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Sökmen K, Talo Yıldırım T, Dündar S. Effect of botulinum toxin-A injection applied to the mentalis muscle on free gingival graft operation: A retrospective study. J ESTHET RESTOR DENT 2024; 36:335-345. [PMID: 37477237 DOI: 10.1111/jerd.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The purpose of this retrospective study was to investigate the effects of Botulinum Toxin-A (BTX-A) injection into the mentalis muscle on the free gingival graft (FGG). MATERIALS AND METHODS Forty patients with keratinized gingiva insufficiency and Cairo's RT 2 gingival recession (formerly classified as Miller class III) in their mandibular central incisors were randomly divided into two groups: FGG and FGG + BTX. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), keratinized gingiva width (KGW), attached gingiva width (AGW), clinical attachment level (CAL), gingival thickness (GT), gingival recession amount (GRA), gingival recession width (GRW), and root closure percentage (RCP%) parameters were measured at baseline and at first, third, and sixth months after the operation. RESULTS There was no difference in PI, GI, and PPD levels in both groups (p > 0.05). While the change in GT and RCP% levels were found to be statistically significantly higher at FGG + BTX group than FGG group, the change in GRW and CAL levels were statistically significantly lower (p < 0.05). CONCLUSION The findings of this study indicate that BTX-A injection applied to the mentalis muscle after FGG operation may have positive effects in terms of KGW, AGW, GT, RCP%, GRW, and CAL parameters. CLINICAL SIGNIFICANCE As a result of the fact that BTX-A injection into the mentalis muscle contributed to the nutrition and immobility of FGG, positive developments were obtained in terms of clinical periodontal parameters. BTX-A injection into the mentalis muscle may be an alternative method that increases the success rate of Cairo's RT 2 gingival recession.
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Affiliation(s)
- Kevser Sökmen
- Faculty of Dentistry, Department of Periodontology, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Tuba Talo Yıldırım
- Faculty of Dentistry, Department of Periodontology, Fırat University, Elazığ, Turkey
| | - Serkan Dündar
- Faculty of Dentistry, Department of Periodontology, Fırat University, Elazığ, Turkey
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Chetana, Sidharthan S, Dharmarajan G, Kale S, Dharmadhikari S, Chordia D. Comparison of the effectiveness of Gingival unit transfer and free Gingival graft in the management of localized Gingival recession - A systematic review. J Oral Biol Craniofac Res 2023; 13:130-137. [PMID: 36578558 PMCID: PMC9791029 DOI: 10.1016/j.jobcr.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Background Gingival Recession (GR) is defined as the displacement of the soft tissue margin apical to the cementoenamel junction which can lead to root exposure and hypersensitivity. Treatment of GR has become an important therapeutic issue due to the increasing number of cosmetic requests from patients. Several techniques exist for the management of GR that include Sub-Epithelial Connective Tissue Graft (SECTG), Pedicle Graft (lateral and coronal), and Free Gingival Graft (FGG) and more. FGG is a non-submerged grafting procedure carried out for the management of recession defects. However, FGG has limitations like aesthetic mismatch and bulky appearance. A relatively newer modification of FGG was introduced by Allen in 2004 wherein a palatal graft including the marginal gingiva and interdental tissue was used as donor tissue for recession coverage. This review aims to study and compare the use of Gingival Unit Graft/Transfer (GUG/GUT) (palatal graft including the marginal gingiva and papillae) and FGG in the management of GR. Materials and Methods Randomized Clinical Trials, Non-Randomized Controlled Clinical Trials for the treatment of Miller Class I,II, and III of GRs by GUG with FGG were identified. Data sources included electronic databases and hand-searched journals. The primary outcome variables were complete root coverage, mean root coverage, vertical recession depth. The secondary outcome variables were keratinized tissue width gain, clinical attachment level and probing depth. Results Three Randomized Control Trials (RCTs) met the inclusion criteria and were evaluated in this systematic review. Both techniques showed significant improvement in clinical parameters. GUG procedure resulted in a greater percentage of sites achieving complete root coverage and vertical recession depth reduction when compared to FGG group in all the studies. Two studies reported significantly greater mean root coverage in GUG group compared to FGG group. GUG procedure revealed statistically significant greater gain in keratinized tissue width when compared to FGG group in all the studies. Conclusion Because of the limited number of selected studies, no conclusive statement could be made regarding the advantage of the GUG technique over FGG. However, the percentage of sites with complete root coverage obtained in the GUG technique is higher than FGG. More RCTs with aesthetic and patient satisfaction-related parameters are needed to provide definite evidence.
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Affiliation(s)
- Chetana
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri, Pune, 411 018, Maharashtra, India
| | - Sangamithra Sidharthan
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri, Pune, 411 018, Maharashtra, India,Corresponding author.
| | - Gopalakrishnan Dharmarajan
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri, Pune, 411 018, Maharashtra, India
| | - Sonal Kale
- Independent Researcher, Public Health Dentist, Pune, India
| | | | - Dhakshay Chordia
- Department of General Surgery, Mahaveer Health Care Center, Chennai, India
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Lahham C, Ta'a MA. Clinical comparison between different surgical techniques used to manage advanced gingival recession (Miller's class III & IV). Heliyon 2022; 8:e10132. [PMID: 36033300 PMCID: PMC9404267 DOI: 10.1016/j.heliyon.2022.e10132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/07/2022] [Accepted: 07/27/2022] [Indexed: 11/07/2022] Open
Abstract
Advanced gingival recession is considered a complex soft tissue problem, which is increased in severity with age, and has multiple etiological factors. Therefore, the treatment is very complicated with low predictability. However, in the last decade, many clinical trials have shown highly predictable results when managing advanced recession cases by surgical intervention. The present review shows different surgical techniques with their clinical outcomes in order to choose the most suitable technique required by the clinical condition. Although there are relatively few studies, modified tunnel technique and coronal advanced flap (CAF) showed the highest percentage of root coverage (%RC) during the first year (up to 86%). These techniques are primarily indicated to manage advanced recession in the esthetic zone. Pedicle buccal fat pad (PBFP) also had a good percentage of root coverage when used in the maxillary posterior area, as it has a high blood supply with minimal risk for infection and necrosis. Free gingival graft (FGG) can be used in the mandibular anterior area, as it creates a band of keratinized tissue that can resist recession with a fair percentage of root coverage. However, color match and graft shrinkage are the main problems of this procedure.
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Affiliation(s)
- Cezar Lahham
- Dental Science Department, Faculty of Graduate Studies, Arab American University, Palestine
| | - Mahmoud Abu Ta'a
- Dental Science Department, Faculty of Graduate Studies, Arab American University, Palestine
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Katti N, Mohanty D, Agrawal P, Raj S, Pradhan S, Baral D. Successful management of gingival recession with interdental attachment loss using gingival unit grafts. J Indian Soc Periodontol 2022; 26:373-377. [PMID: 35959310 PMCID: PMC9362813 DOI: 10.4103/jisp.jisp_539_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/24/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Gingival recession leads to root surface exposure devoid of periodontal attachment. Recession defects with interdental attachment loss (RT2, RT3), further increase the avascular area which is critical for survival of soft-tissue grafts. Nonsubmerged grafts such as free gingival grafts and gingival unit grafts (GUGs) rely primarily on plasmatic circulation from the recipient area during the initial stages of healing for its survival. Methods: Nineteen isolated RT2 recession defects, in the mandibular anterior region, were treated using GUG. The clinical parameters of recession depth (RD), recession width (RW), interdental clinical attachment levels (iCAL) were measured at baseline. Percentage of mean root coverage (MRC) was calculated at 3 months and 6 months. Results: The percentage of mean root coverage (MRC) achieved at the end of 6 months was 81.79% ± 6.16%. Further, Simple linear regression analysis to predict MRC at 6 months using baseline RW revealed, for every 1 mm decrease in RW, the percentage of root coverage significantly increased by 5.25% (P = 0.04). Conclusion: GUG can be used as an alternative treatment modality to achieve successful root coverage in RT2 recession defects. Baseline RW can be used to predict the outcome of root coverage at the end of 6 months.
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The comparison of the efficacy of gingival unit graft with connective tissue graft in recession defect coverage: a randomized split-mouth clinical trial. Clin Oral Investig 2021; 26:2761-2770. [PMID: 34787718 DOI: 10.1007/s00784-021-04252-5] [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: 04/23/2021] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Gingival unit graft (GUG) is defined as the modified form of free gingival graft. The aim of this study is to compare the clinical efficacy of GUG with connective tissue graft (SCTG) with respect to clinical periodontal parameters and patient comfort scores in gingival recessions. MATERIALS AND METHODS Sixteen patients with bilateral recession type 1 (RT1) gingival recessions participated in this randomized and split-mouth study. Thirty-two defects received surgical treatment with SCTG or GUG. The recession defect coverage, periodontal measurements, and patient-reported outcomes (intra- and post-operative patient comfort, aesthetic satisfaction, and hypersensitivity) were evaluated at baseline and post-operative months 1, 3 and 6. RESULTS The favorable results were obtained in both study groups in gingival recession depth (RD), gingival recession width (RW), clinical attachment level (CAL), and keratinized tissue width (KTW). The average percentages of the recession defect coverage (RC) for GUG and SCTG group treatments after 6 months were 68.2 ± 33% and 76.4 ± 30.2%, respectively (p > 0.05). Although there was no significant difference between groups at post-operative 6 months (p > 0.05) in terms of RD, RW, CAL, RC, patient comfort, aesthetic satisfaction, and hypersensitivity parameters, the increase in KTW was significantly higher in GUG group (p < 0.05). CONCLUSIONS It was concluded that although both techniques were effective, GUG can be a convenient method for treatment of RT1 gingival recessions with inadequate KTW and (or) shallow vestibule depth. CLINICAL RELEVANCE According to the results of this study, GUG may be a preferred choice in localized gingival recessions with a lack of keratinized tissue. The trial registration number: NCT04637451.
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Wan W, Zhong H, Wang J. Creeping attachment: A literature review. J ESTHET RESTOR DENT 2020; 32:776-782. [PMID: 32896991 DOI: 10.1111/jerd.12648] [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: 05/04/2020] [Revised: 07/06/2020] [Accepted: 08/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Mucogingival surgery has been widely applied in clinics. An interesting phenomenon after mucogingival surgery is the coronal migration of gingival margin, which is described as "creeping attachment." The goal of this review is to summarize the characteristics, significance, mechanism, and manifestation of the creeping attachment after mucogingival surgery and to describe the factors associated with its occurrence. OVERVIEW A total of 82 relevant articles were included in the literature review. The characteristics and significance of the creeping attachment after mucogingival surgery were analyzed. The mechanism of the creeping attachment was explored. Different manifestations of and factors associated with creeping attachment were summarized. CONCLUSIONS Creeping attachment may occur to obtain additional root coverage after the healing of various mucogingival surgeries. However, this coverage is not always complete nor entirely predictable. CLINICAL SIGNIFICANCE Creeping attachment plays an important role in the prognosis of mucogingival surgeries. This review will help clinicians get a thorough recognition and understanding of this phenomenon.
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Affiliation(s)
- Wenjuan Wan
- Department of Prosthodontics, Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Pediatric Dentistry, Hospital of Dongguan Jianli Stomatology, Dongguan, China
| | - Heli Zhong
- Department of Prosthodontics, Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Prosthodontics, Hospital of Dongguan Jianli Stomatology, Dongguan, China
| | - Jiawei Wang
- Department of Prosthodontics, Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Chakravarthy Y, Chandra RV, Reddy AA, Reddy GP. Lateral osteoperiosteal flap versus lateral pedicle flap in the treatment of class III gingival recession: A single-center, open-label trial. J Indian Soc Periodontol 2020; 24:454-460. [PMID: 33144774 PMCID: PMC7592619 DOI: 10.4103/jisp.jisp_489_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/06/2020] [Accepted: 04/08/2020] [Indexed: 11/04/2022] Open
Abstract
AIMS The aim of this study was to compare outcomes of lateral osteoperiosteal flap (OPF) and lateral pedicle flap (LPF) in the treatment of Miller's Class III gingival recession. MATERIALS AND METHODS Twenty-two anterior maxillary and mandibular sites from 16 participants requiring mucogingival surgery for Miller's Class III gingival recession were included in the study. Eleven sites each were assigned to two groups. OPF: sites treated with lateral OPF and LPF: sites treated with LPF. Recession depth (RD) and bone level (BL) were the primary outcome variables, and probing pocket depth, clinical attachment level (CAL), and keratinized tissue width (KTW) were the secondary variables. All the variables were recorded at baseline (on the day of surgery), 3 months, and 6 months postsurgery. RESULTS OPF and LPF resulted in similar reduction in RD at the end of the study period (P ≤ 0.001). There was no statistically significant difference in RD between OPF and LPF at 6 months (P = 0.862). OPF-treated sites showed greater gain in BL at 3 months (P = 0.0004) and 6 months (P = 0.0002). No significant differences were seen between OPF and LPF in measures of PD, CAL, and KTW. CONCLUSION Data from this 6-month trial seem to suggest that OPF can be used as an alternative procedure for treating Miller's class III recessions with adjacent edentulous sites or wide interproximal spaces. Long-term effects of OPF on the stability of root coverage outcomes are an exciting direction for future research.
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Affiliation(s)
- Yarabham Chakravarthy
- Department of Periodontics, SVS Institute of Dental Sciences, Mahbubnagar, Telangana, India
| | - Rampalli Viswa Chandra
- Department of Periodontics, SVS Institute of Dental Sciences, Mahbubnagar, Telangana, India
| | - Aileni Amarender Reddy
- Department of Periodontics, SVS Institute of Dental Sciences, Mahbubnagar, Telangana, India
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Jenabian N, Bahabadi MY, Bijani A, Rad MR. Gingival Unit Graft Versus Free Gingival Graft for Treatment of Gingival Recession: A Randomized Controlled Clinical Trial. JOURNAL OF DENTISTRY (TEHRAN, IRAN) 2016; 13:184-192. [PMID: 28392815 PMCID: PMC5376545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/26/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Gingival recession can lead to root exposure and discomfort for patients. There are various techniques for root coverage. The aim of this study was to compare the use of gingival unit graft (palatal graft including the marginal gingiva and papillae) with free gingival graft for treatment of localized gingival recession. MATERIALS AND METHODS In this randomized controlled clinical trial, 18 bilateral localized recessions of Miller class I and II were treated in nine systemically healthy patients. Recessions were randomly treated with gingival unit graft in one side and conventional free gingival graft in the other side. Clinical parameters including clinical attachment level, keratinized tissue width, probing depth and vertical recession depth (VRD) were recorded at baseline and at one, three and six months after surgery. The healing index and patient satisfaction were also evaluated. One-way and two-way repeated measures ANOVA and paired t-test were used for statistical analyses. RESULTS Both techniques caused significant improvement in clinical parameters. Gingival unit graft produced higher satisfaction esthetically (P=0.050, 0.024 and 0.024, respectively at the three time points), higher healing index (P<0.001), higher root coverage percentage at one month after surgery (34.04%, P=0.011) and greater reduction of recession width three months after surgery (P=0.007) but the reduction in VRD at this side was not significantly greater. CONCLUSIONS Gingival unit graft might be an acceptable modality in Miller Class I/II recession defects. This technique may have advantages over free gingival graft such as significantly superior clinical and esthetic results.
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Affiliation(s)
- Niloofar Jenabian
- Associate Professor, Oral Health Research Center, Department of the Periodontology, School of Dentistry, Babol University of Medical Sciences, Babol, Iran
| | - Mohadese Yazdanpanah Bahabadi
- Assistant Professor, Department of the Periodontology, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Morteza Rahimi Rad
- Periodontist, Department of Periodontology, School of Dentistry, Golestan University of Medical Sciences, Gorgan, Iran
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