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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Moscowchi A, Moradian-Lotfi S, Koohi H, Sarrafan Sadeghi T. Levels of smoking and outcome measures of root coverage procedures: a systematic review and meta-analysis. Oral Maxillofac Surg 2023:10.1007/s10006-023-01172-4. [PMID: 37528316 DOI: 10.1007/s10006-023-01172-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE This systematic review and meta-analysis was performed to investigate if there was a significant association between the number of cigarettes smoked per day and the results of root coverage procedures. METHODS Electronic search was performed through PubMed, Web of Science, Embase, and Scopus until January 2023. Studies were included if evaluated the outcomes of periodontal plastic surgery procedures for the treatment of gingival recession in smokers. Statistical evaluation was conducted using random-effects method to analyze the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CI). RESULTS From a total of 4494 references, 15 studies were considered relevant to be included in this study. The results showed that 44.39% sites had complete root coverage (CRC) at 6 months (non-smokers: 54.06%, < 10 cigarettes/day: 48%, 10-20 cigarettes/day: 19.56%, ≥ 20 cigarettes/day: 50%). Mean root coverage at 6 months were as follows: non-smokers: 74.94% ± 16.71%, < 10 cigarettes/day: 84.20% ± 2.24%, 10-20 cigarettes/day: 75.30% ± 14.69%, ≥ 20 cigarettes/day: 68.75% ± 26.51%. A significant difference was revealed between non-smokers and individuals who smoked 10-20 cigarettes/day in terms of CRC at 6 months: OR = 0.15 (95% CI = 0.03 to 0.71; P = .017). However, no significant difference was detected comparing 10-20 and ≥ 20 cigarettes/day. CONCLUSION As there was not enough data available, any definitive conclusions about the connection between an increase in the amount of cigarettes consumed per day and the results of root coverage procedures could not be reached. Further research is required with comparative studies involving individuals who smoke varying numbers of cigarettes.
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Affiliation(s)
- Anahita Moscowchi
- Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Evin, Shahid Chamran Highway, Tehran, 1983963113, Iran
| | - Shima Moradian-Lotfi
- Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Evin, Shahid Chamran Highway, Tehran, 1983963113, Iran
| | - Hediye Koohi
- Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Evin, Shahid Chamran Highway, Tehran, 1983963113, Iran
| | - Termeh Sarrafan Sadeghi
- Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Evin, Shahid Chamran Highway, Tehran, 1983963113, Iran.
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Pereira MA, Medikeri RS, Waingade M. A split-mouth randomised controlled trial comparing the clinical effects of MVISTA with chorion membrane or connective tissue graft in multiple gingival recessions. Saudi Dent J 2023; 35:178-184. [PMID: 36942199 PMCID: PMC10024102 DOI: 10.1016/j.sdentj.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023] Open
Abstract
Objectives Modified form of VISTA (MVISTA), a novel surgical procedure, aims at comprehensive root coverage that maintains the inner continuity of the periosteum and papilla. This technique incorporates any regenerative graft material within the tunnel. The objective of study is to compare the MVISTA for treating multiple adjacent gingival recessions and chorion membranes or grafts of connective tissues. Materials and methods This is a split-mouth type randomized trial. In this trial total of 18 patients were considered. The patients in this trial had multiple adjacent, gingival recessions of Miller's Classes I/II, and they were randomized to either the MVISTA with chorion membrane (test) or connective tissue graft (CTG) (control) group. A baseline and one year after surgery were considered for recording to mean root coverage (MRC), complete root coverage (CRC), and clinical periodontal parameters. An intragroup comparison was made. Results The intragroup comparison of recession depth baseline and 12 months after-surgery record found a significant difference between the two groups (P = 0.00). In the postoperative condition, the depth of recession reduction was higher in the test group than in the control group. However, from a statistical perspective, the difference was insignificant (P > 0.05). At the end of the year, it was found that the width of the keratinized tissue had increased significantly (P < 0.05). The MRC in the test group was significantly higher (91.33 %±8.17 %) than that in the control group (89.46 %±11.22 %) (P > 000). At the end of 1 year, the test group showed 66.67 % CRC compared to 44.44 % in the control group. The gingival phenotype displayed statistically significant improvement in the test group (p = 0.004). PD and CAL showed statistically nonsignificant outcomes (P > 0.05). Conclusions As far as multiple adjacent gingival recession treatment is concerned, MVISTA with chorion membrane treatment enhanced the gingival phenotype, restored complete root coverage (66.6%), and increased the width of keratinized tissue. CTG and CM demonstrated good root coverage results; the latter might be used as a substitute graft to treat multiple recessions.
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Affiliation(s)
| | - Raghavendra S. Medikeri
- Department of Periodontology, Sinhgad Dental College and Hospital, Pune, India
- Corresponding author at: Professor, Department of Periodontology, Sinhgad Dental College and Hospital, S. no: 44/1, Vadgaon (Bk.), Off Sinhgad road, Pune 411041, Maharashtra, India.
| | - Manjushri Waingade
- Department of Oral Medicine & Radiology, Sinhgad Dental College and Hospital, Pune, India
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Maity S, Priyadharshini V. Comparison of chorion allograft and subepithelial connective tissue autograft in the treatment of gingival recession- A randomized controlled clinical trial. J Oral Biol Craniofac Res 2023; 13:104-10. [PMID: 36578557 DOI: 10.1016/j.jobcr.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/03/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Background To compare the clinical outcomes of subepithelial connective tissue graft and chorion membrane along with coronally advanced flap in the treatment of gingival recession. Methods A total of 12 patients with 24 sites showing isolated bilateral Miller's class I and II gingival recessions were randomly allocated into two treatment sites. One site, connective tissue graft, (n = 12 sites) while on the contra-lateral site, chorion membrane (n = 12 sites) was used with coronally advanced flap. Clinical parameters: probing depth, recession depth, recession width, width of keratinized gingiva, relative attachment level, thickness of keratinized gingiva were recorded at the baseline, 3 months, and 6 months. The amount of root coverage was evaluated after 6 months. Results Statistically significant differences were observed between test and control sites in terms of recession depth, recession width, width of keratinized gingiva and thickness of keratinized gingiva at 6 months. The test sites presented 66.17 ± 18.85% and the control site showed 87.17 ± 18.33% of root coverage at 6 months. Conclusion Very limited amount of recession coverage with chorion membrane and did not serve as an alternative to connective tissue graft. Trial registration CTRI/2017/12/010964.
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Xie C, Liu Y, Yu H, Mei J. Root coverage of a maxillary lateral incisor with gingival recession, gingival stillman's cleft, bony exostosis, and denture stomatitis: a case report with 3-year follow-up. BMC Oral Health 2022; 22:39. [PMID: 35148727 PMCID: PMC8832819 DOI: 10.1186/s12903-022-02068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Coronally advanced flap combined with connective tissue graft is considered as the golden standard of root coverage. Although Miller class I recession is considered to get complete root coverage, there are some uncommon conditions in different cases. This case reported a maxillary lateral incisor with a gingival recession, a stillman’s cleft, a bony exostosis and a denture stomatitis. Case presentation A 27-year-old female with a gingival recession, a stillman’s cleft and a bony exostosis was treated by coronally advanced flap combined with connective tissue graft technique, and the complete coverage was achieved. Later a denture stomatitis occurred when an acrylic removable partial denture was used, however the gingival margin was not affected. The denture stomatitis disappeared when a new denture with casting palatal plane was produced. In this case of 3-year follow-up, the gingival contour remained stable and the outcome was satisfactory. Conclusion Coronally advanced flap combined with connective tissue graft technique is a classic manner to treat gingival recession especially for a long term stability, even when there is a gingival stillman’s cleft, a bony exostosis and a denture stomatitis.
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Affiliation(s)
- Chengjie Xie
- Department of Periodontics, Stomatological Hospital, Southern Medical University, 366 JiangNan Avenue South, Guangzhou, 510280, China.
| | - Yeungyeung Liu
- Department of Periodontics, Stomatological Hospital, Southern Medical University, 366 JiangNan Avenue South, Guangzhou, 510280, China
| | - Huimin Yu
- Department of Periodontics, Stomatological Hospital, Southern Medical University, 366 JiangNan Avenue South, Guangzhou, 510280, China
| | - Jie Mei
- Department of Periodontics, Stomatological Hospital, Southern Medical University, 366 JiangNan Avenue South, Guangzhou, 510280, China
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Turer OU, Ozcan M, Alkaya B, Seydaoglu G, SelenYildiz H, Haytac MC. The effects of connective tissue graft position on clinical and aesthetical outcomes of gingival recession treatment: a controlled randomized clinical trial. Clin Oral Investig 2021. [PMID: 34820724 DOI: 10.1007/s00784-021-04250-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This randomized controlled clinical trial with 1-year follow-up compared the clinical and aesthetic results of coronally advanced flap (CAF) + connective tissue graft (CTG) positioned apical to the cemento-enamel junction (CEJ) (CAF + CTG-ACEJ) with CAF + CTG positioned on the CEJ (CAF + CTG-CEJ) for treating isolated gingival recession defects. MATERIALS AND METHODS Thirty-eight patients with recession type 1 (RT 1) with a depth ≥ 3, gingival recessions were enrolled. Nineteen patients were randomly assigned to the CAF + CTG-ACEJ group or CAF + CTG-CEJ group. Clinical and aesthetical evaluations were made at 6 and 12 months. RESULTS While the 6 months results showed that both surgical techniques were similar for clinical outcomes, the results achieved at the 6th month were more stable in the CAF + CTG-ACEJ group at the 12th month with significantly better recession depth, mean, and complete root coverage values and aesthetical results. CONCLUSIONS Isolated gingival recession defects can be clinically successfully treated by both CAF + CTG-ACEJ and CAF + CTG-CEJ techniques. CLINICAL RELEVANCE Limited studies have compared the clinical and aesthetical effects of positioning CTG apical to the CEJ for the treatment of gingival recessions. This randomized clinical study showed that CAF + CTG-ACEJ technique can provide additional benefit for the treatment. The described technique is effective in obtaining better long-term CRC stability and aesthetics.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Dias AT, de Menezes CC, Kahn S, Fischer RG, da Silva Figueredo CM, Fernandes GVO. Gingival recession treatment with enamel matrix derivative associated with coronally advanced flap and subepithelial connective tissue graft: a split-mouth randomized controlled clinical trial with molecular evaluation. Clin Oral Investig 2021. [PMID: 34536136 DOI: 10.1007/s00784-021-04119-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The goal of this study was to evaluate the impact of enamel matrix derivative (EMD) on periodontal healing after root coverage (RC) surgery, involving CAF in combination with SCTG, and to assess the molecular profile, verifying the inflammation level in early stage (1 and 2 weeks). MATERIALS AND METHODS Thirty-two recessions (RT1) were submitted to periodontal surgery with (test) or without (control) EMD. The clinical parameters analyzed on the day of surgery and 6 months after the surgical procedure were as follows: recession height and width, keratinized tissue height, percentual root coverage, and the gingival thickness of keratinized tissue. Moreover, the main inflammatory biomarkers and growth factors (IL-1β, IL-6, IL-8, FGF, MIP-1α and β, PDGF, TNF-α, and VEGF) were evaluated at baseline, 7, and 14 days after procedures. RESULTS The average root coverage was significantly higher in the test group as compared to the control group (86% vs. 66%, p = 0.008). The test side had significantly lesser final RH compared to the control side (p = 0.01). Also, there was a significant reduction of RW in both groups, with more significant results in the test group. KTH and GT were not significantly different at any time and group. After 14 days, the immunological analysis showed an increase of VEGF (p = 0.03) on the test group compared to the control side. CONCLUSION The use of EMD in RC surgeries resulted in a significantly higher RC, as well as a significant increase in VEGF expression, suggesting that EMD may contribute to the angiogenic and healing process. CLINICAL RELEVANCE EMD provided better results in root coverage treatment when associated with CAF and SCTG, beyond a greater releasing of angiogenic growth factor (VEGF), which enhanced the result.
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Ramos UD, Bastos GF, Costa CA, de Souza SLS, Taba M, Novaes AB. Root coverage with tunneling technique or modified advanced flap associated with acellular dermal matrix: results from 6 months randomized clinical trial. Clin Oral Investig 2021; 26:773-780. [PMID: 34363104 DOI: 10.1007/s00784-021-04055-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study compared two surgical techniques using acellular dermal matrix (ADM) for the treatment of multiple gingival recessions. MATERIAL AND METHODS Twenty patients, with bilateral RT1 gingival recessions, were selected. One side received a modified extended coronally advanced flap (MECAF), and the contralateral side a supra-periosteal flap (TUN). The evaluated parameters were probing depth (PD), relative clinical attachment level, gingival index, gingival recession height (GR), width of keratinized tissue, keratinized tissue thickness, and gingival recession area at baseline and 6 months postoperative. Pain was evaluated weekly, using a visual analog scale (VAS) during first month postoperative. RESULTS Both groups were effective in reducing GR (ΔGR: MECAF 2.28 mm; TUN 1.93 mm), without significant differences. The % of root coverage was numerically superior favoring MECAF (MECAF 61.24%; TUN 56.07%), without significant differences between groups. VAS scale failed to provide differences between groups. CONCLUSIONS Both treatment were effective in root coverage and might be valuable for the treatment of multiple gingival recessions. The use of vertical releasing incisions and a flap design including the papillae did not hamper root coverage. CLINICAL RELEVANCE This study compared two techniques for use of ADM in large multiple gingival recessions. Within its limitations, both treatments successfully achieved root coverage and were able to reduce gingival recession. It is expected a partial root coverage when using these techniques in large gingival recessions. The study failed to provide significant differences between groups. The use of modified extended coronally advanced flap may be advisable for the treatment of multiple gingival recessions, specially involving large defects when using ADM, to avoid early matrix exposure.
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Affiliation(s)
- Umberto D Ramos
- School of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Gabriel F Bastos
- School of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil.
| | - Camila A Costa
- School of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Sergio L S de Souza
- School of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Mario Taba
- School of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Arthur B Novaes
- School of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
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Mostafa D, Mandil OA. Treatment of gingival recession defects using non-invasive pinhole technique with propolis application, a case report. Int J Surg Case Rep 2021; 83:106042. [PMID: 34090198 PMCID: PMC8188386 DOI: 10.1016/j.ijscr.2021.106042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/18/2021] [Accepted: 05/21/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction and importance Despite the considerable surgical techniques that have been done for the root coverage, surgical difficulties, time, and patients' discomfort are still the main obstacles. However, the morbidity associated with the secondary graft sites has generated interest in new modalities to achieve the esthetic and functional requirements without complications, to reach patient comfort and satisfaction. In our study, we used a recent novel surgical technique which is called the pinhole surgical technique as it is a minimally invasive treatment that reverses gingival recession without using donor graft, flap elevation, or sutures. In this study, we also used propolis for root conditioning as it is a natural anti-infective, anti-inflammatory, and anti-oxidant agent. Presentation of the case A 58-year-old systemically healthy female patient was referred to our periodontal clinics for the root coverage of the upper left canine and the first premolar which were diagnosed as Class II and Class I Miller's classification respectively. A pinhole surgical technique was done using propolis for root conditioning. A pinhole was created and the gingiva was pushed downwards until reaching the desired position coronally with the aid of collagen strips. Then, propolis was applied again postoperatively to enhance healing. Clinical discussion Pinhole surgical technique can immediately cover exposed roots without incisions, donor site or flap reflection. In addition, the use of propolis in root conditioning showed positive results. This is due to its antioxidant and anti-inflammatory effects. Conclusion Pinhole surgical technique using propolis is a promising modality that reaches the periodontist ambition for gingival recession defects. Pinhole surgical technique is considered as an effective alternative treatment for root coverage without the need for incisions, scalpel and donor site. In our case report, propolis was used as a natural antioxidant and antibacterial material in a novel protocol for root conditioning during root coverage procedure resulting postive outcomes. Topical application of propolis can be added to any oral surgical protocol to enhance healing capacity and minimize postoperative complications.
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Affiliation(s)
- Diana Mostafa
- Periodontology and Oral Medicine Department. Alexandria University, Faculty of Dentistry, Egypt; Preventive Dental Sciences, Vision Colleges, Riyadh, Saudi Arabia.
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Maluta R, Monteiro MF, Peruzzo DC, Joly JC. Root coverage of multiple gingival recessions treated with coronally advanced flap associated with xenogeneic acellular dermal matrix or connective tissue graft: a 6-month split-mouth controlled and randomized clinical trial. Clin Oral Investig 2021. [PMID: 33723662 DOI: 10.1007/s00784-021-03879-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aimed to compare xenogeneic dermal matrix (XDM) to connective tissue graft (CTG) associated with coronally advanced flap (CAF) in treating Miller's class I and II (RT1) multiple gingival recession in a split-mouth randomized clinical trial. MATERIALS AND METHODS Fifteen patients with bilateral Miller's class I and II multiple recessions were selected. The patient's side receiving each treatment was randomly allocated to receive XDM or CTG. The clinical parameters were measured at baseline and 6 months of follow-up. RESULTS At 6 months, no significant difference in the root coverage (RC) (95.28 ± 6.89% for CTG and 92.68 ± 7.35% for XDM) and the keratinized tissue (KT) gain (0.91 ± 0.46 mm for CTG and 0.74 ± 0.39 mm for XDM) was observed between groups (p > 0.05). The CTG group presented higher complete root coverage (CRC) than XDM (60% and 33%, respectively) (p = 0.045). Multiple logistic regression indicated that the XDM (p = 0.01) and the XDM and KT interaction (p = 0.02) negatively interfered in the CRC. A 1-mm increase in the baseline KT when using XDM increases almost 6 times the chance of achieving CRC, and XDM reached a similar CRC probability to CTG when the receptor area presented at least 2 mm of KT. CONCLUSIONS Both treatments were effective for treating multiple gingival recession; similar KT gain, GR reduction, and RC were obtained for CTG and XDM, while CTG promoted higher CRC than XDM. Moreover, the amount of KT at baseline was determinant for CRC when treating multiple gingival recession with XDM. CLINICAL RELEVANCE XDM produces limited CRC in sites with a reduced amount of KT. TRIAL REGISTRATION Brazilian Clinical Trials Registry (REBEC) number RBR-56NZQ6.
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Belludi SA, Singhal L, Gubbala M. Peripheral Blood Mesenchymal Stem Cells and Platelet Rich Fibrin Matrix in the Management of Class II Gingival Recession: A Case Report. J Dent (Shiraz) 2021; 22:67-70. [PMID: 33681425 PMCID: PMC7921769 DOI: 10.30476/dentjods.2020.81784.0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The treatment of gingival recession is a frequent demand due to aesthetic concern, root caries, and /or root hypersensitivity. The purpose of this case study was to evaluate the success and predictability of coronally advanced flap (CAF) in combination with peripheral blood mesenchymal stem cells (PBMSCs) and platelet rich fibrin matrix(PRFM) for the management of Miller's Class II gingival recession. CAF followed by placement of PBMSCs and PRFM was performed on a male patient, aged 25 years having Miller’s Class II gingival recession of 5-6 mm on the upper left canine, premolars and molars. The patient was followed up for 3 months. Root coverage of 60.0% and clinical attachment gain of 3 mm were evident following 3 months of follow-up. This novel technique showed an effective way to increase the width of attached gingiva and treat gingival recession.
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Affiliation(s)
- Sphoorthi Anup Belludi
- Dept. of Periodontics, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Laveena Singhal
- Dept. of Periodontics, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Madhuri Gubbala
- Dept. of Periodontics, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
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13
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Nisha S, Shashikumar P. Periosteal pedicle graft with coronally advanced flap and its comparison with modified coronally advanced flap in the treatment of multiple adjacent gingival recessions-a randomized clinical trial. J Oral Biol Craniofac Res 2021; 11:99-106. [PMID: 33532194 DOI: 10.1016/j.jobcr.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/01/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022] Open
Abstract
The present study aimed at evaluating clinical utility of periosteal pedicle graft with coronally advanced flap (PPG + CAF) vs modified coronally advanced flap (M-CAF) in cases of multiple adjacent gingival recessions involving maxillary and mandibular anteriors labially. Random allocation of 40 patients with 269 gingival recessions was done into two groups. In Test group (20 patients) periosteal pedicle graft followed by coronally advanced flap (PPG + CAF) technique was performed and in control group (20 patients) modified coronally advanced flap (M-CAF) was attempted. Primary outcome measures included percentage root coverage (PRC), gingival thickness (GT), probing depth (PD), clinical attachment level (CAL), recession depth (RD) and width of keratinized gingiva (WKG). Secondary outcomes measures were patient centred outcomes, plaque index (PI) and gingival index (GI). Patients were recalled at baseline, 3,6 and 18 months postoperatively. Results There was a significant decrease in the mean recession depth from 3.58 ± 0.53 mm (baseline) to 0.22 ± 0.01 mm (18 months) in PPG + CAF test group and 3.7 ± 0.56 mm (baseline) to 0.21 ± 0.01 mm (18 months) in M-CAF control group. With 85% root coverage in test group and 78% root coverage in control group, the difference was statistically significant at 18 months. The test group showed significant higher clinical attachment level gain and increase in width of keratinized gingiva as compared to control group. Conclusion In both the study groups PPG + CAF and M-CAF, significant root coverage was achieved. However, in terms of increase in width of keratinized gingiva, gingival thickness and percentage root coverage, PPG + CAF group presented significantly better results than M-CAF group at 18 months follow up. Thus, periosteum can be used as a pedicle graft along with coronally advanced flap as an alternative method in achieving better results with minimal cost.
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Affiliation(s)
- Swet Nisha
- Department of Periodontology, JSS Dental College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
| | - Pratibha Shashikumar
- Department of Periodontology, JSS Dental College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
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Tattan M, Moore KS, Chambrone L, Avila-Ortiz G, Elangovan S. Degree of Risk of Bias in Randomized Controlled Trials: Does It Have an Impact on Root Coverage Outcomes? J Evid Based Dent Pract 2021; 21:101526. [PMID: 34051960 DOI: 10.1016/j.jebdp.2021.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/30/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Improvement over time in mean (MRC) and complete root coverage (CRC) reported in randomized controlled trials (RCTs) has been documented. Our objective was to assess the effect that the ROB has on relevant outcomes reported in RCTs evaluating the efficacy of a commonly performed root coverage procedure. METHODS RCTs that involved the use of a bilaminar technique of coronally advanced flap with connective tissue graft were selected. The following data were extracted: MRC, CRC, whether conflict of interest was addressed (yes/no), adequacy of random sequence generation, allocation concealment, and blinding of outcome assessment. Trials were categorized into four groups as per different time periods: before Consolidated Standards of Reporting Trials (CONSORT) (before 1996), CONSORT (1997 to 2001), CONSORT 2001 (2002 to 2010), and CONSORT 2010 (2011 to 2019). Differences between group means were assessed using statistical analyses. RESULTS The search yielded a total of 47 RCTs published between 1993 and 2019 that met the inclusion criteria. A trend toward lower ROB over time in the selected RCTs was observed. However, differences in MRC and CRC with respect to the degree ROB of included trials were not significant. CONCLUSIONS Degree of ROB did not influence MRC and CRC reported in the RCTs included in this investigation. This finding suggests that the observed improvement of clinical outcomes over time should be attributed to other factors, such as refinement of surgical techniques.
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Affiliation(s)
- Mustafa Tattan
- Department of Periodontics, The University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Katherine S Moore
- Dental Student, The University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Leandro Chambrone
- Department of Periodontics, The University of Iowa College of Dentistry, Iowa City, IA, USA; Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal; Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogota, Colombia
| | - Gustavo Avila-Ortiz
- Department of Periodontics, The University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Satheesh Elangovan
- Department of Periodontics, The University of Iowa College of Dentistry, Iowa City, IA, USA.
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15
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Konflanz W, Orth CC, Celeste RK, Muniz FWMG, Haas AN. Influence of Donor Site and Harvesting Technique of Connective Tissue Graft on Root Coverage Outcomes of Single Gingival Recessions: Systematic Review and Meta-analyses. J Int Acad Periodontol 2021; 23:79-98. [PMID: 33512344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To compare the outcomes of root coverage when the (1) donor site of connective tissue graft is the palate or tuberosity and (2) when connective tissue graft is harvested with intra- or extra-oral de-epithelization techniques. METHODS The primary outcome was patient satisfaction. Secondary outcomes included complete root coverage, percentage of root coverage and keratinized tissue width. Searches were conducted until December 2019 in PubMed, EMBASE, Scopus and CENTRAL. RESULTS 3275 studies were retrieved, but no randomized trials (randomized controlled trials) were found comparing tuberosity and palate. Data were extracted for one arm assessing any connective tissue graft technique from 56 randomized controlled trials to compare intra-oral de-epithelization and extra-oral de-epithelization outcomes. Among these studies, none have harvested connective tissue graft from tuberosity. Patient satisfaction for intra-oral de-epithelization and extra-oral de-epithelization ranged between 79% and 95%. Complete root coverage for intra-oral de-epithelization and extra-oral de-epithelization techniques was 55% (95%CI 46-65) and 70% (95%CI 63-77). Metaregression analyzes demonstrated that free gingival graft presented 4.41 higher chance of CRC [odds ratio (OR)=4.41, p=0.001] compared to single incision technique, followed by Bruno's (OR=4.39) and double-blade (OR=3.85) techniques. There were no differences between de-epithelization techniques for percentage of root coverage and keratinized tissue width. CONCLUSION No evidence was found to support the use of connective tissue grafts from the tuberosity. If complete root coverage is the major clinical goal, extra-oral deepithelization may be preferred over intra-oral de-epithelization techniques.
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Affiliation(s)
- Willian Konflanz
- Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Cassio Cardona Orth
- Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil and Instituto Implanteperio, São Paulo, Brazil
| | - Roger Keller Celeste
- Department of Preventive and Social Denstitry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Alex Nogueira Haas
- Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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16
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Imamura K, Mashimo Y, Saito A. Root Coverage with Connective Tissue Graft in Patients with Thin Periodontal Biotype: A Case Series with 12-month Follow-up. Bull Tokyo Dent Coll 2020; 61:221-229. [PMID: 33177270 DOI: 10.2209/tdcpublication.2020-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Preoperative gingival thickness is an important factor in the success of complete root coverage. Here, two cases are reported in which a biotype probe was used to assess the periodontal biotype before performance of a root coverage procedure. Clinical examinations were performed at baseline and at 3, 6, and 12 months postoperatively. The following clinical parameters were evaluated: probing depth, recession height, clinical attachment level, bleeding on probing, and width of keratinized gingiva. At baseline and at 12 months postoperatively, periodontal biotype was estimated using the biotype probe. The root coverage esthetic score was assessed to determine esthetic outcome at baseline and at 3, 6, and 12 months postoperatively. The periodontal biotypes in the mandibular central and lateral incisors were judged to be thin. These teeth presented with Miller Class II gingival recession after orthodontic therapy. Gingival recession was treated with a coronally advanced flap and autogenous connective tissue graft. In both cases, improvements in all clinical parameters and root coverage esthetic scores were evaluated at 3, 6, and 12 months postoperatively. The treated recession showed 100% root coverage. The periodontal biotype changed from one that was thin to one that was thick at the surgical sites. In both the present cases, objective preoperative assessment of the periodontal biotype allowed the appropriate surgical procedure to be selected.
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Affiliation(s)
| | - Yuko Mashimo
- Department of Periodontology, Tokyo Dental College
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17
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de Carvalho Formiga M, Nagasawa MA, Moraschini V, Ata-Ali J, Sculean A, Shibli JA. Clinical efficacy of xenogeneic and allogeneic 3D matrix in the management of gingival recession: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:2229-2245. [PMID: 32519234 DOI: 10.1007/s00784-020-03370-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/21/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVE A systematic review and meta-analysis was thus conducted to answer the following focused question based on PICO strategy: Is there any 3D matrix biomaterial used for root coverage of human Miller class I and II defects equivalent with the connective tissue graft in localized defects of at least 2 mm and 3 mm? MATERIAL AND METHODS The search on electronic database included MEDLINE, Cochrane Central Register of Controlled Trials, Clinical Trials.gov, Web of Science, and New Zealand/Australian Clinical Trials. Only randomized clinical trials (RCTs) that compared connective tissue graft (CTG) with at least one 3D matrix alone for root coverage in Class I and II Miller localized defects of at least 2 mm, with at least 6 months follow-up, were included in this systematic review. RESULTS A total of 14 studies were included for meta-analysis (12 compared CTG with acellular dermal matrix allograft and 2 compared CTG with Xenogenic Collagen Matrix). Relative root coverage showed no significant difference among the materials, for either 2 or 3 mm minimal recessions. For keratinized tissue width, on 2 mm recessions, CTG showed superiority above other biomaterials, but on 3 mm recessions, it seemed to have the same results. The percentage of recessions with complete root coverage for both 2 and 3 mm recessions showed similar results for all biomaterials. CONCLUSIONS With their limits, the present data concluded that CTG, acellular dermal matrix allograft, and xenogenic collagen matrix provided similar results for root coverage. CLINICAL RELEVANCE To know if there is a 3D matrix with equivalent predictable results for root coverage, that we could avoid the morbidity of the connective tissue graft for these cases.
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Affiliation(s)
- Márcio de Carvalho Formiga
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Guarulhos, Sao Paulo, Brazil
| | - Magda Aline Nagasawa
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Guarulhos, Sao Paulo, Brazil
| | - Vittorio Moraschini
- Department of Periodontology, Fluminense Federal University, Rio de Janeiro, Brazil.,Department of Periodontology, Denta Research Division, School of Dentistry, Veiga de Almeida Univewristy, Rua Ibiturana, 108, Maracanã, Rio de Janeiro, Brazil
| | - Javier Ata-Ali
- Department of Dentistry, Faculty of Health Sciences, Universidad Europea de Valencia, Valencia, Spain
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jamil Awad Shibli
- Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, Guarulhos, Sao Paulo, Brazil.
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Al-Hamdan K. Long-term predictability of allogenic dermal matrix for root coverage: Three years observation period on 15 consecutive cases. Saudi Dent J 2021; 33:99-104. [PMID: 33551623 DOI: 10.1016/j.sdentj.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/05/2020] [Indexed: 11/23/2022] Open
Abstract
Gingival recession is an apical migration of gingival margin that is a common finding on patients with meticulous oral hygiene and periodontitis patients. Several surgical treatment techniques of gingival recession have been described. The most challenging situation is the presence of multiple adjacent recession defects. 15 patients with total of 53 recession defects have been treated with Acellular Dermal Matrix (ADM). The following clinical parameters were evaluated recession depth (RD), probing depth (PD); and the width of the keratinized tissue (KT). Upon completion of the study; there was statistically significant (P-value = 0.00) reduction in recession depth from baseline, one and three years after the surgery (2.6 mm, 0.32 mm, and 0.17 mm, respectively). There was statistically significant (P-value = 0.00) increase in the width of keratinized tissue from baseline to one year and three years (3.47 mm, 5.02 mm, and 5.40 mm, respectively). Based on this study the use of ADM with the coronally advanced flap resulted in a significant increase in keratinized tissue and percentage of root surface coverage.
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19
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Shkreta M, Atanasovska-Stojanovska A, Dollaku B, Belazelkoska Z. Exploring the Gingival Recession Surgical Treatment Modalities: A Literature Review. Open Access Maced J Med Sci 2018; 6:698-708. [PMID: 29731944 PMCID: PMC5927507 DOI: 10.3889/oamjms.2018.185] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 12/01/2022] Open
Abstract
Gingival recessions present complex soft tissue pathology, with a multiple aetiology and a high prevalence which increases with age. They are defined as an exposure of the root surface of the teeth as a result of the apical migration of the gingival margin beyond the cementum-enamel junction, causing functional and aesthetic disturbances to the affected individuals. Aiming to ensure complete root coverage and satisfying aesthetic outcomes, a wide range of surgical techniques have been proposed through the decades for the treatment of the gingival recessions. The following literature review attempts to provide a comprehensive, structured and up-to-date summary of the relevant literature regarding these surgical techniques, aiming to emphasise for each technique its indications, its long-term success and predictability, its advantages and disadvantages about each other.
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Affiliation(s)
- Mirsad Shkreta
- Department of Oral Pathology and Periodontology, Dental Clinical Center, Faculty of Stomatology, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Aneta Atanasovska-Stojanovska
- Department of Oral Pathology and Periodontology, Dental Clinical Center, Faculty of Stomatology, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Blerta Dollaku
- Department of Restorative Dentistry and Endodontics, Faculty of Dentistry, University “Hasan Prishtina”, Prishtina, Kosovo
| | - Zlatanka Belazelkoska
- Department of Oral Pathology and Periodontology, Dental Clinical Center, Faculty of Stomatology, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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20
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Agossa K, Godel G, Dubar M, S Y K, Behin P, Delcourt-Debruyne E. Does Evidence Support a Combined Restorative Surgical Approach for the Treatment of Gingival Recessions Associated With Noncarious Cervical Lesions? J Evid Based Dent Pract 2017; 17:226-238. [PMID: 28865819 DOI: 10.1016/j.jebdp.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Gingival recessions are frequently associated with noncarious cervical lesions. Combined restorative surgical approaches have been suggested for the management of these combined defects. The aim of this review was to analyze the current evidence on the effectiveness of these combined restorative surgical approaches. METHODS A systematic review of randomized controlled studies published from January 2006 to June 2016 was performed. RESULTS Ten articles comparing combined restorative surgical approaches to surgery alone were included. Both the procedures showed similar outcomes in term of root coverage but the combined restorative surgical approach achieved better result in the reduction of dentin hypersensitivity. In combined restorative surgical treatments, resin-modified glass ionomers showed better antimicrobial properties but poorer esthetic outcome than resin composites. CONCLUSION Data to support or refute definitely the interest of combined approaches for the treatment of gingival recessions associated with noncarious cervical lesions are limited.
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Affiliation(s)
- Kevimy Agossa
- Univ. Lille, Inserm, CHU Lille, U1008, Controlled Drug Delivery Systems and Biomaterials, Lille, France; Department of Periodontology, School of Dentistry, University of Lille, Lille, France.
| | | | - Marie Dubar
- Department of Periodontology, Lorraine University, Nancy, France
| | - Kadiatou S Y
- Department of Restorative Dentistry and Endodontics, School of Dentistry, University of Lille, Lille, France
| | - Pascal Behin
- Department of Prosthodontics, School of Dentistry, University of Lille, Lille, France
| | - Elisabeth Delcourt-Debruyne
- Univ. Lille, Inserm, CHU Lille, U1008, Controlled Drug Delivery Systems and Biomaterials, Lille, France; Department of Periodontology, School of Dentistry, University of Lille, Lille, France
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21
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Moreira ARO, Santamaria MP, Silvério KG, Casati MZ, Nociti Junior FH, Sculean A, Sallum EA. Coronally advanced flap with or without porcine collagen matrix for root coverage: a randomized clinical trial. Clin Oral Investig 2016; 20:2539-49. [PMID: 26917493 DOI: 10.1007/s00784-016-1757-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 02/16/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The objective of this study is to clinically evaluate the outcomes following treatment of single gingival recessions with either coronally advanced flap technique (CAF) alone or combined with a porcine collagen matrix graft (CM). MATERIALS AND METHODS This is a randomized parallel design clinical trial, including forty patients with single Miller Class I or II gingival recession, with a depth ≥ 2 mm and located at upper canines or premolars. The patients were randomly assigned to receive either CAF or CAF + CM. The primary outcome variable was gingival recession reduction (Rec Red). RESULTS Baseline recession depth was 3.14 ± 0.51 mm for CAF group and 3.16 ± 0.65 mm for CAF + CM group (p > 0.05). Both groups showed significant Rec Red (p < 0.05), up to 6 months. Rec Red for CAF + CM was 2.41 ± 0.73 mm and was 2.25 ± 0.50 mm for CAF alone (p > 0.05). Root coverage was 77.2 % in the CAF + CM group and 72.1 % in the CAF group (p > 0.05). Complete root coverage (CRC) was found in 40 % of the cases in the CAF + CM group and in 35 % of the sites treated with CAF. Keratinized tissue thickness (KTT) was 0.26 mm higher in CAF + CM group (p < 0.05). CONCLUSIONS It can be concluded that CAF + CM does not provide a superior recession reduction when compared to CAF; however, it may offer a small gain in KTT after 6 months. CLINICAL RELEVANCE CAF + CM can be suggested as a valid therapeutic option to achieve root coverage and some increase in soft tissue thickness after 6 months.
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22
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Abstract
We report a case of gingival recession in the mandibular incisor region requiring a connective tissue graft. The patient was a 17-year-old girl who visited the Tokyo Dental College Chiba Hospital in 2014 with the chief complaint of gingival recession in the lower incisor region. She had received orthodontic treatment for 5 years and noticed the gingival recession on completion of active orthodontic treatment in 2013. Gingival recession in tooth #31 extended 3 mm beyond the muco-gingival junction (MGJ) and was clinically diagnosed as Miller Class II recession; probing depth was 6 mm. Following initial periodontal therapy, a connective tissue graft procedure was implemented. The connective tissue was harvested from the left palate. Healing was uneventful, and the grafted site showed a favorable outcome at 6 months postoperatively. We are continuing to carefully monitor the condition of periodontal tissue.
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Affiliation(s)
| | - Satoru Inagaki
- Department of Microbiology, Tokyo Dental College.,Inagaki Dental Clinic
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23
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Shirakata Y, Sculean A, Shinohara Y, Sena K, Takeuchi N, Bosshardt DD, Noguchi K. Healing of localized gingival recessions treated with a coronally advanced flap alone or combined with an enamel matrix derivative and a porcine acellular dermal matrix: a preclinical study. Clin Oral Investig 2015; 20:1791-800. [PMID: 26612398 DOI: 10.1007/s00784-015-1680-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effects of a porcine acellular dermal matrix (PADM) with or without an enamel matrix derivative (EMD) on gingival recession defects treated with a coronally advanced flap (CAF) in dogs. MATERIALS AND METHODS Miller class II gingival recession defects (5 mm wide and 7 mm deep) were surgically created on the labial side of bilateral maxillary canines in 12 dogs. After 8 weeks of plaque accumulation, the 24 chronic defects were randomly assigned to one of the following 4 treatments: CAF, CAF with PADM (CAF/PADM), CAF with EMD (CAF/EMD), and CAF with EMD and PADM (CAF/EMD/PADM). The animals were sacrificed 10 weeks after surgery for histologic evaluation. RESULTS In all groups, root coverage was obtained to a varying degree. PADM was well incorporated in gingival connective tissue in the CAF/PADM and in the CAF/EMD/PADM groups. The height of newly formed bone was significantly greater in the CAF/EMD/PADM group than in the CAF and CAF/PADM groups. New cementum with periodontal ligament-like tissue was predominantly found in the CAF/EMD and CAF/EMD/PADM groups. The CAF/EMD/PADM group showed the greatest amount of new cementum among the groups examined, although the difference was not statistically significant. CONCLUSION Within the limitations of the present study, it can be concluded that CAF/EMD/PADM treatment may promote periodontal regeneration in gingival recession defects. CLINICAL RELEVANCE The present results suggest that the combination of EMD and PADM in conjunction with CAF may represent a promising approach for treating single Miller class II gingival recessions.
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Affiliation(s)
- Y Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan.
| | - A Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Y Shinohara
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - K Sena
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - N Takeuchi
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - D D Bosshardt
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - K Noguchi
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
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Chakraborthy S, Sambashivaiah S, Kulal R, Bilchodmath S. Amnion and Chorion Allografts in Combination with Coronally Advanced Flap in the Treatment of Gingival Recession: A Clinical Study. J Clin Diagn Res 2015; 9:ZC98-ZC101. [PMID: 26501023 DOI: 10.7860/jcdr/2015/12971.6572] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 07/10/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Guided tissue regeneration (GTR) based root coverage using different allograft membranes has been utilized to correct gingival recession defects with promising results. Amnion and chorion allograft membranes of alternative origin derived from human placental tissue has been advocated in the treatment of gingival recession. However, chorion membrane has been used in combination with amnion membrane no study has compared these allograft membranes in the treatment of gingival recession. Therefore, the purpose of this study was to clinically evaluate and compare the efficacy of amnion membrane and chorion membrane in combination with coronally advanced flap in the treatment of gingival recessions. MATERIALS AND METHODS Twelve systemically healthy patients having at least 2 bilateral Miller's Class I or Class II gingival recession were recruited and coronally advanced flap was performed with amnion membrane or chorion membrane. Clinical parameters such as gingival Index, plaque index, length of the recession, width of the recession, width of keratinized gingiva, relative attachment level were evaluated at baseline, 3 and 6 months post-surgery. RESULTS The mean decrease in length of recession (LR) for Chorion site was 2.00±1.54mm and amnion site was 1.58±1.14mm. The gain in attachment level for amnion site was 2.17±1.53mm and for chorion site was 1.58±1.22mm. The total mean percentage of root coverage was 34% for chorion site and 22% for amnion site. CONCLUSION Both amnion membrane and chorion membrane has shown to be versatile allograft material to be used in the treatment of root coverage.
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Affiliation(s)
- Sonali Chakraborthy
- Post Graduate Student, Department of Periodontology, Rajarajeswari Dental College and Hospital , Bangalore, India
| | - Savita Sambashivaiah
- Professor and HOD, Department of Periodontology, Rajarajeswari Dental College and Hospital , Bangalore, India
| | - Rithesh Kulal
- Reader, Department of Periodontology, Rajarajeswari Dental College and Hospital , Bangalore, India
| | - Shivaprasad Bilchodmath
- Reader, Department of Periodontology, Rajarajeswari Dental College and Hospital , Bangalore, India
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Gholami GA, Gholami H, Amid R, Kadkhodazadeh M, Mehdizadeh AR, Youssefi N. Bone-added periodontal plastic surgery: a new approach in esthetic dentistry. Ann Surg Innov Res 2015; 9:1. [PMID: 25763099 PMCID: PMC4355546 DOI: 10.1186/s13022-015-0010-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/21/2015] [Indexed: 11/16/2022]
Abstract
This article proposes a combined technique including bone grafting, connective tissue graft, and coronally advanced flap to create some space for simultaneous bone regrowth and root coverage. A 23 year-old female was referred to our private clinic with a severe class II Miller recession and lack of attached gingiva. The suggested treatment plan comprised of root coverage combined with xenograft bone particles. The grafted area healed well and full coverage was achieved at 12-month follow-up visit. Bone-added periodontal plastic surgery can be considered as a practical procedure for management of deep gingival recession without buccal bone plate.
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Affiliation(s)
- Gholam Ali Gholami
- Department of Periodontics, Dental School, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Hadi Gholami
- Department of Prosthodontics, Faculty of Dental Medicine, University of Bern, Bern, Switzerland
| | - Reza Amid
- Department of Periodontics, Dental School, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Mahdi Kadkhodazadeh
- Department of Periodontics, Dental School, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Amir Reza Mehdizadeh
- Dental Research Center, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Navid Youssefi
- Dental Research Center, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
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Agarwal C, Purohit P, Sharma SK, Sharma A. Modified Approach of Double Papillae Laterally Positioned Flap Technique using Alloderm® for Root Coverage. J Clin Diagn Res 2014; 8:ZD25-7. [PMID: 25177655 DOI: 10.7860/jcdr/2014/8367.4606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 05/30/2014] [Indexed: 11/24/2022]
Abstract
Cosmetic concern is on increase in dental patients these days resulting in more demand for periodontal plastic surgical procedures. Gingival recession is one of the common problems which impairs aesthetic and may result in hypersensitivity and increase chances of root caries. Several plastic procedures are available to correct the defect. Double papilla laterally positioned flap combined with Alloderm has been used to cover single tooth class I recession site as adequate width of keratinized gingiva is present on adjacent teeth. The technique has resulted in 80% of root coverage.
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Affiliation(s)
- Chitra Agarwal
- Senior Lecturer, Department of Periodontology, Jodhpur Dental College General Hospital , Jodhpur, India
| | - Pragya Purohit
- Senior Resident, Department of Oral Surgery, Mathura Das Mathur Medical College , Jodhpur, India
| | | | - Aashish Sharma
- Senior Lecturer, Department of Public Health Dentistry, Jodhpur Dental College General Hospital , Jodhpur, India
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27
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Rana TK, Phogat M, Sharma T, Prasad N, Singh S. Management of gingival recession associated with orthodontic treatment: a case report. J Clin Diagn Res 2014; 8:ZD05-7. [PMID: 25177647 PMCID: PMC4149153 DOI: 10.7860/jcdr/2014/9767.4555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 05/19/2014] [Indexed: 11/24/2022]
Abstract
Many patients undergo orthodontic treatment for aesthetic improvement. It is well established that the patients who undergo orthodontic treatment have a high susceptibility to present plaque accumulation on their teeth because of the presence of brackets, wires and/or other orthodontic elements on the teeth surfaces with which the oral hygiene procedures might be more difficult. The orthodontic treatment is a double-action procedure regarding the periodontal tissues which may be very meaningful in increasing the periodontal health status and may be a harmful procedure which can be followed by several types of periodontal complications. There is a strong correlation between the severity and extent of gingival recessions and the orthodontic treatment suggesting that orthodontic tooth movement may lead to gingival recession. The principal objective in the treatment of gingival recession is to cover the exposed root surfaces to improve aesthetics and to reduce hypersensitivity. Different soft tissue grafting procedures have been proposed in the treatment of gingival recessions. Subepithelial connective tissue graft is a reliable method for treatment of gingival recession. The purpose of this case report was to illustrate the relationship between orthodontic therapy and gingival recession and to describe the management of this case.
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Affiliation(s)
- Tarun Kumar Rana
- Senior Lecturer, Department of Orthodontics, Seema Dental College & Hospital, Rishikesh, Uttarakhand, India
| | - Megha Phogat
- Senior Lecturer, Department of Periodontics, Seema Dental College & Hospital, Rishikesh, Uttarakhand, India
| | - Tarun Sharma
- Reader, Department of Orthodontics, Seema Dental College & Hospital, Rishikesh, Uttarakhand, India
| | - Narayana Prasad
- Professor and Head, Department of Orthodontics, Seema Dental College & Hospital, Rishikesh, Uttarakhand, India
| | - Shailendra Singh
- Senior Lecturer, Department of Orthodontics, Vanachal Dental College, Garwa, Jharkhand, India
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28
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Singh J, Bharti V. The effect of laterally positioned flap-revised technique and 24% ethylenediaminetetraacetic acid root conditioning on root coverage: A case report. Saudi Dent J 2014; 26:132-8. [PMID: 25057234 PMCID: PMC4095044 DOI: 10.1016/j.sdentj.2014.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/21/2013] [Accepted: 03/31/2014] [Indexed: 11/20/2022] Open
Abstract
Complete root coverage is considered the true goal of treatment of gingival recession defects because only complete coverage assures recovery from the hypersensitivity and esthetic defects associated with recession areas. Previous studies have shown that the laterally positioned flap (LPF) technique or root surface biomodification yields a higher percentage of complete root coverage upon gingival recession treatment. This article highlights the use of the laterally positioned pedicle flap-revised technique (LPFRT) as a modification of the LPF technique, along with 24% EDTA gel as a root surface biomodification agent, in the management of localized gingival recession defects. Clinical examination revealed a Miller class II recession defect on the buccal aspect of the lower right central incisor, as well as the presence of aberrant frenum pull adjacent to the recession defect. The LPFRT, together with 24% EDTA gel, was speculated to cover the gingival recession defect. The frenectomy, along with periosteal fenestration, was planned simultaneously with LPFRT. After 6 months of therapy, the clinical condition was stable with complete root coverage and satisfactory healing of the gingival tissues at both the donor and recipient sites with no signs of inflammation.
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Affiliation(s)
- Jagmohan Singh
- Employees’ State Insurance Model Hospital, Ministry of Labour & Employment, Govt. of India, Bari Brahmana, Jammu & Kashmir, India
| | - Vipin Bharti
- Dept. of Periodontology, Govt. Dental College and Hospital, Patiala, Punjab, India
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29
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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. J Clin Diagn Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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30
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Jayavel K, Swaminathan M, Kumar S. Ridge augmentation and root coverage using acellular dermal matrix: a case report. Dent Res J (Isfahan) 2010; 7:88-91. [PMID: 22013463 PMCID: PMC3177374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Excessive alveolar bone resorption is commonly found when teeth are extracted. This is a problem in anterior part of mouth because it will result in an unaesthetic pontic on a narrow hollowed out alveolar ridge. Yet, another problem is gingival recession and root exposure in adjacent teeth which represent a therapeutic problem to the clinician.Use of acellular dermal matrix graft is an appropriate solution to obtain root coverage in areas with localized or generalized soft tissue recessions, particularly if the recessions create aesthetic concern or root sensitivity or shallow root caries lesions. This case report describes a surgical technique using acellular dermal matrix graft on a class III ridge defect and Millers grade II gingival recessions.There was a gain in both bucco-lingual and apico-coronal dimensions of the ridge, in both height and width directions, when compared to baseline and after 3 months. Recession was also covered compared to the baseline condition.
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Affiliation(s)
- Kavitha Jayavel
- Senior Lecturer, Department of Periodntics, Rajah Mmuthiah Dental College and Hospital, Annamalai University, Annamalai Nayar, Tamil Nadu, India.,
Correspondence to: Kavitha Jayavel,
| | - Mythili Swaminathan
- Professor, Department of Periodntics, Rajah Mmuthiah Dental College and Hospital, Annamalai University, Annamalai Nayar, Tamil Nadu, India
| | - Senthil Kumar
- Professor, Department of Periodntics, Rajah Mmuthiah Dental College and Hospital, Annamalai University, Annamalai Nayar, Tamil Nadu, India
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31
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Singh S, Roy S, Mandlik VB, Thapliyal GK, Prasanth T. Pouch and Tunnel Technique for Root Coverage using Palatal Connective Tissue Graft. Med J Armed Forces India 2008; 64:191-2. [PMID: 27408136 DOI: 10.1016/s0377-1237(08)80083-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 08/25/2007] [Indexed: 11/15/2022] Open
Affiliation(s)
- S Singh
- Graded Specialist (Periodontology), 320 Field Ambulance, C/o 99APO
| | - S Roy
- Officer Commanding, MDC Barrackpore
| | | | - G K Thapliyal
- Classified Specialist (Oral & Maxillofacial Surgery), AFDC, New Delhi
| | - T Prasanth
- PG Resident (Dept of Dental Surgery), AFMC, Pune
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