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Saleh MHA, Dias DR, Ravida A, Wang HL. Root surface biomodification in periodontal therapy: Biological rationale and clinical applications. Periodontol 2000 2024. [PMID: 38978341 DOI: 10.1111/prd.12576] [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: 02/08/2024] [Revised: 04/09/2024] [Accepted: 05/10/2024] [Indexed: 07/10/2024]
Abstract
Regenerative periodontal therapy aims to form new cementum, periodontal ligament, and alveolar bone, all sealed by gingival tissue. The root surface acts as the wound margin during this regeneration process. Root surface biomodification (root conditioning/root decontamination), therefore, seems instrumental in promoting surface decontamination and enhancing tissue attachment by removing the smear layer, exposing collagen fibrils, and facilitating blood clot formation and stabilization. This review attempted to provide an all-encompassing, evidence-based assessment of the role of root surface biomodification in regenerative periodontal therapy, particularly in intrabony defects, furcation defects, and root coverage procedures. The reviewed evidence suggested that root conditioning agents, whether used independently or in conjunction with bone graft materials, biological agents, membranes, or connective tissue grafts, do not offer any clinical advantage regarding clinical attachment gain. Thus, integrating chemical methods with the mechanical root instrumentation process does not necessarily contribute to superior clinical outcomes.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Debora R Dias
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| | - Andrea Ravida
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Halim FC, Sulijaya B. Allogenic Acellular Dermal Matrix and Xenogeneic Dermal Matrix as Connective Tissue Graft Substitutes for Long-Term Stability Gingival Recession Therapy: A Systematic Review and Meta-Analysis. Eur J Dent 2024; 18:430-440. [PMID: 37848072 PMCID: PMC11132762 DOI: 10.1055/s-0043-1772778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Connective tissue graft (CTG) serves as a gold standard for gingival recession therapy. Yet the availability of CTG is limited, and it increases patient morbidity. Allogenic acellular dermal matrix (AADM) and xenogeneic dermal matrix (XDM) have been proven to be effective substitutes of CTG although the long-term stability is unclear. The aim of this study was to analyze the long-term stability outcome of gingival recession therapy using AADM and XDM compared to CTG. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted independently from several online databases (PubMed, Scopus, and Embase). Five of 233 publications were included for final qualitative analysis and meta-analysis focusing on the mean difference of clinical parameters such as recession depth (RD), recession width (RW), probing depth (PD), clinical attachment loss (CAL), tissue thickness (TT), keratinized tissue width (KTW), and mean root coverage (MRC). Meta-analyses of RD, RW, CAL, TT, KTW, and MRC display an overall mean of 0.2 mm (95% confidence interval [CI]: -0.45 to -0.05), 0.29 mm (95% CI: -0.65 to 0.08), 0.2 mm (95% CI: -0.69 to 0.29), 0.25 mm (95% CI: -0.53 to 0.03), 0.26 mm (95% CI: -0.5 to 0.02), and 9.19% (95% CI: -13.95 to -4.43]), respectively, favoring the CTG. PD was the only parameter that favored the AADM or XDM with an overall mean of 0.03 mm (95% CI: -0.05 to 0.11). In all, if the long-term stability is the goal, the CTG is considered superior for gingival recession therapy. However, if it is contraindicated, the AADM and XDM might be considered as alternatives.
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Affiliation(s)
- Felita Clarissa Halim
- Periodontology Specialist Program, Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Benso Sulijaya
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
- Dental Division, Universitas Indonesia Hospital, Depok, West Java, Indonesia
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Bertoldi C, Consolo U, Lalla M, Zaffe D, Tanza D, Cairo F, Cortellini P. Long-term stability (21-30 years) of root coverage outcomes using sub-epithelial connective tissue grafts at single or multiple gingival recessions: A longitudinal case series. J Clin Periodontol 2024; 51:2-13. [PMID: 37794814 DOI: 10.1111/jcpe.13882] [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: 12/15/2022] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
AIM To evaluate outcomes and predictive factors for the long-term stability of root coverage using a sub-epithelial connective tissue graft. MATERIALS AND METHODS One-hundred and two healthy subjects (221 gingival recessions, GRs) were treated from 1987 to 1996. Keratinized tissue width (KTW), GR depth (RD), GR width (RW) and GR area (RA) were evaluated at baseline (M0) and at 1 month (M1), 1 year (M2), 11 years (M3), 21 years (M4) and 27 years (M5) after surgery. Primary outcomes consisted of complete root coverage (cRC) and relative dimensional changes in recession depth (measured in mm [c%-RD]), recession width (measured in mm [c%-RW]) and recession area (measured in mm2 [c%-RA]). RESULTS cRC was 88.7% at 1 year (M2), 59.8% at M3, 44.4% at M4 and 51.9% at M5. Average c%-RD was 95.2% at 1 year, 81.9% at M3, 71.5% at M4 and 81.7% at M5. KTW increased after surgery and over time and was positively correlated with favourable outcomes. Increased baseline RA was associated with less favourable clinical outcomes. CONCLUSIONS The sub-epithelial connective tissue graft is effective in the treatment of GRs and facilitates long-term stability of clinical outcomes. Wider baseline RA was a strong predictor of unfavourable short- and long-term RC outcomes.
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Affiliation(s)
- Carlo Bertoldi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Lalla
- Department of Economics Marco Biagi, University of Modena and Reggio Emilia, Modena, Italy
| | - Davide Zaffe
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Donato Tanza
- Department of Neurosciences - Head and Neck, Modena General Hospital, Modena, Italy
| | - Francesco Cairo
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Pierpaolo Cortellini
- European Research Group on Periodontology (ERGOPERIO), Bern, Switzerland
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
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Pabst A, Becker P, Kuchen R, Schumann S, Kasaj A. A comparative study of cyanoacrylate-based tissue adhesive and surgical sutures on marginal flap stability following coronally advanced flap. Clin Oral Investig 2023; 28:5. [PMID: 38123821 PMCID: PMC10733215 DOI: 10.1007/s00784-023-05390-8] [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: 09/22/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The present study evaluated the biomechanical characteristics of cyanoacrylate-based tissue adhesive (TA) compared to surgical sutures in coronally advanced flap (CAF) procedures using an ex-vivo model. MATERIAL AND METHODS Thirty-six half-pig mandibles were divided into three groups, n=12 each: (I) CAF fixed with sutures (sling and tag suture technique), (II) CAF fixed with TA, and (III) CAF fixed with sutures and TA. At mandibular premolars, gingival recession defects extending 3 mm apical to the cemento-enamel junction (CEJ) were created. CAF procedures were performed using a split-full-split approach, with coronal advancement of the flap to 1 mm above the marked CEJ and stabilization according to the respective groups I-III. Marginal flap stability against pull-of forces (maximum tensile force) was measured with a universal material testing machine until the CEJ became visible. RESULTS The comparison between groups I-III demonstrated a significantly increased maximum tensile force for the TA (II) compared to the suture group (I) (p<0.001). A significantly increased maximum tensile force was found for the suture and TA (III) compared to the suture group (I) (p<0.001). There was also a significantly increased maximum tensile force in the suture and TA (III) compared to the TA group (II) (p<0.001). CONCLUSION The results suggest that cyanoacrylate-based TA can increase marginal flap stability compared to sutures in CAF procedures. CLINICAL RELEVANCE Cyanoacrylate-based TA can be considered a useful and valuable adjunct to conventional suturing techniques in periodontal plastic surgery, especially in cases where high flap stability is required. The results of this ex-vivo study can only be transferred to the clinical situation with limitations. Clinical long-term follow-up data must be generated.
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Affiliation(s)
- Andreas Pabst
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacher Str 170, 56072, Koblenz, Germany
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Philipp Becker
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacher Str 170, 56072, Koblenz, Germany
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Robert Kuchen
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany
| | - Sven Schumann
- Institute of Anatomy, University Medical Center Mainz, Johann-Joachim-Becher-Weg 13, 55128, Mainz, Germany
| | - Adrian Kasaj
- Department of Periodontology and Operative Dentistry, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
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Blasi G, Vilarrasa J, Abrahamian L, Monje A, Nart J, Pons R. Influence of immediate postoperative gingival thickness and gingival margin position on the outcomes of root coverage therapy: A 6 months prospective case series study using 3D digital measuring methods. J ESTHET RESTOR DENT 2023; 35:1039-1049. [PMID: 37021694 DOI: 10.1111/jerd.13042] [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: 02/03/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND To assess linear and volumetric changes following the treatment of gingival recessions (GRs) by means of a modified coronally advanced tunnel technique combined with acellular dermal matrix (MTUN + ADM). MATERIALS AND METHODS Patients presenting GR type 1 (RT1) GRs underwent root coverage surgery consisting of MTUN + ADM. Clinical measurements were made, and intraoral scans were obtained at baseline, postoperatively, and 6 weeks, 3 and 6 months after surgery, to evaluate changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), recession area (RA), marginal gingival thickness (MGT), and mucosal volume (MV). The impact of patient-level and surgical-site variables upon percentage root coverage (% RC) and the likelihood of achieving complete root coverage (CRC) were explored. RESULTS A total of 20 patients (n = 47 teeth) were treated. After 6 months, RD and RA decreased, while KTW, MGT, and MV increased. The mean % RC was 93% at 6 months and CRC was found on 72.3% of the sites at 6 months. The postoperative MGT changes at 1.5 and 3 mm were significantly correlated to % RC and CRC at 6 months. Each additional mm of postoperative gain of gingival thickness resulted in a 4-fold increase in the probability of achieving CRC. Additionally, gingival margin positioned ≥0.5 mm coronal to the cementoenamel junction immediately after surgery was a strong predictor of CRC. CONCLUSIONS The MGT gain at 1.5 and 3 mm achieved in the immediate postoperative period is a significant predictor of CRC at 6 months when treating multiple GRs via MTUN + ADM. CLINICAL SIGNIFICANCE The Scientific rationale for the study relies on the lack of 3D digital measuring tools in the assessment of soft tissue healing dynamics after root coverage therapy. The principal findings of this study can be summarized as follows: tooth type, tooth position, and post-operative gingival margin position and gingival thickness and volume changes are predictors of CRC. Therefore, the practical implications are that the more thickness and more coronal advancement achieved immediately after root coverage surgery, the higher chance of achieving CRC.
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Affiliation(s)
- Gonzalo Blasi
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, Baltimore School of Dentistry, University of Maryland, Baltimore, Maryland, USA
| | - Javi Vilarrasa
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Lory Abrahamian
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Alberto Monje
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - José Nart
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ramón Pons
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
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Kofina V, Wang YS, Fial A, Tatakis DN. Intra-marrow penetrations and root coverage outcomes: a systematic review. BMC Oral Health 2023; 23:256. [PMID: 37138270 PMCID: PMC10157995 DOI: 10.1186/s12903-023-02964-6] [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: 01/26/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Intra-marrow penetrations (IMPs) have been performed during guided tissue regeneration (GTR) procedures with reported clinical benefits. The aim of this systematic review was to investigate the use and effect of IMPs during root coverage procedures. METHOD A broad search for human and animal studies was performed on PubMed, Cochrane Database of Systematic Reviews and Cochrane Central Registry of Controlled Trials and Web of Science, following a registered review protocol (PROSPERO). All prospective study designs, case series and case reports on gingival recession treatment (follow-up ≥ 6 months) that employed IMPs were included. Root coverage, complete root coverage prevalence, and adverse effects were recorded, and risk of bias was assessed. RESULTS Of 16,181 screened titles, 5 articles (all of them human studies) met inclusion criteria. All studies (including two randomized clinical trials) treated Miller class I and II recession defects, using coronally advanced flap with IMPs alone or in conjunction with GTR protocols. Therefore, all treated defects received IMPs and no studies compared protocols with and without IMPs. Outcomes were indirectly compared with existing root coverage literature. Mean root coverage was 2.7 mm and 68.5% at 6.8 months (median: 6 months, range 6-15 months) for sites treated with IMPs. CONCLUSION IMPs are rarely used during root coverage procedures, have not been associated with intra-surgical or wound healing adverse effects and have not been investigated as independent factor. Future clinical studies are needed to directly compare treatment protocols with and without IMPs and investigate the potential benefits of IMPs for root coverage.
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Affiliation(s)
- Vrisiis Kofina
- Department of Surgical Sciences, School of Dentistry, Marquette University, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Ying S Wang
- Division of Periodontology, College of Dentistry, The Ohio State University, 4121 Postle Hall, 305 W. 12th Ave, Columbus, OH, 43210, USA
- Department of Periodontics, School of Dentistry, Texas A&M University, 3302 Gaston Avenue, Dallas, TX, 75246, USA
| | - Alissa Fial
- Raynor Memorial Libraries, Marquette University, P. O. Box 3141, Milwaukee, WI, 53201-3141, USA
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, 4121 Postle Hall, 305 W. 12th Ave, Columbus, OH, 43210, USA.
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Toledano-Osorio M, Muñoz-Soto E, Toledano M, Vallecillo-Rivas M, Vallecillo C, Ramos-García P, Osorio R. Treating Gingival Recessions Using Coronally Advanced Flap or Tunnel Techniques with Autografts or Polymeric Substitutes: A Systematic Review and Meta-Analysis. Polymers (Basel) 2022; 14:polym14071453. [PMID: 35406326 PMCID: PMC9002830 DOI: 10.3390/polym14071453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 02/01/2023] Open
Abstract
Gingival recessions are a prevalent oral mucosa alteration. To solve this pathology, palatal mucosa or polymeric soft tissue substitutes are used when performing coronal advanced flap (CAF) or tunnel (TUN) surgical techniques. To evaluate which is the most successful approach, a literature review and meta-analysis were conducted. For the electronic search the National Library of Medicine, the Cochrane Oral Health Group Trials Register, EMBASE and WOS were used. Pooled data for the percentage of root coverage was collected and weighted means were calculated. Heterogeneity was determined using the Higgins (I2) statistic and a random-effects model was applied. Thirteen studies were included in the systematic review (12 randomized and 1 controlled clinical trials) in which both techniques (394 patients) were compared with a follow-up of 4 to 12 months. Galbraith and Baujat plots were used to control for the presence of potential outliers. After performing the meta-analysis (11 studies), the mean root coverage was similar when using the TUN or CAF techniques (p = 0.49). The only differences between the two were found for single recessions, where CAF offered a higher percentage of root coverage (mean difference = 4.98%; p = 0.006). There were no differences when applying an autograft or a polymeric substitute with either of the two tested surgical techniques (p = 0.445).
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Saxena A, Bhusari P, Singh A, Nagi R, Chaturvedi SS. Coronally advanced flap with and without hyaluronic acid (HYALOSS) for the treatment of gingival recession – a randomized clinical trial. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2022. [DOI: 10.1051/mbcb/2022034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: To compare and evaluate the surgical outcome of gingival recession treatment using CAF alone or in conjunction with hyaluronic acid (HA) on Miller's Class I and class II gingival recession defects. Materials and methods: After randomisation, the control group (15 patients) received CAF alone and the test group (15 patients) received HA as an adjunct to CAF technique for an isolated gingival recession accompanied by an adequate width of keratinized gingiva on maxillary canines and premolars. All patients were evaluated at 7, 15, 30, 60 and 90 days interval post-operatively. Data obtained was subjected to statistical analysis and p value <0.05 was considered as statistically significant. Results: At 90 days interval statistically highly significant root coverage was obtained with mean gain of 66.1% in control group and 86.6% in test group. Statistically significant reduction in depth of gingival recession and gain in clinical attachment level was found for control and the test groups, and intergroup comparison showed statistically significant differences for root coverage and clinical attachment level between the groups (p = 0.000), however no significant differences were found for width of attached gingiva, keratinized gingiva and gingival thickness between the groups at 90 days (p > 005). Conclusion: HA has proven to be beneficial in the field of regenerative therapy. Our analysis suggested that HA can be used as a promising adjunct with CAF for root coverage, however further studies are required to imply the results on larger population.
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Govindasamy BR, Naik VK, Balasundaram A. Comparison of coronally advanced versus semilunar coronally repositioned flap in the management of maxillary gingival recessions. Saudi Dent J 2021; 33:642-649. [PMID: 34803313 PMCID: PMC8589608 DOI: 10.1016/j.sdentj.2020.05.005] [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: 03/04/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/07/2022] Open
Abstract
Objectives Maxillary gingival recessions can be managed by both semilunar coronally repositioned flap (SLCRF) and coronally advanced flap (CAF). The objective of this study was to compare SLRCF and CAF in terms of wound healing and periodontal parameters in the presence of magnification. Materials and methods Thirty patients with Miller’s class I gingival recession in maxillary anteriors and premolars were assigned to 2 groups including SLCRF and CAF. All procedures were performed using 2.5× magnifying loupes. Wound healing and periodontal clinical parameters were assessed at baseline and at 2nd, 4th, 8th and 12th week. Results No significant difference was observed in wound healing and mean percentage root coverage in both the groups at 12th week (p > 0.05). However, SLCRF showed a statistically significant reduction in percentage of root coverage (PRC) at 12th week compared to 2nd week (p < 0.05). A significant gain in Clinical attachment level, width of keratinised tissue and a significant reduction in Recession Depth and Probing Depth were seen in both the groups at 12th week. Conclusion Within the limitation of this study, both techniques resulted in similar wound healing at 12th week with the use of magnification. CAF provided more root coverage compared to SLCRF technique in the maxillary class I gingival recession defects.
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Affiliation(s)
| | - Vanaja Krishna Naik
- Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK.,Department of Periodontics, SRM Dental College, Chennai, India
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Shibli JA, Feres M, Figueiredo LC, Castro Dos Santos N, Retamal-Valdes B. Decontamination and Biomodification of Periodontally Affected Root Surface for Successful Regeneration: Is There Room for Improvement? Dent Clin North Am 2021; 66:11-38. [PMID: 34794549 DOI: 10.1016/j.cden.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Periodontitis is a multifactorial inflammatory condition associated with an oral microbiome dysbiosis that results in gingival inflammation and clinical attachment loss. Periodontal therapies are based on scaling and root planing to disturb the bacterial biofilm mechanically and remove calculus and contaminated cementum. Research does not support the use of root modifiers for decontamination and biomodification of periodontally affected root surfaces. Standardized clinical trials in large populations, assessing biological and patient-reported outcome measures, are necessary to evaluate candidate biomaterials for decontamination and biomodification of periodontally affected root surfaces.
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Affiliation(s)
- Jamil Awad Shibli
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Praça Tereza Cristina 229, Centro, Guarulhos, São Paulo 07023-070, Brazil.
| | - Magda Feres
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Praça Tereza Cristina 229, Centro, Guarulhos, São Paulo 07023-070, Brazil
| | - Luciene C Figueiredo
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Praça Tereza Cristina 229, Centro, Guarulhos, São Paulo 07023-070, Brazil
| | - Nidia Castro Dos Santos
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Praça Tereza Cristina 229, Centro, Guarulhos, São Paulo 07023-070, Brazil.
| | - Belen Retamal-Valdes
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Praça Tereza Cristina 229, Centro, Guarulhos, São Paulo 07023-070, Brazil
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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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Franceschi D, Prato GPP, Gianfilippo RD. Double connective tissue graft to treat deep coronal-radicular abrasion: A 19-year follow-up case report. Clin Adv Periodontics 2021; 11:171-175. [PMID: 34236132 DOI: 10.1002/cap.10176] [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: 11/07/2020] [Accepted: 06/30/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION When gingival recession is combined with cervical abrasion, root coverage outcomes are less predictable due to the challenging adaptation of the connective tissue graft (CTG) to the marked root step. Removing additional tooth structure can improve soft-tissue adaptation with the downside of a possible increase in dental hypersensitivity or pulpitis. Therefore, the aim of this report was to demonstrate a surgical technique using two grafts which does not require any further modification of the root surface, in order to successfully treat recession associated with deep cervical abrasion. CASE PRESENTATION A case of gingival recession associated with a deep root step and cemento-enamel junction alteration (B+; abrasion depth > 1 mm) was successfully treated via a bilaminar grafting technique using two CTG layers covered by a coronally advanced flap (CAF). The tooth surface was polished and did not receive any grinding, blending, planing, or other alterations. Complete recession coverage, complete abrasion coverage, and resolution of baseline sensitivity were achieved 1 year after surgical intervention and were maintained for 19 years with further coronal displacement of the gingival margin due to creeping attachment. CONCLUSIONS The double CTG technique showed optimal clinical results in terms of coverage and resolution of hypersensitivity of a recession associated with a deep cervical abrasion. No additional removal of dental tissue was needed, and the clinical outcomes were stably maintained over a long-term follow-up.
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Affiliation(s)
- Debora Franceschi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
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Kumar S, Hirani T, Shah S, Mehta R, Bhakkand SR, Shishoo D. Treating Public Health Dilemma of Gingival Recession by the Dehydrated Amnion Allograft: A 5-Year Longitudinal Study. FRONTIERS IN ORAL HEALTH 2020; 1:540211. [PMID: 35047979 PMCID: PMC8757781 DOI: 10.3389/froh.2020.540211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022] Open
Abstract
Aim: This study aimed to evaluate the efficacy of dehydrated amnion allograft with coronally positioned flap procedure in paired Miller's class I recession defects. Methods: A total of 51 subjects were included in the study with bilateral Miller's class I gingival recession defects. In the test group, patients were treated with an amniotic membrane (AM) with a coronally positioned flap, while in the control group, patients were treated with coronally positioned flap alone. Clinical parameters such as recession depth, recession width (RW), probing depth (PD), relative attachment level (RAL), width of keratinized gingiva (WKG), and thickness of keratinized gingiva (TKG) were recorded at baseline and after 5 years of follow-up. Result: The mean baseline recession was 2.95 ± 0.89 in the test group and 2.70 ± 0.85 in the control group, and both were statically non-significant. At the end of 6 months, all the parameters, when compared with the baseline, showed a significant improvement. Intergroup comparison showed the non-significant difference in all settings except the TKG. Conclusion: AM proved to help improve the TKG. This increase in thickness helps in the long-term maintenance of the gingival margin in Miller's class I recession defect.
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Affiliation(s)
- Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
| | - Tanvi Hirani
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
| | - Sujay Shah
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
| | - Rupal Mehta
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
| | - Susmita R Bhakkand
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
| | - Deepak Shishoo
- Department of Physiology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
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İzol BS, Üner DD. A New Approach for Root Surface Biomodification Using Injectable Platelet-Rich Fibrin (I-PRF). Med Sci Monit 2019; 25:4744-4750. [PMID: 31241048 PMCID: PMC6610486 DOI: 10.12659/msm.915142] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background This study investigated the potential effects of Injectable Platelet-Rich Fibrin (I-PRF) on root coverage of free gingival graft surgery. Material/Method A total of 40 patients with Miller class I or II gingival recession were included. The patients who participated in this study were randomly divided into 2 groups, including the control and experiment groups. The patients in the control group were treated only with free gingival graft (FGG). The patients in the experiment group were treated with free gingival graft and injected with I-PRF as a root surface biomodification agent (FGG+I-PRF). The patients were called back after 3 months, and the amount of exposed root surface was determined and compared to the preoperative findings. Results The mean initial exposed root surface was 4.7±1.49 mm for the FGG+I-PRF group, 4.1±1.07 mm for the FGG group, and 4.4±1.31 mm for all subjects. Three months after the operation, the mean root surface coverage values of the 2 groups were 3.5±1.05 and 3.9±0.78 mm in the control and experiment groups, respectively. Conclusions The findings showed that the injection of Injectable Platelet-Rich Fibrin (I-PRF) had a positive effect on root coverage in free gingival graft surgery.
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Affiliation(s)
- Bozan Serhat İzol
- Department of Periodontology, Faculty of Dentistry, Bingöl University, Bingöl, Turkey
| | - Devrim Deniz Üner
- Department of Periodontology, Faculty of Dentistry, Harran University, Şanlıurfa, Turkey
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Dai A, Huang J, Ding P, Chen L. Long‐term stability of root coverage procedures for single gingival recessions: A systematic review and meta‐analysis. J Clin Periodontol 2019; 46:572-585. [PMID: 30980404 DOI: 10.1111/jcpe.13106] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 03/13/2019] [Accepted: 03/26/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Anna Dai
- Department of Periodontology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | - Jia‐Ping Huang
- Department of Periodontology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | - Pei‐Hui Ding
- Department of Periodontology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | - Li‐Li Chen
- Department of Periodontology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
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Effect of EDTA root conditioning on the outcome of coronally advanced flap with connective tissue graft: a systematic review and meta-analysis. Clin Oral Investig 2018; 22:2727-2741. [DOI: 10.1007/s00784-018-2635-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
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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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Tavelli L, Barootchi S, Ravidà A, Suárez-López del Amo F, Rasperini G, Wang HL. Influence of suturing technique on marginal flap stability following coronally advanced flap: a cadaver study. Clin Oral Investig 2018; 23:1641-1651. [DOI: 10.1007/s00784-018-2597-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/20/2018] [Indexed: 02/07/2023]
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Zucchelli G, Tavelli L, Ravidà A, Stefanini M, Suárez-López del Amo F, Wang HL. Influence of tooth location on coronally advanced flap procedures for root coverage. J Periodontol 2018; 89:1428-1441. [DOI: 10.1002/jper.18-0201] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/20/2018] [Accepted: 05/27/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI
| | - Andrea Ravidà
- Department of Periodontics & Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | | | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI
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Jayakumar P, Suresh S, Sudhakar U, Kumukcham S. Efficacy of low-level laser therapy as an adjunct to button anchored coronally advanced flap for gingival recession: A Doppler study. J Indian Soc Periodontol 2018; 22:365-368. [PMID: 30131632 PMCID: PMC6077971 DOI: 10.4103/jisp.jisp_194_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 04/23/2018] [Indexed: 12/04/2022] Open
Abstract
Coverage of the exposed root is one of the periodontal plastic surgical procedures, which is one of the important periodontal treatment modalities. The introduction of innovation in new interdisciplinary treatment modalities has allowed us the use of orthodontic button in root coverage procedures using a coronally advanced flap (CAF) to provide the initial stabilization. This case report also evaluates the effectiveness of low-level laser therapy (LLLT) to detect the microvascular blood flow changes in the gingiva and alveolar mucosa where LLLT has been given after button-anchored CAF procedure during postoperative healing to detect blood flow changes of mucosa where LLLT was not given in other surgical sites. Three-month postoperative results showed that the LLLT used as an adjunct to CAF with the orthodontic button for stabilization is an effective surgical approach in the management of Miller's Class I recession defects.
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Affiliation(s)
- Parvathee Jayakumar
- Department of Periodontics, Thai Moogambigai Dental College, Chennai, Tamil Nadu, India
| | - Snophia Suresh
- Department of Periodontics, Thai Moogambigai Dental College, Chennai, Tamil Nadu, India
| | - Uma Sudhakar
- Department of Periodontics, Thai Moogambigai Dental College, Chennai, Tamil Nadu, India
| | - Sophia Kumukcham
- Department of Periodontics, Thai Moogambigai Dental College, Chennai, Tamil Nadu, India
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Culhaoglu R, Taner L, Guler B. Evaluation of the effect of dose-dependent platelet-rich fibrin membrane on treatment of gingival recession: a randomized, controlled clinical trial. J Appl Oral Sci 2018; 26:e20170278. [PMID: 29768524 PMCID: PMC5958936 DOI: 10.1590/1678-7757-2017-0278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022] Open
Abstract
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).
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Affiliation(s)
| | - Levent Taner
- Gazi University, Faculty of Dentistry, Department of Periodontology, Ankara, Turkey
| | - Berceste Guler
- Dumlupınar University, Faculty of Dentistry, Department of Periodontology, Kütahya, Turkey
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22
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Pini Prato GP, Magnani C, Chambrone L. Long-term evaluation (20 years) of the outcomes of coronally advanced flap in the treatment of single recession-type defects. J Periodontol 2018. [DOI: 10.1002/jper.17-0379] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Leandro Chambrone
- Unit of Basic Oral Investigation (UIBO); School of Dentistry; El Bosque University, Bogota, Colombia; and School of Dentistry, Ibirapuera University (Unib); São Paulo Brazil
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Zuhr O, Rebele SF, Cheung SL, Hürzeler MB. Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery. Periodontol 2000 2018; 77:123-149. [PMID: 29493018 DOI: 10.1111/prd.12214] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Diverse clinical advancements, together with some relevant technical innovations, have led to an increase in popularity of tunneling flap procedures in plastic periodontal and implant surgery in the recent past. This trend is further promoted by the fact that these techniques have lately been introduced to a considerably expanded range of indications. While originally described for the treatment of gingival recession-type defects, tunneling flap procedures may now be applied successfully in a variety of clinical situations in which augmentation of the soft tissues is indicated in the esthetic zone. Potential clinical scenarios include surgical thickening of thin buccal gingiva or peri-implant mucosa, alveolar ridge/socket preservation and implant second-stage surgery, as well as soft-tissue ridge augmentation or pontic site development. In this way, tunneling flap procedures developed from a technique, originally merely intended for surgical root coverage, into a capacious surgical conception in plastic periodontal and implant surgery. The purpose of this article is to provide a comprehensive overview on tunneling flap procedures, to introduce the successive development of the approach along with underlying ideas on surgical wound healing and to present contemporary clinical scenarios in step-by-step photograph-illustrated sequences, which aim to provide clinicians with guidance to help them integrate tunneling flap procedures into their daily clinical routine.
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Cairo F. Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontol 2000 2017; 75:296-316. [DOI: 10.1111/prd.12186] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 2016; 86:S8-51. [PMID: 25644302 DOI: 10.1902/jop.2015.130674] [Citation(s) in RCA: 258] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This paper aims to create a "bridge" between research and practice by developing a practical, extensive, and clinically relevant study that translates evidence-based findings on soft tissue root coverage (RC) of recession-type defects to daily clinical practice. METHODS This review is prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused questions. A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE and EMBASE databases up to and including June 2013. Systematic reviews (SRs), randomized clinical trials, controlled clinical trials, case series, and case reports evaluating recession areas that were treated by means of RC procedures were considered eligible for inclusion through the three parts of the study (part I, an overview of the base of SRs; part II, an alternative random-effects meta-analyses on mean percentage of RC and sites exhibiting complete RC; and part III, an SR of non-randomized trials exploring other conditions not extensively evaluated by previous SRs). Data on Class I, II, III, and IV recessions, type of histologic attachment achieved with treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions, tooth type and location, long-term effectiveness outcomes, unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes were assessed as well. RESULTS Of the 2,456 potentially eligible trials, 234 were included. Data on Class I, II, III, and IV gingival recessions, histologic attachment achieved after treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions/biomodification, tooth type and location, long-term effectiveness outcomes and unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes (i.e., esthetic, visual analog scale, complications, hypersensitivity, patients perceptions) were assessed. Subepithelial connective tissue (CT)-based procedures and coronally advanced flap plus acellular dermal matrix grafts, enamel matrix derivative, or collagen matrix led to the best improvements of recession depth, clinical attachment level (CAL) gain, and keratinized tissue (KT). Some conditions, such as smoking and use of magnification, may affect RC outcomes. CONCLUSIONS All RC procedures can provide significant reduction in recession depth and CAL gain for Miller Class I and II recession-type defects. Subepithelial CT graft-based procedures provided the best outcomes for clinical practice because of their superior percentages of mean and complete RC, as well as significant increase of KT.
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Affiliation(s)
- Leandro Chambrone
- UIBO (Unit of Basic Oral Investigation), Faculty of Dentistry, El Bosque University, Bogotá, Colombia
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Khobragade S, Kolte A, Kolte R, Shrirao T, Potey A. Modified coronally advanced flap with and without orthodontic button application in management of multiple proximate gingival recession defects: A randomized clinical trial. Contemp Clin Dent 2016; 7:544-549. [PMID: 27994426 PMCID: PMC5141673 DOI: 10.4103/0976-237x.194121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Gingival recession indicates oral display of the root surface due to apical movement of gingival margin. Coronally advanced flap (CAF) is often used periodontal plastic surgical technique to accomplish root coverage. The purpose of this clinical trial is to assess and compare the effectiveness of modified CAF with orthodontic button application (CAF+B) and without orthodontic button application (CAF) for the correction of multiple recession defects. Materials and Methods: Twenty patients exhibiting bilateral multiple proximate Millers Class I and/or Class II gingival recession defects were included in the study. Each set of proximate recession defects was designated randomly to test or control group. Control group was treated by CAF alone and test group by CAF+B. Baseline and postoperative clinical parameters at 2, 4, and 6 months time interval were recorded. Results: Mean root coverage percentage from baseline to 6 months in control group was 78.30% ± 20.75% and in test group was 92.23% ± 15.6%. Complete root coverage was 43.8% in control group and 77.47% in test group. Visual analog scale pain measurements did not reveal any difference among both the groups. Patient satisfaction with esthetics was very high in CAF+B group when compared with CAF group. Conclusion: Both treatment modalities, i.e., CAF and CAF+B are effectual in the treatment of proximate Miller's Class I and Class II gingival recession defects, but CAF+B showed significantly superior clinical results.
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Affiliation(s)
- Sumedh Khobragade
- Department of Periodontics and Implantology, VSPM's Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Abhay Kolte
- Department of Periodontics and Implantology, VSPM's Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Rajashri Kolte
- Department of Periodontics and Implantology, VSPM's Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Tushar Shrirao
- Department of Periodontics and Implantology, VSPM's Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Anushree Potey
- Department of Periodontics and Implantology, VSPM's Dental College and Research Centre, Nagpur, Maharashtra, India
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Thamaraiselvan M, Elavarasu S, Thangakumaran S, Gadagi JS, Arthie T. Comparative clinical evaluation of coronally advanced flap with or without platelet rich fibrin membrane in the treatment of isolated gingival recession. J Indian Soc Periodontol 2015; 19:66-71. [PMID: 25810596 PMCID: PMC4365161 DOI: 10.4103/0972-124x.145790] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 06/02/2014] [Indexed: 12/03/2022] Open
Abstract
Aim: The aim of this study was to determine whether the addition of an autologous platelet rich fibrin (PRF) membrane to a coronally advanced flap (CAF) would improve the clinical outcome in terms of root coverage, in the treatment of isolated gingival recession. Materials and Methods: Systemically healthy 20 subjects each with single Miller's class I or II buccal recession defect were randomly assigned to control (CAF) or test (CAF + PRF) group. Clinical outcome was determined by measuring the following clinical parameters such as recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (WKT), gingival thickness (GTH), plaque index (PI), and gingival index (GI) at baseline, 3rd, and 6th month postsurgery. Results: The root coverage was 65.00 ± 44.47% in the control group and 74.16 ± 28.98% in the test group at 6th month, with no statistically significant difference between them. Similarly, CAL, PD, and WKT between the groups were not statistically significant. Conversely, there was statistically significant increase in GTH in the test group. Conclusion: CAF is a predictable treatment for isolated Miller's class I and II recession defects. The addition of PRF to CAF provided no added advantage in terms of root coverage except for an increase in GTH.
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Affiliation(s)
- Murugan Thamaraiselvan
- Department of Periodontics, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India ; Department of Periodontics, J K K Nattaraja Dental College, Komarapalayam, Karnataka, India
| | - Sugumari Elavarasu
- Department of Periodontics, J K K Nattaraja Dental College, Komarapalayam, Karnataka, India
| | | | | | - Thangavelu Arthie
- Department of Periodontics, J K K Nattaraja Dental College, Komarapalayam, Karnataka, India
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de Sanctis M, Clementini M. Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 2014; 41 Suppl 15:S108-22. [PMID: 24640996 DOI: 10.1111/jcpe.12189] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/27/2022]
Abstract
AIM To identify critical elements in design and execution of coronally advanced flap, lateral positioned flap and their variations for the treatment of facial gingival recessions or peri-implant soft tissue dehiscences. MATERIALS AND METHODS Clinical studies were identified with both electronic and hand searches, and examined for the following aspects: flap design and incision techniques, flap elevation, root conditioning, flap mobility, flap stability and suturing. Moreover, prognostic factors for complete recession coverage were identified. RESULTS Some critical elements are evident in flap design and execution: the dimension and the thickness of tissue positioned over the denuded roots; the use on root surface of enamel matrix derivate; the stability and suturing of the flap in a position coronal to the cemento-enamel junction. The pre-determination of the clinical cemento-enamel junction, smoking status, operator surgical skills and the compliance to a supportive care programme have a role in obtaining and maintaining a complete root coverage. CONCLUSIONS Different flap approaches are available when performing periodontal plastic surgery, resulting in a great variability in clinical outcomes. The possibility of using pedicle flaps alone to achieve complete soft tissue coverage of facial implant dehiscence has not yet been investigated.
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Affiliation(s)
- Massimo de Sanctis
- Department of Periodontology, Tuscany Dental School, Univesity of Siena-Florence, Siena, Italy
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Bhusari P, Agrawal N, Upadhyay S, Verma S, Jain A, Jaroli S. Classification & prevalence of dental surface defects in areas of gingival recession- a clinical study. J Clin Diagn Res 2014; 8:ZF01-4. [PMID: 25177665 DOI: 10.7860/jcdr/2014/8499.4577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 05/22/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Apical migration of the gingival margin beyond the cement-enamel junction (CEJ) is called as gingival recession. Various classifications of gingival recession have been proposed to evaluate different degrees of damage to periodontal tissues, but do not consider the condition of the exposed root surface: presence of an identifiable CEJ and presence of root abrasion. Sometimes these lesions may be associated with enamel abrasion. Therefore, the aim of this paper is to propose the new classification of dental surface defects in gingival recession area. METHODS Two factors were evaluated to set up a classification system: presence (A) or absence (B) of CEJ and presence (+) or absence (-) of dental surface discrepancy caused by abrasion (step). Four classes (A+, A-, B+, and B-) were identified on the basis of these variables. The classification was used on 1,000 gingival recessions to examine the distribution of the four classes. RESULTS Out of 1,000 exposed root surfaces, 380 showed an identifiable CEJ associated with step (Class A+, 38%); 280 an identifiable CEJ without any associated step (Class A-, 28%); 200 an unidentifiable CEJ with a step (Class B+, 20%); and 140 an unidentifiable CEJ without any associated step (Class B-, 14%). CONCLUSION The proposed classification describes the dental surface defects that are of paramount importance in diagnosing gingival recession areas which might help in selecting the definite treatment approach.
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Affiliation(s)
- Prashant Bhusari
- Professor, Department of Periodontics, Modern Dental College & Research Centre , Indore, India
| | - Nitin Agrawal
- Post Graduate Student, Department of Periodontics, Modern Dental College & Research Centre , Indore, India
| | - Shivam Upadhyay
- Post Graduate Student, Department of Periodontics, Modern Dental College & Research Centre , Indore, India
| | - Shiras Verma
- Senior Lecturer, Department of Periodontics, Institute of Dental Education and Advance Studies . Gwalior (M.P.), India
| | - Amiyavardhan Jain
- Post Graduate Student, Department of Periodontics, Modern Dental College & Research Centre , Indore, India
| | - Shraddha Jaroli
- Post Graduate Student, Department of Conservative & Endodontics, Modern Dental College & Research Centre , Indore, India
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Moka LR, Boyapati R, M S, D NS, Swarna C, Putcha M. Comparison of coronally advanced and semilunar coronally repositioned flap for the treatment of gingival recession. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2014; 8:ZC04-8. [PMID: 25121054 DOI: 10.7860/jcdr/2014/8928.4428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/09/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gingival Recession (GR) occurs in population with low oral hygiene levels. Root coverage may be achieved by a number of surgical techniques, including pedicle gingival grafts, free grafts, connective tissue grafts, gtr may also be used. The objective of the present study is to compare the clinical outcomes of the Semilunar Coronally Repositioned Flap (SCRF) and Coronally Advanced Flap (CAF) procedure in the treatment of miller's class I gingival recession defects in maxillary teeth. MATERIALS AND METHODS Twenty systemically healthy patients, with isolated miller's class 1 gingival recessions, were selected and allocated randomly into two groups, Group I and Group II with 10 patients in each. In Group I, the patients were treated with coronally advanced flap procedure with sling sutures, whereas in Group II, patients were treated with semilunar coronally repositioned flap without sutures. RESULTS Descriptive statistical analysis has been carried out in the present study. RESULTS on continuous measurements are presented on Mean ± SD. Significance is assessed at 5 % level of significance. Student t-test (two tailed, dependent) has been used to find the significance of study parameters between baseline - 3 months and baseline - 6 months, 90% Confidence interval for mean has been computed. CONCLUSION CAF provides consistently better results than SCRF With all other parameters, such as clinical attachment levels, percentage of root coverage and complete root coverage and esthetics were taken into account, caf was found to be superior. In contrary to this, there is significant increase in width of keratinized tissue in scrf group.
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Affiliation(s)
- Leela Rani Moka
- Senior Lecturer, Department of Periodontics, GSL College of Dental Sciences , Rajahmundry, Andhra Pradesh, India
| | - Ramanarayana Boyapati
- Senior Lecturer, Department of Periodontics, Mamata Dental College , Khammam, Andhra Pradesh, India
| | - Srinivas M
- Professor, Department of Periodontics, Sibar Institute of Dental Sciences , Guntur, Andhra Pradesh, India
| | - Narasimha Swamy D
- Professor & HOD, Department of Periodontics, Sibar Institute of Dental Sciences , Guntur, Andhra Pradesh, India
| | - Chakrapani Swarna
- Professor, Department of Periodontics, Sibar Institute of Dental Sciences , Guntur, Andhra Pradesh, India
| | - Madhusudhan Putcha
- Senior Lecturer, Department of Periodontics, Dr Sudha & Nageswara Rao Siddhartha Institute of Dental Sciences , Chinaoutpalli, Krishna District, Andhra Pradesh, India
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Kilic D, Kesim S, Liman N, Sumer Z, Ozturk A. In VitroComparison of the Effects of Dental Filling Materials on Mouse Fibroblasts. BIOTECHNOL BIOTEC EQ 2014. [DOI: 10.5504/bbeq.2012.0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Taiyeb Ali TB, Shapeen IM, Ahmed HB, Javed F. Efficacy of acellular dermal matrix and autogenous connective tissue grafts in the treatment of gingival recession defects among Asians. ACTA ACUST UNITED AC 2014; 6:125-32. [DOI: 10.1111/jicd.12085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/11/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Tara B. Taiyeb Ali
- Department of Oral Pathology, Oral Medicine & Periodontology; Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
| | | | | | - Fawad Javed
- 3D Imaging and Biomechanical Laboratory; College of Applied Medical Sciences; King Saud University; Riyadh Saudi Arabia
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Yilmaz E, Ozcelik O, Comert M, Ozturan S, Seydaoglu G, Teughels W, Haytac MC. Laser-Assisted Laterally Positioned Flap Operation: A Randomized Controlled Clinical Trial. Photomed Laser Surg 2014; 32:67-74. [DOI: 10.1089/pho.2013.3602] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eftal Yilmaz
- Department of Periodontology, Faculty of Dentistry, University of Cukurova, Adana, Turkey
| | - Onur Ozcelik
- Department of Periodontology, Faculty of Dentistry, University of Cukurova, Adana, Turkey
| | - Murat Comert
- Department of Periodontology, Faculty of Dentistry, University of Cukurova, Adana, Turkey
| | - Seda Ozturan
- Department of Periodontology, Faculty of Dentistry, Bezmialem University, İstanbul, Turkey
| | - Gulsah Seydaoglu
- Department of Biostatistics, Faculty of Medicine, University of Cukurova, Adana, Turkey
| | - Wim Teughels
- Periodontology Section, Department of Oral Sciences, Catholic University Leuven, and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Mehmet Cenk Haytac
- Department of Periodontology, Faculty of Dentistry, University of Cukurova, Adana, Turkey
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Kim SM, Choi YH, Kim YG, Park JW, Lee JM, Suh JY. Analysis of the Esthetic Outcome after Root Coverage Procedures Using a Comprehensive Approach. J ESTHET RESTOR DENT 2013; 26:107-18. [DOI: 10.1111/jerd.12085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sung Mi Kim
- Department of Periodontology; School of Dentistry, Kyungpook National University; Daegu Korea
| | - Youn Hee Choi
- Department of Preventive Dentistry; School of Dentistry, Kyungpook National University; Daegu Korea
| | - Yong Gun Kim
- Department of Periodontology; School of Dentistry, Kyungpook National University; Daegu Korea
| | - Jin Woo Park
- Department of Periodontology; School of Dentistry, Kyungpook National University; Daegu Korea
| | - Jae Mok Lee
- Department of Periodontology; School of Dentistry, Kyungpook National University; Daegu Korea
| | - Jo Young Suh
- Department of Periodontology; School of Dentistry, Kyungpook National University; Daegu Korea
- Institute for Hard Tissue and Bio-tooth Regeneration; School of Dentistry, Kyungpook National University; Daegu Korea
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Douglas de Oliveira DW, Oliveira-Ferreira F, Flecha OD, Gonçalves PF. Is Surgical Root Coverage Effective for the Treatment of Cervical Dentin Hypersensitivity? A Systematic Review. J Periodontol 2013; 84:295-306. [DOI: 10.1902/jop.2012.120143] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Cortellini P, Pini Prato G. Coronally advanced flap and combination therapy for root coverage. Clinical strategies based on scientific evidence and clinical experience. Periodontol 2000 2012; 59:158-84. [PMID: 22507065 DOI: 10.1111/j.1600-0757.2011.00434.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
During the past three decades, several surgical techniques have been proposed to treat single and multiple gingival recessions. Evidence indicates that coronally advanced flap-based approaches result in the best clinical results. Among all the different techniques, the use of a graft under a coronally advanced flap results in the best short- and long-term outcomes in terms of root coverage and gain in keratinized tissue. The use of a coronally advanced flap + connective tissue graft would appear to be the best choice for root coverage. However, harvesting a graft from the palate adds morbidity, surgical chair-time and requires increased surgical skills. A potential alternative could be the use of enamel matrix derivatives under a coronally advanced flap, and this achieves similar clinical outcomes and is less invasive, but adds economic costs to the treatment. Evidence shows that a coronally advanced flap alone in many instances results in complete root coverage and is stable over time. A coronally advanced flap is less invasive for the patient, requires less chair-time and probably less surgical skill. It would therefore be desirable to use a coronally advanced flap approach when indicated. It has been hypothesized that a coronally advanced flap approach alone could be successfully applied when the residual gingiva is thick and wide, although existing evidence does not support this hypothesis in full. Accordingly, the adjunctive use of a graft or enamel matrix derivatives could be restricted to sites at which there is thin and narrow residual gingiva.
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Al-Hezaimi K, Rudek I, Al-Hamdan KS, Javed F, Iezzi G, Piattelli A, Wang HL. Efficacy of acellular dermal matrix and coronally advanced flaps for the treatment of induced gingival recession defects: a histomorphometric study in dogs. J Periodontol 2012; 84:1172-9. [PMID: 23088530 DOI: 10.1902/jop.2012.120380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Gingival recession (GR) defects can be treated by various methods, including acellular dermal matrix (ADM) or coronally advanced flaps (CAFs). The aim of this histomorphometric experiment is to compare the efficacy of ADM and CAF for treating GR defects in dogs. METHODS In eight beagle dogs, a critical-size labial GR defect was surgically induced on bilateral maxillary cuspids under general anesthesia. Test sites received ADM and CAF, and control sites underwent CAF treatment alone. Plaque index (PI), bleeding index (BI), and gingival index (GI) were measured at 4 weeks (baseline), 8 weeks, and 16 weeks. Width of keratinized gingiva (KG) was determined at baseline and at 16 weeks. Depth of recession and width of GR below the cemento-enamel junction (CEJ) was also determined. After 4 months, animals were sacrificed, and jaw blocks were histomorphometrically assessed for tissue thickness and distance from the stent to the gingival margin (GM) and to the CEJ. RESULTS At 4-, 8-, and 16-week intervals, there was no significant difference in the BI, GI, and PI at the test and control sites. At 16 weeks, thickness of KG was significantly higher at the control sites than test sites (P <0.01). There was no difference in the midfacial recession depth and recession width at the test and control sites at baseline and before euthanasia (16 weeks). Histomorphometrically, there was no significant difference in tissue thicknesses and distances from the stent to the GM and CEJ in the test and control sites. CONCLUSION ADM might yield similar results to a CAF alone and could decrease the amount of KG.
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Affiliation(s)
- Khalid Al-Hezaimi
- 3D Imaging and Biomechanical Laboratory, College of Dentistry and College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
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Cardaropoli D, Tamagnone L, Roffredo A, Gaveglio L. Treatment of Gingival Recession Defects Using Coronally Advanced Flap With a Porcine Collagen Matrix Compared to Coronally Advanced Flap With Connective Tissue Graft: A Randomized Controlled Clinical Trial. J Periodontol 2012; 83:321-8. [DOI: 10.1902/jop.2011.110215] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pini Prato G, Rotundo R, Franceschi D, Cairo F, Cortellini P, Nieri M. Fourteen-year outcomes of coronally advanced flap for root coverage: follow-up from a randomized trial. J Clin Periodontol 2011; 38:715-20. [DOI: 10.1111/j.1600-051x.2011.01744.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ozcelik O, Haytac MC, Seydaoglu G. Treatment of multiple gingival recessions using a coronally advanced flap procedure combined with button application. J Clin Periodontol 2011; 38:572-80. [DOI: 10.1111/j.1600-051x.2011.01724.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pini-Prato G, Franceschi D, Cairo F, Nieri M, Rotundo R. Classification of dental surface defects in areas of gingival recession. J Periodontol 2010; 81:885-90. [PMID: 20450362 DOI: 10.1902/jop.2010.090631] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A clinical classification of surface defects in gingival recession area is proposed. METHODS Two factors were evaluated to set up a classification system: presence (A) or absence (B) of cemento-enamel junction (CEJ) and presence (+) or absence (-) of dental surface discrepancy caused by abrasion (step). Four classes (A+, A-, B+, and B-) were identified on the basis of these variables. To validate the classification three different calibrated examiners applied the proposed classification system to 46 gingival recessions and kappa statistics were performed. The classification was used on 1,010 gingival recessions from 353 patients to examine the distribution of the four classes. RESULTS The kappa statistics for intrarater agreement ranged from 0.74 to 0.95 (almost perfect agreement), whereas interrater agreement ranged from 0.26 to 0.59 (moderate agreement). Out of 1,010 exposed root surfaces associated with gingival recession, 144 showed an identifiable CEJ associated with a root surface defect (Class A+, 14%); 469 an identifiable CEJ without any associated step (Class A-, 46%); 244 an unidentifiable CEJ with a step (Class B+, 24%); and 153 an unidentifiable CEJ without any associated step (Class B-, 15%). CONCLUSION The proposed classification describes the dental surface defects that are of paramount importance in diagnosing gingival recession areas.
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Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root-Coverage Procedures for the Treatment of Localized Recession-Type Defects: A Cochrane Systematic Review. J Periodontol 2010; 81:452-78. [DOI: 10.1902/jop.2010.090540] [Citation(s) in RCA: 194] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Santana RB, Furtado MB, Mattos CM, de Mello Fonseca E, Dibart S. Clinical Evaluation of Single-Stage Advanced Versus Rotated Flaps in the Treatment of Gingival Recessions. J Periodontol 2010; 81:485-92. [DOI: 10.1902/jop.2010.090237] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Henriques PSG, Pelegrine AA, Nogueira AA, Borghi MM. Application of subepithelial connective tissue graft with or without enamel matrix derivative for root coverage: a split-mouth randomized study. J Oral Sci 2010; 52:463-71. [DOI: 10.2334/josnusd.52.463] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Alghamdi H, Babay N, Sukumaran A. Surgical management of gingival recession: A clinical update. Saudi Dent J 2009; 21:83-94. [PMID: 23960465 DOI: 10.1016/j.sdentj.2009.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 03/04/2009] [Accepted: 05/23/2009] [Indexed: 10/20/2022] Open
Abstract
Gingival recession is defined as the apical migration of the junctional epithelium with exposure of root surfaces. It is a common condition seen in both dentally aware populations and those with limited access to dental care. The etiology of the condition is multifactorial but is commonly associated with underlying alveolar morphology, tooth brushing, mechanical trauma and periodontal disease. Given the high rate of gingival recession defects among the general population, it is imperative that dental practitioners have an understanding of the etiology, complications and the management of the condition. The following review describes the surgical techniques to treat gingival recession.
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Affiliation(s)
- Hamdan Alghamdi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Byun HY, Oh TJ, Abuhussein HM, Yamashita J, Soehren SE, Wang HL. Significance of the Epithelial Collar on the Subepithelial Connective Tissue Graft. J Periodontol 2009; 80:924-32. [DOI: 10.1902/jop.2009.080673] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database Syst Rev 2009:CD007161. [PMID: 19370675 DOI: 10.1002/14651858.cd007161.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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 periodontal plastic surgery (PPS) procedures. OBJECTIVES To evaluate the effectiveness of different root coverage procedures in the treatment of recession-type defects. SEARCH STRATEGY The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched up to October 2008. The main international periodontal journals were handsearched. There were no restrictions with regard to publication status or language of publication. SELECTION CRITERIA Only randomised controlled clinical trials (RCTs) of at least 6 months' duration evaluating recession areas (Miller's Class I or II > 3 mm) and that were treated by means of PPS procedures were included. DATA COLLECTION AND ANALYSIS Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. MAIN RESULTS Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significant greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTG) compared to guided tissue regeneration with resorbable membranes (GTR rm). A significant greater gain in the keratinized tissue was found for enamel matrix protein when compared to coronally advanced flap (0.40 mm) and for SCTG when compared to GTR rm plus bone substitutes. Limited 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 the treatment of localised recession-type defects. In cases where both root coverage and gain in the keratinized tissue are expected, the use of subepithelial connective tissue grafts seems to be more adequate. Randomised controlled clinical trials are necessary to identify possible factors associated with the prognosis of each PPS procedure. The potential impact of bias on these outcomes is unclear.
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Affiliation(s)
- Leandro Chambrone
- Department of Periodontology, University of São Paulo, Av. Prof. Lineu Prestes, 2227 Cidade Universitária, São Paulo, SP, Brazil, 05508-000.
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Zucchelli G, Mounssif I, Stefanini M, Mele M, Montebugnoli L, Sforza N. Hand and Ultrasonic Instrumentation in Combination With Root-Coverage Surgery: A Comparative Controlled Randomized Clinical Trial. J Periodontol 2009; 80:577-85. [DOI: 10.1902/jop.2009.080485] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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The Influence of Tobacco Smoking on the Outcomes Achieved by Root-Coverage Procedures. J Am Dent Assoc 2009; 140:294-306. [PMID: 19255173 DOI: 10.14219/jada.archive.2009.0158] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nieri M, Rotundo R, Franceschi D, Cairo F, Cortellini P, Pini Prato G. Factors Affecting the Outcome of the Coronally Advanced Flap Procedure: A Bayesian Network Analysis. J Periodontol 2009; 80:405-10. [DOI: 10.1902/jop.2009.080146] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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