85.3% (controls) of the cases (p = 0.9872). Significantly less pain was reported using VAS (p = 0.0342) post-operatively in the SCTG+EMD group. Professional assessment of esthetic outcomes using RES showed a significant difference (9.25 versus 8.71, p = 0.0103) in favor of the test group. Conclusions Both treatment modalities were equally effective in treatment of multiple GR and led to similar improvements in clinical parameters. However, the application of EMD as an adjunct resulted in less post-operative pain and better professionally assessed esthetic outcomes. Clinical relevance Patients’ early morbidity and 6-month esthetic outcomes following GR coverage with MCAT might be influenced by means of EMD utilization.
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30
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Akcan SK, Ünsal B. Gingival recession treatment with concentrated growth factor membrane: a comparative clinical trial. J Appl Oral Sci 2020; 28:e20190236. [PMID: 32236353 PMCID: PMC7105285 DOI: 10.1590/1678-7757-2019-0236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/23/2019] [Indexed: 02/07/2023] Open
Abstract
Objective This clinical trial sought to evaluate the clinical effectiveness of concentrated growth factor (CGF) and compare it with connective tissue graft (CTG) with coronally advanced flap (CAF) in the treatment of Miller Class I gingival recessions (GR). Methodology This split-mouth study included 74 Miller Class I isolated (24 teeth) or multiple (50 teeth) GRs in 23 jaws of 19 patients. GRs were randomly treated using CGF (test group: 37 teeth; 12 teeth in isolated GRs, 25 teeth in multiple GRs) or CTG with CAF (control group: 37 teeth;12 teeth isolated GRs, 25 teeth in multiple GRs). Clinical variables, plaque index (PI), gingival index (GI), probing depth (PD), recession depth (RD), recession width (RW), clinical attachment level (CAL), keratinized tissue thickness (KTT), keratinized tissue width (KTW), and root coverage (RC) were assessed at the baseline as well as at three and six months post-surgery. Healing index (HI) were obtained in the second and third weeks post-surgery. Postoperative pain was assessed for the first seven days using a horizontal visual analog scale (VAS). Results No significant change was observed in PI, GI, or PD values in either the intergroup or the intragroup comparisons. A statistically significant decrease was observed in CAL, RD, and RW, and KTT increased in all groups at three and six months compared with the baseline. The control group had greater increases in KTW, KTT, and RC at three and six months. No significant difference was found in CAL or RD at the third and sixth months between the two groups. Healing was found to be similar for both groups in the second and third weeks post-surgery. The VAS values in the control group were higher than in the test group, especially at the second, fourth, fifth, and seventh days postoperatively. Conclusions CTG is superior to CGF with CAF for increasing KTT, KTW, and RC. CGF may be preferable due to decreased postoperative pain.
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Affiliation(s)
- Serap Karakış Akcan
- Beykent University, Faculty of Dentistry, Department of Periodontology, İstanbul, Turkey
| | - Berrin Ünsal
- Gazi University, Faculty of Dentistry, Department of Periodontology, Ankara, Turkey
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31
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Petsos H, Eickholz P, Raetzke P, Nickles K, Dannewitz B, Hansmeier U. Clinical and patient‐centred long‐term results of root coverage using the envelope technique in a private practice setting: 10‐year results—A case series. J Clin Periodontol 2020; 47:372-381. [DOI: 10.1111/jcpe.13242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/10/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Hari Petsos
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt/Main Germany
- Private Practice Soest Germany
| | - Peter Eickholz
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt/Main Germany
| | - Peter Raetzke
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt/Main Germany
| | - Katrin Nickles
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt/Main Germany
- Private Practice Mannheim Germany
| | - Bettina Dannewitz
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt/Main Germany
- Private Practice Weilburg Germany
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32
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Tavelli L, Barootchi S, Cairo F, Rasperini G, Shedden K, Wang H. The Effect of Time on Root Coverage Outcomes: A Network Meta-analysis. J Dent Res 2019; 98:1195-1203. [DOI: 10.1177/0022034519867071] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The stability of root coverage outcomes has gained a great deal of interest. However, insufficient evidence is available, mainly due to limited direct comparisons among different techniques and the small sample size among clinical trials. Therefore, the aim of this study was to propose a mixed-models network meta-analysis (NMA) that includes the novelty of assessing time on root coverage outcomes while simultaneously comparing different surgical approaches. A literature search was performed by 2 individual reviewers to identify randomized clinical trials (RCTs) reporting the outcomes of root coverage procedures of at least 2 time points to estimate the slopes of different treatment approaches. The primary outcomes were the changes in slopes for recession depth (REC), keratinized tissue width (KTW), and clinical attachment level. Sixty RCTs with a total of 2,554 gingival recessions (1,864 patients) were included in the NMA. Connective tissue graft (CTG) and enamel matrix derivative (EMD) approaches provided superior initial REC reduction compared to flap advancement alone. However, only CTG-based procedures were effective in maintaining the stability of the gingival margin over time, while EMD, acellular dermal matrix, collagen matrix, and flap alone showed a similar tendency for gingival recession recurrence. Baseline REC and KTW at the earliest postoperative recall were predictors for the stability of the gingival margin. In addition, a geographic center effect on the treatment slopes was observed for REC and KTW. While limitations of the present linear mixed-modeling approach should be considered as it refers to estimation and comparison of time slopes based on an examined while linear framework, the designed NMA showed to be an effective tool for the simultaneous comparison of multiple treatment approaches while taking into account the critical element of time.
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Affiliation(s)
- L. Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - S. Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - F. Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - G. Rasperini
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- University of Milan, Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca’ Granda Polyclinic, Milan, Italy
| | - K. Shedden
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - H.L. Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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33
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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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Fan KA, Zhong JS, Ouyang XY, Xie Y, Chen ZY, Zhou SY, Zhang Y. [Vestibular incision subperiosteal tunnel access with connective tissue graft for the treatment of Miller classI and II gingival recession]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:80-85. [PMID: 30773549 DOI: 10.19723/j.issn.1671-167x.2019.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the clinical outcomes of vestibular incision subperiosteal tunnel access (VISTA) with connective tissue graft (CTG) in the treatment of Miller classes I and II localized gingival recession. METHODS Ten patients with 10 Miller classes I and II localized gingival recessions were enrolled in the study. All defects were equal to or above 2 mm in recession depth. All the patients received treatment with VISTA+CTG. Their clinical parameters, including recession depth (Rec), recession width (RW), keratinized tissue width (KT), clinical attachment loss (CAL), probing depth (PD) were recorded and compared before surgery and 6 months later. The mean root coverage (MRC) and complete root coverage (CRC) were calculated at the end of 6 months. A visual analogue scale (VAS) was used to estimate the patients' discomfort during the operation and during the 2 weeks post-operation. Patient-based aesthetic satisfaction 6 months after surgery was evaluated by a VAS. RESULTS The mean Rec was (2.65±0.82) mm at baseline, and (0.35±0.58) mm after 6 months. The VISTA+CTG treatment resulted in an improvement of (2.30±0.98) mm in recession depth (P<0.001). MRC was 86.67%±21.94% and CRC reached 70% at the end of 6 months. KT increased (0.90±1.22) mm (P<0.05). Aesthetic satisfaction on the patients' level was 8.30 based on VAS (0=unsatisfied, 10=extremely satisfied). The patients' discomfort during the operation and 2 weeks post operation were 2.40 and 4.30 (0=no pain, 10=extreme pain). Furthermore, clinical outcomes showed no statistically significant difference between the gingival biotypes, and between the teeth positioned in maxillary and in mandibular. CONCLUSION VISTA+CTG could be an effective treatment for Miller classes I and II localized gingival recession. Clinical outcomes indicated decrease in recession depth and width, and increase in width of keratinized tissue. Patients suffered little pain during the operation and 2 weeks post-operation of healing and accessed good aesthetic satisfaction. VISTA+CTG could be an option for the treatment of Miller classes I and II localized gingival recession.
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Affiliation(s)
- K A Fan
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - J S Zhong
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - X Y Ouyang
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Y Xie
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Z Y Chen
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - S Y Zhou
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Y Zhang
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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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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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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Tavelli L, Barootchi S, Nguyen TV, Tattan M, Ravidà A, Wang H. Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta‐analysis. J Periodontol 2018; 89:1075-1090. [DOI: 10.1002/jper.18-0066] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Shayan Barootchi
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Trang V.N. Nguyen
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Mustafa Tattan
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Andrea Ravidà
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Hom‐Lay Wang
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
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Santamaria MP, Silveira CA, Mathias IF, Neves FLDS, Santos LM, Jardini MAN, Tatakis DN, Sallum EA, Bresciani E. Treatment of single maxillary gingival recession associated with non‐carious cervical lesion: Randomized clinical trial comparing connective tissue graft alone to graft plus partial restoration. J Clin Periodontol 2018; 45:968-976. [DOI: 10.1111/jcpe.12907] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Mauro Pedrine Santamaria
- Department of PeriodontologyCollege of Dentistry – FOSJCUNESP – São Paulo State University São José dos Campos São Paulo Brazil
| | - Camila Augusto Silveira
- Department of PeriodontologyCollege of Dentistry – FOSJCUNESP – São Paulo State University São José dos Campos São Paulo Brazil
| | - Ingrid Fernandes Mathias
- Department of Restorative DentistryCollege of Dentistry – FOSJCUNESP – São Paulo State University São José dos Campos São Paulo Brazil
- Department of Restorative Dental SciencesCollege of DentistryUniversity of Florida Gainesville Florida
| | - Felipe Lucas da Silva Neves
- Department of PeriodontologyCollege of Dentistry – FOSJCUNESP – São Paulo State University São José dos Campos São Paulo Brazil
| | - Lúcio Murilo Santos
- Department of PeriodontologyCollege of Dentistry – FOSJCUNESP – São Paulo State University São José dos Campos São Paulo Brazil
| | - Maria Aparecida Neves Jardini
- Department of PeriodontologyCollege of Dentistry – FOSJCUNESP – São Paulo State University São José dos Campos São Paulo Brazil
| | - Dimitris N. Tatakis
- Division of PeriodontologyCollege of DentistryThe Ohio State University Columbus Ohio
| | - Enilson Antônio Sallum
- Piracicaba Dental SchoolDepartment of Prosthodontics and PeriodonticsDivision of PeriodonticsUNICAMP ‐ University of Campinas Piracicaba São Paulo Brazil
| | - Eduardo Bresciani
- Department of Restorative DentistryCollege of Dentistry – FOSJCUNESP – São Paulo State University São José dos Campos São Paulo Brazil
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Gómez-Meda R, Torres-Sanchez C, Mareque-Bueno S, Zufía-González J, Torres-Lagares D, Gutierrez-Pérez JL. Papilla and pontic area regeneration in patient with gingival smile: A clinical case. J Clin Exp Dent 2018; 10:e507-e512. [PMID: 29849978 PMCID: PMC5971083 DOI: 10.4317/jced.54859] [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: 03/24/2018] [Accepted: 04/11/2018] [Indexed: 11/05/2022] Open
Abstract
Purpose Connective tissue grafts are widely documented as a predictable technique for treating Miller Class I and II recessions, as well as procedures in which soft tissue augmentation is required for aesthetic reasons. This article aims to explore the resolution of a clinical case with this type of problema. Clinical case This case describes a technique for reconstructing a pontic area and adjacent papilla by means of two consecutive connective tissue grafts. The first graft served to increase the amount of tissue in the horizontal direction, and the second promoted vertical reconstruction of the defect. Results and Conclusion In cases with aesthetic requirements, restorative intervention may be able to mask tissue loss, but it can hardly achieve optimal aesthetic results. Periodontal plastic surgery techniques can be used to achieve that ideal result. The clinician must diagnose conditions in order to select correct treatment regimen for each individual case. Key words:Papilla, gingival smile, pontic, restorative dentistry.
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Affiliation(s)
- Ramón Gómez-Meda
- DDS, MS, Private practice in Periodontics and prosthodontics, Ponferrada, León, Spain
| | - Carlos Torres-Sanchez
- DDS, MS, PhD, Associate Research, Oral Surgery and Prosthodontics Department, Dentistry Faculty, University of Seville, Seville, Spain
| | - Santiago Mareque-Bueno
- DDS MS, Private practice in Periodontics. Pontevedra, España. Profesor Santiago de Compostela University
| | | | - Daniel Torres-Lagares
- DDS, MS, PhD,Master Chief of Oral Surgery, Dentistry Department, University of Seville, Seville, Spain
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