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Bednarz W, Majer J, Pakuszyńska-Błaszczyk J, Dominiak M, Gedrange T, Zielińska-Pałasz A. Laterally Positioned Flap Procedure with Augmented or Nonaugmented Palatal Connective Tissue Grafts in the Treatment of Multiple Adjacent Gingival Recessions: A Two-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12208. [PMID: 36231511 PMCID: PMC9566521 DOI: 10.3390/ijerph191912208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
The most commonly used technique for covering gingival recessions is the coronally advanced flap (CAF) technique due to its high success rate. In clinical situations where there is less keratinized tissue apical to the defect due to unfavorable anatomical conditions, a more advantageous technique for this situation should be considered, specifically the laterally positioned flap (LPF). The aim of this study was to compare the gingival thickness after gingival recession coverage using the laterally positioned flap supported by an augmented and non-augmented connective tissue graft (CTG). Thirty-four patients with 105 gingival recessions of Miller's class I and/or II were enrolled in this study. The method of choice was the laterally positioned flap. The test group was treated with previously augmented CTG harvested from the palatal mucosa while the control group was treated with a non-augmented CTG. Clinical measurements were recorded at baseline, 6, 12 and 24 months after intervention. Clinical results showed a statistically more significant percentage of average and complete gingival recession coverage in the test group. The LPF in combination with an augmented CTG proves to be an effective alternative to the CAF. Greater improvement in gingival thickness was observed in the LPF with augmented CTG than in non-augmented CTG.
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Affiliation(s)
- Wojciech Bednarz
- Specialist Outpatient Medical Clinic MEDIDENT, Okulickiego 19 Str., PL 38-300 Gorlice, Poland
| | - Jennifer Majer
- Department of Orthodontics, Carl Gustav Carus Campus, Technische Universität Dresden, Fetscherstr. 74, D-01309 Dresden, Germany
| | | | - Marzena Dominiak
- Department of Dental Surgery, Medical University in Wroclaw, Krakowska 26 str., PL 50-425 Wroclaw, Poland
| | - Tomasz Gedrange
- Department of Orthodontics, Carl Gustav Carus Campus, Technische Universität Dresden, Fetscherstr. 74, D-01309 Dresden, Germany
- Department of Dental Surgery, Medical University in Wroclaw, Krakowska 26 str., PL 50-425 Wroclaw, Poland
| | - Agata Zielińska-Pałasz
- Specialist Outpatient Medical Clinic MEDIDENT, Okulickiego 19 Str., PL 38-300 Gorlice, Poland
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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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3
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Clementini M, Castelluzzo W, Ciaravino V, Agostinelli A, Vignoletti F, Ambrosi A, De Sanctis M. The effect of immediate implant placement on alveolar ridge preservation compared to spontaneous healing after tooth extraction: Soft tissue findings from a randomized controlled clinical trial. J Clin Periodontol 2020; 47:1536-1546. [PMID: 32956551 DOI: 10.1111/jcpe.13369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 09/04/2020] [Indexed: 12/31/2022]
Abstract
AIM To compare soft tissue dimensional changes and relative differences in soft and hard tissue volumes 4 months after single-tooth extraction and three different treatment modalities: spontaneous healing (SH) and alveolar ridge preservation by means of a deproteinized bovine bone mineral and a collagen matrix, with (IMPL/DBBM/CM) or without (DBBM/CM) immediate implant placement. MATERIALS AND METHODS STL files from study casts obtained at baseline and after 4 months were matched to calculate buccal soft tissue linear and volumetric changes. DICOM files from CBCTs were superimposed to STL files allowing the evaluation of soft tissue thickness at baseline and 4 months. RESULTS Mean horizontal reduction accounted for 1.46 ± 0.20 (SH), 0.85 ± 0.38 (DBBM-CM) and 0.84 ± 0.30 IMPL/DBBM-CM, with no statistical differences. Soft tissue thickness had a significant mean increase of 0.95 for SH group, compared to a non-significant mean decrease for DBBM-CM (0.20) and IMPL/DBBM-CM groups (0.07). CONCLUSION A preservation technique with DBBM-CM, with or without immediate implant placement, did not reduce the horizontal linear and volumetric changes at the buccal soft tissue profile significantly at 4 months after tooth extraction when compared to spontaneous healing. This is due to a significant increase in soft tissue thickness in spontaneously healing sites.
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Affiliation(s)
- Marco Clementini
- Department of Periodontology, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Walter Castelluzzo
- Department of Periodontology, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Vincenzo Ciaravino
- Department of Periodontology, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Agnese Agostinelli
- Department of Periodontology, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Fabio Vignoletti
- Department of Periodontology, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Alessandro Ambrosi
- Department of Periodontology, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo De Sanctis
- Department of Periodontology, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
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Holtzman LP, Blasi G, Rivera E, Herrero F, Downton K, Oates T. Gingival Thickness and Outcome of Periodontal Plastic Surgery Procedures: A Meta-regression Analysis. JDR Clin Trans Res 2020; 6:295-310. [PMID: 32718265 DOI: 10.1177/2380084420942171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the impact of soft tissue thickness (STT) on root coverage achieved with different periodontal plastic surgery procedures. BACKGROUND Gingival recession has been managed successfully through various surgical approaches, with great variability in outcomes. Anatomic characteristics of the recipient site and selected technique account in part for this variability. Gingival flap thickness is one of the most critical site-related characteristics. METHODS An electronic search was conducted on the major databases (PubMed, Embase, Web of Science). Human prospective studies with at least 6 mo of follow-up and with a numeric baseline measurement for gingival thickness were eligible. Only studies including nonsmoking patients were considered. Variables included surgical approach, participant characteristics, local anatomic factors, and follow-up time. Primary outcome was mean percentage root coverage (%RC) achieved, and complete root coverage was a secondary outcome. RESULTS A total of 42 studies were included (35 randomized controlled trials, 5 case series, 1 prospective cohort study, and 1 controlled clinical trial). Across studies, the pooled %RC was 81.9% (95% CI, 79.1% to 84.7%). The %RC was not significantly associated (P = 0.267) with baseline soft tissue thickness; however there was a significant (P = 0.031) inverse relationship between STT and %RC after 12-mo follow-up. Subgroup analysis showed that for no graft, there was a significant (P = 0.025) positive relationship between STT and %RC with the exclusion of the single outlier study based on STT. CONCLUSIONS STT plays a limited role in predicting root coverage across all approaches; when flaps are performed with no graft, the effect of STT is most critical. The length of time following surgery appears to influence outcomes, with 12-mo follow-up offering greater insight. KNOWLEDGE TRANSFER STATEMENT The results of this study can suggest to clinicians which periodontal plastic surgery technique to employ when treating challenging cases. In particular, it can be helpful when selecting the treatment approach to treat thin phenotype sites. This study could help clinicians provide a more appropriate treatment decision in such cases.
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Affiliation(s)
- L Paternò Holtzman
- Department of Periodontology and Prosthodontics, G. Eastman Dental Hospital, Rome, Italy.,Private practice, Rome, Italy.,Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - G Blasi
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.,Department of Periodontology, International University of Catalonia, Barcelona, Spain
| | - E Rivera
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - F Herrero
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.,Private practice, San Juan, Puerto Rico
| | - K Downton
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Baltimore, MD, USA
| | - T Oates
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
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Zuhr O, Rebele SF, Vach K, Petsos H, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 2‐year results of an RCT using 3D digital measuring for volumetric comparison of gingival dimensions. J Clin Periodontol 2020; 47:1144-1158. [DOI: 10.1111/jcpe.13328] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/07/2020] [Accepted: 05/30/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Otto Zuhr
- Private Practice Hürzeler/Zuhr Munich Germany
- Department of Periodontology Center of Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Germany
| | - Stephan F. Rebele
- Private Practice Rebele Dinkelsbühl Germany
- Department of Periodontics School of Dental Medicine University of Pennsylvania Philadelphia PA USA
| | - Kirstin Vach
- Faculty of Medicine and Medical Center Institute of Medical Biometry and Statistics University of Freiburg Freiburg Germany
| | - Hari Petsos
- Department of Periodontology Center of Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Germany
- Private Practice Dr. Korte Soest Germany
| | - Markus B. Hürzeler
- Private Practice Hürzeler/Zuhr Munich Germany
- Department of Operative Dentistry and Periodontology University School of DentistryAlbert‐Ludwigs‐University Freiburg Germany
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6
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Noelken R, Al-Nawas B. A modified surgical approach for hard and soft tissue reconstruction of severe periimplantitis defects: laser-assisted periimplant defect regeneration (LAPIDER). Int J Implant Dent 2020; 6:22. [PMID: 32519257 PMCID: PMC7283420 DOI: 10.1186/s40729-020-00218-6] [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: 02/16/2020] [Accepted: 04/15/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The main problem in periimplantitis is often the combination of severe periimplant bone loss with a contaminated implant surface and an insufficient soft tissue situation. Classic surgical concepts with crestal access to the bony defect and debridement of the surface most often lead to partial defect regeneration and a soft tissue recession. An incision directly above the pathologic bony lesion is contrary to general surgical treatment rules. AIM To overcome this problem, a new surgical concept was developed which allows to clean the implant surface, reconstruct the bony defect, and improve soft tissue height and thickness without cutting the papilla complex. This publication presents the innovative regenerative treatment approach for severe periimplantitis defects. MATERIAL AND METHODS After diagnosis and non-surgical pre-treatment of a severe periimplantitis lesion, the following treatment protocol was applied: horizontal mucosal incision 5 mm apical to marginal mucosa, supraperiosteal preparation in apical direction, cutting through periosteum at the level of the implant apex, subperiosteal coronal flap elevation, exploration and cleaning of the periimplant defect, thorough debridement of the implant surface with the Er:YAG laser, subperiosteal grafting with connective tissue, grafting of the bony defect with autogenous bone chips from the mandibular ramus, and bilayered suturing of periosteum and mucosa. Implant survival, marginal bone levels, periimplant probing depths, recession, and facial mucosa thickness (PIROP ultrasonic measurement) were evaluated in a pilot case at 1-year follow-up examination. RESULTS Inter-proximal, oral, and buccal marginal bone levels increased significantly to the level of the implant shoulder from pre-operative to 1-year follow-up examination. No signs of suppuration or periimplant infection were present. Probing depths and recession decreased significantly, while the facial mucosa thickness improved from pre-operative to final examination. CONCLUSIONS Marginal bone levels and soft tissue improvement suggest feasibility for the regeneration of severe periimplant hard and soft tissue deficiencies by this new treatment approach. With the use of this concept, the simultaneous implant surface cleansing and improvement of hard and soft tissue seem to be possible and unfavorable postoperative exposition of titanium surface might be prevented. Comparative studies are planned to quantify the effects of this new surgical protocol.
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Affiliation(s)
- Robert Noelken
- Private Practice for Oral Surgery, Paradiesplatz 7-13, 88131, Lindau/Lake Constance, Germany.
- Department of Oral and Maxillofacial Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany
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Kanmaz B, Kanmaz MG, Kaval B, Buduneli N. Root coverage with coronally advanced flap:6-year follow-up. Aust Dent J 2019; 64:346-352. [PMID: 31494957 DOI: 10.1111/adj.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to evaluate the long-term stability of root coverage without a regular control programme after coronally advanced flap (CAF) procedures in isolated gingival recessions. MATERIAL AND METHODS Recession defects were treated with CAF using microsurgery technique. Probing depth, clinical attachment level, keratinized gingival width, plaque index, papilla bleeding index, recession depth, recession width and root surface area was evaluated at baseline, and then postoperative 6-month and 6-year follow-up sessions. Percentages of root coverage and complete root coverage rates were also calculated. RESULTS In total, 12 defects in 12 patients of the 36 defects in 30 patients were available for analysis at the 6-year follow-up examination (66.7% of the initial sites could be reached). Percentage of mean root coverage was 95.06% at 6-month and 69.27% at 6-year and the difference was statistically significant (P < 0.05). Complete root coverage rate decreased from 75% (at 6-month) to 50% (at 6-year), but the difference was not statistically significant (P > 0.05). CONCLUSION Within the limits of this long-term follow-up study, there seems to be a rather high risk for relapse after root coverage with CAF possibly due to the lack of regular recalls and persistent traumatic tooth brushing habits.
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Affiliation(s)
- B Kanmaz
- Department of Periodontology, Faculty of Dentistry, İzmir Demokrasi University, Izmir, Turkey
| | - M G Kanmaz
- Private CTG Oral and Dental Health Center, İzmir, Turkey
| | - B Kaval
- Karşıyaka Oral and Dental Health Center, İzmir, Turkey
| | - N Buduneli
- Department of Periodontology, Faculty of Dentistry, Ege University, İzmir, Turkey
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Clementini M, Agostinelli A, Castelluzzo W, Cugnata F, Vignoletti F, De Sanctis M. The effect of immediate implant placement on alveolar ridge preservation compared to spontaneous healing after tooth extraction: Radiographic results of a randomized controlled clinical trial. J Clin Periodontol 2019; 46:776-786. [DOI: 10.1111/jcpe.13125] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/08/2019] [Accepted: 04/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Marco Clementini
- Department of Periodontology Università Vita‐Salute San Raffaele Milan Italy
| | - Agnese Agostinelli
- Department of Periodontology Università Vita‐Salute San Raffaele Milan Italy
| | - Walter Castelluzzo
- Department of Periodontology Università Vita‐Salute San Raffaele Milan Italy
| | - Federica Cugnata
- University Centre of Statistics for Biomedical Sciences (CUSSB) Università Vita‐Salute San Raffaele Milan Italy
| | - Fabio Vignoletti
- 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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