Clinical Comparison of the Subepithelial Connective Tissue versus Platelet-Rich Fibrin for the Multiple Gingival Recession Coverage on Anterior Teeth Using the Tunneling Technique

Comparison Between Autologous Albumin Gel and Liquid Platelet-Rich Fibrin Mixture Versus Connective Tissue Graft to Modify the Gingival Phenotype: A Randomized Controlled Trial

Objectives To assess changes in gingival thickness (GTH) and the width of keratinized gingival tissue (KTW) following treatment with either connective tissue graft (CTG) or an albumin gel-platelet-rich fibrin mixture (Alb-PRF). Materials and methods Twenty treatment sites were included in a split-mouth design involving 10 patients with a thin gingival phenotype in the mandibular anterior region. The sample was randomly divided into two groups, with the Alb-PRF applied to the experimental group and CTG used for the control group. GTH and KTW were measured at baseline and after one, three, and six months. Results GTH increased in both groups during all follow-up periods. However, no statistically significant differences (p > 0.05) between the groups were observed at baseline and six months. At three months, the experimental group exhibited significantly higher GTH (p < 0.001). Additionally, at three and six months, the CTG group showed a superior increase in KTW (p < 0.05). Conclusion Within the constraints of this study, Alb-PRF application for modifying thin gingival phenotypes proved to be an effective therapeutic option, potentially serving as an alternative to CTGs. Although Alb-PRF resulted in thicker gingiva, CTG demonstrated a greater enhancement in KTW.

Efficacy of Tunnel Technique (TUN) versus Coronally Advanced Flap (CAF) in the Management of Multiple Gingival Recession Defects: A Meta-Analysis

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.

Comparative Evaluation of Platelet-Rich Fibrin versus Connective Tissue Grafting in Treatment of Gingival Recession Using Pouch and Tunnel Technique: A Randomized Clinical Study

AIMS

The aim of the study was to compare the clinical efficacy of platelet-rich fibrin (PRF) and connective tissue grafting in the treatment of gingival recession (GR) using pouch and tunnel (P and T) technique.

MATERIALS AND METHODS

A total of 40 Class I or Class II GR defects in 17 patients were randomized treated with P and T with PRF (Group I, n = 20) and P and T with CTG (Group II, n = 20). The parameters measured were plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), horizontal gingival recession (HGR), vertical gingival recession (VGR), width of attached gingiva (WAG), width of keratinised gingiva (WKG), gingival thickness-mid buccal (GTMB), and gingival thickness interdental papilla (GTIP). Postsurgical discomfort level (PSDL), hypersensitivity score (HS), and patient esthetic score (PES) were recorded using visual analog scale (VAS). The PI, GI, PPD, CAL, HGR, VGR, WAG, WKG, GTMB, and GTIP were assessed at pretreatment (baseline) and 1-, 3-, and 6-month posttreatment. The PSDL, HS, and PES were assessed at baseline, day 10, 1, 3, and 6-month posttreatment.

RESULTS

P and T with PRF and CTG resulted in root coverage of 73.75% ± 7.80% and 70.83% ±8.26%, respectively. Patient response and acceptance for the surgical treatment modality showed less discomfort and better esthetics in Group I as compared to Group II.

CONCLUSIONS

PRF treated sites were comparable to the gold standard CTG with better patient acceptance and a lesser invasive approach in terms of graft procurement.

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

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.

Efficacy of Platelet-rich Fibrin in Interdental Papilla Reconstruction as Compared to Connective Tissue Using Microsurgical Approach

AIM

This study aims to evaluate autologous platelet-rich fibrin (PRF) and autogenous connective tissue graft (CTG) in interdental papilla (IDP) reconstruction with buccal and palatal split-thickness flap (STF) using microsurgical technique.

MATERIALS AND METHODS

Forty Class I or Class II open gingival or cervical embrasure in maxillary anterior region in 14 patients were surgical treated for the reconstruction of IDP. For experimental Group I (STF with PRF, n = 20), surgical site was flushed with PRF fluid. PRF was then placed under the buccal flap and in the IDP region and squeezed. For experimental Group II (STF with CTG, n = 20) after the preparation of recipient site, CTG procured from palate was trimmed to the desired size and shape and placed at the site. Clinical parameters and patient satisfaction response recorded were plaque index, gingival index, probing pocket depth, clinical attachment level, height of IPD, and papilla index score (PIS).

RESULTS

STF surgery in combination with PRF or CTG, are an effective procedure to increase IDP-height with mean values of 3.10 mm (87.3%) and 3.45 mm (95.8%) for Group I (STF + PRF) and Group II (STF + CTG), respectively. In terms of complete fill (CF) achieved at 3 months, in the present study, the result showed that 90% CF was obtained in Group I (STF + PRF) and 95% in Group II (STF + CTG). The patient response and acceptance for surgical treatment modality in terms of patient postsurgical discomfort score and patient esthetic score was higher for Group II (STF + CTG) than Group I (STF + PRF).

CONCLUSION

Based on single-centered 3 months' follow-up, it may be concluded that STF surgery in combination with PRF or CTG is an effective procedure to increase IDP-height; however, a long-term multicentric randomized clinical trial may be necessary to evaluate the clinical outcome for autologous PRF in comparison to CTG with STF.

Evaluation of the effect of dose-dependent platelet-rich fibrin membrane on treatment of gingival recession: a randomized, controlled clinical trial

Miller's class I gingival recessions (GR) have been treated using coronally advanced flap (CAF) with platelet-rich fibrin membrane (PRF membrane) or connective tissue graft (CTG).

Management of multiple recession defects in esthetic zone using platelet-rich fibrin membrane: A 36-month follow-up case report

A patient undergoing orthodontic treatment presented with multiple recession defects in maxillary anterior region. After thorough clinical examination and assessment, measurements were recorded. Maxillary anterior teeth with recession defects of 3–4 mm were treated with coronally advanced flap and platelet-rich fibrin (PRF) membrane. Regular follow-up was maintained for the patient at 3, 6 , 12, 18, 24, 30, and 36 months. After 36 months, significant root coverage of 100 percent was observed in four defects and 50% coverage in one defect. This shows that PRF membrane along with coronally advanced provides a predictable and significant result for management of recession defects.