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Katti N, Kp R, Barik AK, Das SK, Peri S, Mohanty D. Enhancing root coverage and esthetic outcomes in isolated gingival recession using orthodontic intervention and lateral closed tunnel technique: An interdisciplinary prospective case series. Clin Adv Periodontics 2024. [PMID: 38526009 DOI: 10.1002/cap.10285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Gingival recession (GR) in malposed tooth in association with bone dehiscence and/or fenestration poses a challenge for successful root coverage treatment. Lateral closed tunnel (LCT) technique is particularly useful in isolated GR in mandibular anterior region, where the shallow vestibular depth prevents tension-free coronal mobilization of tissues. METHODS Twenty patients with GR associated with tooth malposition were treated using a combined orthodontic-periodontic approach with a torquing auxiliary spring followed by LCT technique. RESULTS The two techniques resulted in a combined recession depth reduction from 3.75 ± 1.14 mm to 0.40 ± 0.50 mm at the end of 6-month study period. The orthodontic intervention led to an increase in labial marginal bone levels, as assessed through cone beam computed tomography (CBCT), while the LCT achieved closure of residual recession defect. Also, an increase of keratinized tissue width from 0.81 ± 0.88 mm at baseline to 3.30 ± 0.67 mm at 6 months was achieved. Mean root coverage percentage (MRC%) of 91.40% + 10.25% was seen, with 11 out of 20 sites (55%) showing complete root coverage (CRC). CONCLUSIONS Single tooth orthodontic repositioning followed by LCT technique proved effective in successfully managing isolated recession defects in the mandibular anterior gingival region, which often presents challenging mucogingival conditions. The precise single tooth repositioning resulted in labial marginal bone augmentation, while the LCT surgical approach allowed residual defect closure. KEY FINDINGS Why are these cases new information? Correction of single tooth malposition is achieved before recession coverage treatment to achieve a favorable environment for graft uptake. The reduction in denuded root surface along with the bone remodeling results in increasing the ratio of vascular to avascular region, thus improving the overall prognosis of the treatment. What are the keys to successful management of these cases? The lateral closed tunnel technique involves creating a mucoperiosteal tunnel to close the recession site. Precision is crucial to avoid damage to surrounding tissues. The recipient site should be wider than the width of recession to improve graft vascularity. What are the primary limitations to success in these cases? Limitations may arise when dealing with complex cases, such as multiple teeth involvement or teeth with significant vertical or horizontal bone loss.
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Affiliation(s)
- Neelima Katti
- Department of Periodontics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
| | - Rimsha Kp
- Department of Orthodontics and Dentofacial Orthopaedics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
| | - Ashish Kumar Barik
- Department of Orthodontics and Dentofacial Orthopaedics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
| | - Surya Kanta Das
- Department of Orthodontics and Dentofacial Orthopaedics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
| | - Srivani Peri
- Department of Periodontics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
| | - Devapratim Mohanty
- Department of Periodontics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
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Fernández-Jiménez A, García-De-La-Fuente AM, Marichalar-Mendia X, Aguirre-Zorzano LA, Estefanía-Fresco R. Treatment of deep single RT2 and RT3 antero-mandibular gingival recessions with a combination of surgical techniques: A case series study. J ESTHET RESTOR DENT 2024; 36:363-372. [PMID: 37594747 DOI: 10.1111/jerd.13120] [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: 03/29/2023] [Revised: 06/18/2023] [Accepted: 07/29/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To evaluate root coverage (RC) in deep single antero-mandibular RT2 and RT3 gingival recessions (GR) and to investigate the influence of several factors in RC. MATERIALS AND METHODS Fifteen single antero-mandibular GR with a minimum depth of 3 mm were consecutively treated with a new one-stage technique (laterally positioned flap with a tunnel access and a connective tissue graft). At baseline and at 12-month follow-up, the percentage of mean root coverage (%MRC), the recession reduction (RecRed), complete root coverage (CRC) and the gain of keratinized tissue width (KTW) were assessed. Descriptive, intergroup comparative and correlation analyses were performed. RESULTS At 12 months, a %MRC of 77.29 ± 21.48% with a mean RecRed of 4.10 ± 1.51 mm was achieved. The %MRC was 84.71 ± 21.08% in RT2, and 62.43 ± 14.17% in RT3. The mean gain of KTW was 2.10 ± 0.89 mm, with a mean gain of 2.0 ± 1.03 mm for RT2 and 2.3 ± 0.57 mm for RT3. CRC was observed in six cases, all of them being RT2. A positive association was found between the %MRC and the initial position of the tooth and of both papillae. CONCLUSIONS This technique might be a valuable approach for the treatment of deep single antero-mandibular RT2 and RT3 recessions, even in malpositioned teeth. CLINICAL SIGNIFICANCE A combination of different surgical techniques could provide greater vascularization to the CTG especially in malpositioned teeth in sextant V with a large avascular area to be covered.
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Affiliation(s)
- A Fernández-Jiménez
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - A M García-De-La-Fuente
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - X Marichalar-Mendia
- Research Group: GIU21/042, Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - L A Aguirre-Zorzano
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Clínica Dr. Aguirre, Bilbao, Spain
| | - R Estefanía-Fresco
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Clínica Dr. Aguirre, Bilbao, Spain
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Sabri H, SamavatiJame F, Sarkarat F, Wang HL, Zadeh HH. Clinical efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) for treatment of multiple gingival recession defects: a systematic review, meta-analysis and meta-regression. Clin Oral Investig 2023; 27:7171-7187. [PMID: 38010424 DOI: 10.1007/s00784-023-05383-7] [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: 10/14/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES This study investigated the efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) compared to other methods for treating multiple adjacent gingival recessions (MAGRs) through a systematic review and meta-analysis. MATERIALS AND METHODS A systematic literature search was performed through June 2023, to identify clinical trials investigating VISTA for root coverage on MAGRs. A meta-analysis with meta-regression model was employed on the primary outcomes of mean and complete root coverages (MRC, CRC), comparing VISTA with other techniques. Clinical efficacy of various graft materials was assessed. RESULTS Fourteen studies were included, 8 of which met the criteria for quantitative assessment. The cumulative MRC (88.15% ± 20.79%) and CRC (67.85% ± 21.72%) of VISTA were significantly higher compared to the tunneling technique (SMD = 0.83 (95% CI [0.36, 1.30], p < 0.01). The baseline recession depth showed a negative correlation with CRC, whereas baseline keratinized gingiva width exhibited a positive correlation with this outcome. CONCLUSIONS The VISTA technique, particularly with acellular dermal matrix (ADM) or connective tissue graft (CTG) materials, offers superior outcomes compared to the tunneling technique. The capacity of platelet-rich fibrin (PRF) to substitute for connective tissue graft (CTG) in VISTA-root coverage was noteworthy, provided there is adequate keratinized tissue width. CLINICAL RELEVANCE VISTA in concert with acellular dermal matrix or CTG resulted in improved root coverage, surpassing the outcomes achieved through tunneling. PRF emerged as a viable alternative to CTG, when used in conjunction with VISTA, demonstrating comparable mean root coverage. This is particularly evident in situations where sufficient keratinized gingiva is available and when patient comfort is taken into consideration.
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Affiliation(s)
- Hamoun Sabri
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Ann Arbor, MI, USA
| | - Fatemeh SamavatiJame
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Farzin Sarkarat
- Department of Oral and Maxillofacial Surgery, Gulf Medical University, Ajman, UAE
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Homayoun H Zadeh
- VISTA Institute for Therapeutic Innovations, 6325 Topanga Canyon Blvd, Suite 101, Woodland Hills, Los Angeles, CA, 91367, USA.
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Malhotra S, Tewari S, Sharma R, Sharma RK, Tanwar N, Arora R. Clinical evaluation of root coverage in Miller class III/RT2 labial gingival recession treated with interdisciplinary periodontal-orthodontic therapy: a randomized controlled clinical trial. J Periodontal Implant Sci 2023; 53:53.e55. [PMID: 38290996 DOI: 10.5051/jpis.2204100205] [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: 10/13/2022] [Revised: 03/21/2023] [Accepted: 04/30/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE The aim of current study was to evaluate percentage root coverage (RC%) in isolated Miller class III/RT2 labial gingival recession (GR) associated with malaligned mandibular anteriors, using interdisciplinary periodontal-orthodontic treatment as compared to mucogingival surgery alone. METHODS Thirty-six systemically healthy patients having isolated Miller class III/RT2 GR with respect to malaligned mandibular anteriors, were randomly divided into test group: mucogingival surgery using subepithelial connective tissue graft followed by orthodontic treatment and control group: mucogingival surgery alone. Primary clinical parameters included (RC%), recession depth, keratinized tissue width, mid-labial clinical attachment level, interdental clinical attachment level (iCAL), periodontal phenotype (PP), gingival thickness (GT), root coverage esthetics score (RES) and hypersensitivity. Total duration of follow up was 12 months. RESULTS Mean RC% was significantly more achieved in test group (66.67%±40.82%) in comparison to control group (39.93%±31.41%) at the end of study (P=0.049). Further, complete root coverage was attained in 5/8 cases of test group versus 1/2 cases of control group after 3/12 months respectively. RES and hypersensitivity, showed statistically significant improvement after complete follow up period in both the groups. An ideal RES score of 10 was achieved in 4/7 cases of test group while in 1/2 cases of control group after 3/12 months respectively. Correlation analysis revealed significant negative correlation between RC% and iCAL. Correlation of RC% with GT and PP was non-significant. CONCLUSIONS Interdisciplinary periodontal-orthodontic approach may be more beneficial in terms of achieving improved RC%, esthetic and resolution of hypersensitivity in the management of Miller class III/RT2 GR in malaligned mandibular anteriors. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04255914.
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Affiliation(s)
- Sakshi Malhotra
- Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Shikha Tewari
- Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, India.
| | - Rekha Sharma
- Department of Orthodontics and Dentofacial Orthopaedics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Rajinder Kumar Sharma
- Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Nishi Tanwar
- Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Ritika Arora
- Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
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Xue F, Zhang R, Liu J, Duan J, Zhang Y, Cai Y. Digitally measured exposed root surface area for predicting the effectiveness of modified coronally advanced tunnel combined de-epithelialized gingival grafting in the treatment of multiple adjacent gingival recessions. Clin Oral Investig 2023; 27:4503-4512. [PMID: 37227498 DOI: 10.1007/s00784-023-05072-5] [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: 02/15/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To assess the predictive value of baseline digitally measured exposure root surface area (ERSA) on the effectiveness of modified coronally advanced tunnel and de-epithelialized gingival grafting (MCAT + DGG) technique for the treatment of multiple adjacent gingival recessions (MAGRs). MATERIALS AND METHODS A total of 96 gingival recessions (48 RT1 and 48 RT2) from 30 subjects were included. ERSA was measured on the digital model obtained by intraoral scanner. Generalized linear model was used to analyze the possible correlation of ERSA, Cairo recession type (RT), gingival biotype, keratinized gingival width (KTW), tooth type, and cervical step-like morphology on the mean root coverage (MRC) and complete root coverage (CRC) at 1-year after MCAT + DGG. The predictive accuracy of CRC is tested using receiver-operator characteristic curves. RESULTS At 1-year postoperatively, the MRC for RT1 was 95.14 ± 10.25%, which was significantly higher than 78.42 ± 22.57% for RT2 (p < 0.001). ERSA (OR:1.342, p < 0.001), KTW (OR:1.902, p = 0.028) and lower incisors (OR:15.716, p = 0.008) were independent risk factors for predicting MRC. ERSA and MRC showed significant negative correlation in RT2(r = -0.558, p < 0.001), but not in RT1(r = 0.220, p = 0.882). Meanwhile, ERSA (OR:1.232, p = 0.005) and Cairo RT (OR:3.740, p = 0.040) were independent risk factors for predicting CRC. For RT2, the area under curve was 0.848 and 0.898 for ERSA without or with other correction factors, respectively. CONCLUSIONS Digitally measured ERSA may provide strong predictive values for RT1 and RT2 defects treated with MCAT + DGG. CLINICAL RELEVANCE This study demonstrates that digitally measured ERSA is a valid outcome predictor for root coverage surgery, especially applicable for predicting RT2 MAGRs.
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Affiliation(s)
- Fei Xue
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Rui Zhang
- Third Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Jia Liu
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, No.22 South Avenue Zhongguancun, Beijing, 100081, People's Republic of China
| | - Jinyu Duan
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Yong Zhang
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China.
| | - Yu Cai
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, No.22 South Avenue Zhongguancun, Beijing, 100081, People's Republic of China.
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Comparative study of the modified VISTA technique (m-VISTA) versus the coronally advanced flap (CAF) in the treatment of multiple Miller class III/RT2 recessions: a randomized clinical trial. Clin Oral Investig 2023; 27:505-517. [PMID: 36264343 PMCID: PMC9889485 DOI: 10.1007/s00784-022-04746-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To compare the percentage of mean root coverage (MRC%) obtained in the treatment of multiple Miller class III/RT2 gingival recessions using the modified VISTA (m-VISTA) technique versus the coronally advanced flap (CAF) technique, using a connective tissue graft (CTG) in both cases. MATERIALS AND METHODS Twenty-four patients were randomly treated with m-VISTA (test group (TG) = 12) or CAF (control group (CG) = 12). A calibrated, experienced, and blinded examiner collected data related to multiple periodontal clinical variables, especially the recession (REC) in order to calculate the MRC% at 6 and 12 months, which was the primary outcome of the study. Also, the radiological bone level, the characteristics of the CTG, and postsurgical incidences were assessed. Finally, a descriptive and an analytical statistical analysis of the variables and their associations was performed. RESULTS The recessions (n = 84) were located mainly in the mandible (n = 65) and in posterior sectors (premolars: n = 35; molars: n = 8). At 6 months, the MRC% was 61% (2 mm) for both study groups, and at 12 months, it increased to 73.26% (2.11 mm) in the TG and decreased to 56.49% (1.78 mm) in the CG. CONCLUSION When approaching multiple Miller class III/RT2 recessions, there were no statistically significant differences in the MRC% at 6 and 12 months between the group treated with the m-VISTA technique and the group treated with the CAF. CLINICAL RELEVANCE The characteristics of the m-VISTA technique, such as the closed approach, the mobilization of the papilla, and the coronal stabilization of the CTG, could facilitate the maturation of the tissues in the treatment of Miller class III/RT2 recessions. This would favor better root coverage. TRIAL REGISTRATION NCT03258996.
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Bednarz W, Majer J, Pakuszyńska-Błaszczyk J, Dominiak M, Gedrange T, Zielińska-Pałasz A. Laterally Positioned Flap Procedure with Augmented or Nonaugmented Palatal Connective Tissue Grafts in the Treatment of Multiple Adjacent Gingival Recessions: A Two-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12208. [PMID: 36231511 PMCID: PMC9566521 DOI: 10.3390/ijerph191912208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
The most commonly used technique for covering gingival recessions is the coronally advanced flap (CAF) technique due to its high success rate. In clinical situations where there is less keratinized tissue apical to the defect due to unfavorable anatomical conditions, a more advantageous technique for this situation should be considered, specifically the laterally positioned flap (LPF). The aim of this study was to compare the gingival thickness after gingival recession coverage using the laterally positioned flap supported by an augmented and non-augmented connective tissue graft (CTG). Thirty-four patients with 105 gingival recessions of Miller's class I and/or II were enrolled in this study. The method of choice was the laterally positioned flap. The test group was treated with previously augmented CTG harvested from the palatal mucosa while the control group was treated with a non-augmented CTG. Clinical measurements were recorded at baseline, 6, 12 and 24 months after intervention. Clinical results showed a statistically more significant percentage of average and complete gingival recession coverage in the test group. The LPF in combination with an augmented CTG proves to be an effective alternative to the CAF. Greater improvement in gingival thickness was observed in the LPF with augmented CTG than in non-augmented CTG.
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Affiliation(s)
- Wojciech Bednarz
- Specialist Outpatient Medical Clinic MEDIDENT, Okulickiego 19 Str., PL 38-300 Gorlice, Poland
| | - Jennifer Majer
- Department of Orthodontics, Carl Gustav Carus Campus, Technische Universität Dresden, Fetscherstr. 74, D-01309 Dresden, Germany
| | | | - Marzena Dominiak
- Department of Dental Surgery, Medical University in Wroclaw, Krakowska 26 str., PL 50-425 Wroclaw, Poland
| | - Tomasz Gedrange
- Department of Orthodontics, Carl Gustav Carus Campus, Technische Universität Dresden, Fetscherstr. 74, D-01309 Dresden, Germany
- Department of Dental Surgery, Medical University in Wroclaw, Krakowska 26 str., PL 50-425 Wroclaw, Poland
| | - Agata Zielińska-Pałasz
- Specialist Outpatient Medical Clinic MEDIDENT, Okulickiego 19 Str., PL 38-300 Gorlice, Poland
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Górski B, Górska R, Szerszeń M, Kaczyński T. Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes. Clin Oral Investig 2021; 26:673-688. [PMID: 34218303 PMCID: PMC8791902 DOI: 10.1007/s00784-021-04045-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/21/2021] [Indexed: 12/27/2022]
Abstract
Objectives To investigate factors that influence 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG) with enamel matrix derivative (EMD) (tests) or without (controls). Materials and methods Twenty patients with 150 GR were treated. Logistic regression models were used to identify baseline parameters that could predict 12-month average root coverage (ARC), complete root coverage (CRC), root esthetic coverage score (RES), gain in keratinized tissue width (KTW), and gain in gingival thickness (GT). Results The likelihood of ARC > 85% increased sevenfold (odds ratio [OR] = 7.33; 95% confidence interval [CI] = 2.43–12.12), of achieving CRC: 21-fold (OR = 21.23; 95% CI = 10.21–45.32), and of gaining RES = 10: tenfold (OR = 10.23; 95% CI = 5.78–32.23) in favor of EMD-treated sites. With each 1-mm2 increase in baseline avascular exposed root surface area (AERSA), the odds of failure (ARC ≤ 85%, not achieving CRC and postoperative GT ≤ 2 mm) increased almost fourfold (OR = 3.56; 95% CI = 1.98–10.19), fourfold (OR = 4.23; 95% CI = 1.11–9.02), and nearly sixfold (OR = 5.76; 95% CI = 2.43–12.87), respectively. The greater the baseline GT, the more likely the chance of achieving CRC (OR = 10.23; 95% CI = 8.37–16.23) and RES = 10 (OR = 5.50; 95% CI = 3.34–16.43). All models exhibited fair to excellent discrimination and satisfactory calibration. Conclusions Based on logistic regression, EMD application improved postoperative ARC, CRC and RES; baseline AERSA predicted 12-month ARC, CRC, and GT gain, whereas baseline GT was a predictor of achieving CRC and perfect RES. Clinical relevance Additional use of EMD, lower baseline AERSA, and greater baseline GT significantly increase the odds of obtaining better outcomes 12 months after MCAT + SCTG technique.
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Affiliation(s)
- Bartłomiej Górski
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland.
| | - Renata Górska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
| | - Marcin Szerszeń
- Department of Dental Prosthetics, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
| | - Tomasz Kaczyński
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
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Fernández-Jiménez A, García-De-La-Fuente AM, Estefanía-Fresco R, Marichalar-Mendia X, Aguirre-Urizar JM, Aguirre-Zorzano LA. Complete root coverage in the treatment of Miller class III or RT2 gingival recessions: a systematic review and meta-analysis. BMC Oral Health 2021; 21:145. [PMID: 33752657 PMCID: PMC7986294 DOI: 10.1186/s12903-021-01494-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background The primary objective of this systematic review and meta-analysis was to assess the evidence on complete root coverage (CRC) achieved by periodontal plastic techniques in the treatment of Miller class III/RT2 gingival recessions, comparing techniques developed along the twentieth century (pre-twenty-first) versus surgical approaches of the twenty-first century (21st). Methods An electronic bibliographic search was carried out in four databases up to December 2019, focusing on studies that reported CRC results in Miller class III or RT2 recessions treatment with at least a six-month follow-up. In addition, a random-effects models’ meta-analysis was performed for the CRC, comparing pre-twenty-first versus twenty-first century techniques at 6 months, 12 months and more than 12 months. Results Thirty-seven publications were included. A total of 933 gingival recessions were treated, 298 with pre-twenty-first century surgical techniques and 635 with techniques from the twenty-first century. CRC was achieved at 6 months on half of the recessions (pre-twenty-first: 57.60% vs. 21st: 51.11%), but decreased markedly for twenty-first century techniques at 12 months (pre-twenty-first: 63.82% vs. 21st: 32.87%). Thereafter, this difference was the other way around (> 12 months: pre-twenty-first: 5.26% vs. 21st: 19.65%). The meta-analysis showed a high heterogeneity, with no significant differences amongst the techniques. Conclusions Although CRC might be achievable by treating Miller class III or RT2 recessions with any of the described techniques, its long-term stability is not predictable. More randomized clinical trials with longer follow-ups and several visits, are needed. In addition, the patient’s satisfaction should also be assessed. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01494-3.
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Affiliation(s)
- Aitziber Fernández-Jiménez
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - Ana-María García-De-La-Fuente
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain.
| | - Ruth Estefanía-Fresco
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - Xabier Marichalar-Mendia
- Department of Nursing I, University of the Basque Country (UPV/EHU), Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - José-Manuel Aguirre-Urizar
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - Luis-Antonio Aguirre-Zorzano
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
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Fernández-Jiménez A, Estefanía-Fresco R, García-De-La-Fuente AM, Marichalar-Mendia X, Aguirre-Zorzano LA. Description of the modified vestibular incision subperiosteal tunnel access (m-VISTA) technique in the treatment of multiple Miller class III gingival recessions: a case series. BMC Oral Health 2021; 21:142. [PMID: 33743644 PMCID: PMC7981913 DOI: 10.1186/s12903-021-01511-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Gingival recession is a common finding in the adult population. It is considered a challenge for clinicians to obtain a complete root coverage of Miller class III recession. The aim of this case series was to assess the outcomes achieved with the use of modified VISTA technique (m-VISTA) in patients having multiple Miller class III recessions after 6 months. Methods Ten patients (six women and four men; mean age: 53 years), who showed multiple Miller class III recessions (depth ≥ 2 mm) and who met the established inclusion and exclusion criteria, were treated by postgraduate students with the use of m-VISTA technique. Results A total of 38 recessions were performed. The recessions were mainly located in the mandible (80%), which included six molars. The mean baseline recession was 3.12 mm. Post the intervention, a mean root coverage of 58.72% was achieved, with complete root coverage observed in 29% of the recessions. Conclusions m-VISTA may offer several advantages in the treatment of Miller class III gingival recession. Nevertheless, more clinical trials with a longer follow-up period are needed to arrive at a concrete conclusion about its advantages. Trial registration: NCT03258996. Data registration: 08/18/2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01511-5.
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Affiliation(s)
- Aitziber Fernández-Jiménez
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - Ruth Estefanía-Fresco
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
| | - Ana-María García-De-La-Fuente
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain.
| | | | - Luis-Antonio Aguirre-Zorzano
- Department of Stomatology II, University of the Basque Country (UPV/EHU), UPV/EHU. Barrio Sarriena S/N, 48940, Leioa, Biscay, Spain
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Ozcelik O, Seydaoglu G, Haytac CM. Diode laser for harvesting de-epithelialized palatal graft in the treatment of gingival recession defects: a randomized clinical trial. J Clin Periodontol 2016; 43:63-71. [PMID: 26660000 DOI: 10.1111/jcpe.12487] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 12/30/2022]
Abstract
AIMS The aim of present randomized controlled clinical study was to evaluate the effects of the use of diode laser for graft harvesting and palatal wound irradiation on post-operative morbidity and root coverage outcomes after a coronally advanced flap (CAF) with de-epithelialized gingival grafts (DGG). METHODS Fifty-two patients with isolated recessions were treated. The CTG resulted from the de-epithelialization of a free gingival graft (FGG) with blade (control group:DGG-B) or diode laser (DL) (test group:DGG-L). The DL was used to de-epithelialize the outer part of the FGG and photo-biostimulate the palatal wound area. Post-operative morbidity was evaluated by using Oral Health-related Quality of Life (OHQoL) and Visual Analogue Scale-discomfort (VAS). Root coverage outcomes were also evaluated 6 months after operation. RESULTS Statistically significant differences were found for OHQoL (p = 0.0001) and VAS (p = 0.0001) at the 7th day post-operatively favouring test sites. Root coverage results did not show a statistically significant difference. CONCLUSIONS While both techniques were effective with regard to root coverage at 6 months, the DGG-L technique decreased post-operative morbidity associated with palatal donor-site surgery.
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Affiliation(s)
- Onur Ozcelik
- Department of Periodontology, Cukurova University, Adana, Turkey
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Rizzante FAP, Maenosono RM, Duarte MAH, Furuse AY, Palma-Dibb RG, Ishikiriama SK. In Vitro Evaluation of Dentin Hydraulic Conductance After 980 nm Diode Laser Irradiation. J Periodontol 2015; 87:320-6. [PMID: 26643221 DOI: 10.1902/jop.2015.150444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Dentin hypersensitivity treatments are based on the physical obliteration of the dentinal tubules to reduce hydraulic conductance. The aim of the present study is to evaluate the hydraulic conductance of bovine root dentin after irradiation with a 980-nm diode laser, with or without associated fluoride varnish. METHODS Sixty bovine root dentin specimens were divided into six groups (n = 10 in each group): G1, G3, and G5 (0.5 W, 0.7 W, and 1 W diode laser, respectively); G2, G4, and G6 (fluoride varnish application + 0.5 W, 0.7 W, and 1 W diode laser, respectively). The dentin hydraulic conductance was evaluated at four time periods with a fluxmeter: 1) with smear layer, 2) after 37% phosphoric acid etching, 3) after the treatments, and 4) after 6% citric acid challenge. After the dentinal fluid flow measurements, specimens were also evaluated for mineral composition using energy dispersive X-ray spectroscopy (EDS). RESULTS Analysis demonstrated a better result with increased irradiation power (P < 0.001), especially if the diode laser irradiation was associated with the application of fluoride varnish (P < 0.001), ensuring a greater reduction in permeability. Considering the groups treated only with laser irradiation, the 1 W group was superior when compared with the 0.5 W and 0.7 W irradiated groups immediately after treatment (P < 0.001). After citric acid testing, all groups showed similar results, except when comparing the 1 W groups with the 0.5 W groups (P = 0.04). EDS results of the irradiated groups showed an increase in the proportion of calcium and phosphorus ions, which demonstrates a superficial composition modification after laser treatments. CONCLUSION Laser irradiation of exposed dentin promoted significant reduction in the dentin hydraulic conductance, mainly with higher energy densities and association with fluoride varnish.
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Affiliation(s)
- Fabio A P Rizzante
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Rafael M Maenosono
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marco A H Duarte
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Adilson Y Furuse
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Regina G Palma-Dibb
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo
| | - Sérgio K Ishikiriama
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
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Ozcelik O, Seydaoglu G, Haytac MC. Prediction of root coverage for single recessions in anterior teeth: a 6-month study. J Clin Periodontol 2015; 42:860-867. [PMID: 26297634 DOI: 10.1111/jcpe.12449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the predictive values of baseline inter-dental papilla height (IPH), loss of inter-dental papilla height (LPH), avascular exposed root surface area (AERSA) and inter-dental clinical attachment level (ICAL) measurements on complete root coverage (CRC) of single recession defects treated with coronally advanced flap and connective tissue graft technique (CAF+CTG). MATERIAL & METHODS A total of 122 patients with one isolated gingival recession were enrolled. All recession defects without loss of ICAL (ID-CAL) (RT1) and with an amount of ID-CAL equal or smaller to the buccal attachment loss (RT2), located at upper and lower anterior teeth were treated with CAF+CTG. IPH, LPH, AERSA and ICAL parameters were analysed for possible correlation with CRC after 6 months. RESULTS The CRC was 86.7% for RT1, 74.2% for RT2 groups. The ROC analyses revealed acceptable cut-off points for baseline AERSA, IPH and LPH for achieving CRC. The results of logistic regression analyses showed that having baseline AERSA≥19 mm(2) (OR:23.7), IPH lower ≤1 mm (OR:97.3) and belonging to RT2 group (OR:15.0) were found to be independent risk factors related with not achieving final CRC. CONCLUSION This study indicates that AERSA and IPH may be used to predict the final CRC outcomes in RT1 and RT2 defects treated with CAF+CTG.
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Affiliation(s)
- Onur Ozcelik
- Department of Periodontology, Cukurova University, Adana, Turkey
| | | | - M Cenk Haytac
- Department of Periodontology, Cukurova University, Adana, Turkey
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