Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life

Aim

To evaluate the non‐inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient‐reported outcomes (PROM).

Material and methods

One hundred and eighty‐seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient‐reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates.

Results

Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six‐month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non‐inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8–8.8).

Conclusion

Replacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.

Concentrated growth factor in the treatment of adjacent multiple gingival recessions: a split-mouth randomized clinical trial

AIM

The aim of this study was to determine the clinical effect of concentrated growth factor (CGF) in combination with coronally advanced flap (CAF) compared to CAF alone for the treatment of multiple adjacent gingival recessions (GRs).

MATERIALS AND METHODS

Twenty patients with a total of 119 Miller Class I and II GRs in the maxilla were included to this study. Recessions were randomly treated according to a split-mouth design by means of CAF + CGF (test; 60 defects) or CAF (control; 59 defects). Clinical outcomes were evaluated at baseline and 6 months after surgery.

RESULTS

The mean root coverage (MRC) was 82.06% and 86.67%, complete root coverage (CRC) was 45.8% (27/59) and 56.7% (34/60) for CAF and CAF + CGF, respectively at 6th month. Statistically no difference was demonstrated between the two groups in terms of recession depth (RD), MRC and CRC at 6th month. The increase in width of keratinized gingiva (KGW) and gingival thickness (GT) were statistically significant in the CAF + CGF group compared to the CAF group at 6th month.

CONCLUSIONS

The use of CGF in combination with CAF did not provide additional benefits in RD, CRC and MRC. This study suggests that use of CGF + CAF may increase the success of GRs because of a significant increase in KGW and GT.

Soft tissue phenotype modification predicts gingival margin long-term (10-year) stability: Longitudinal analysis of six randomized clinical trials

Aim

To assess the prognostic value of soft tissue phenotype modification following root coverage procedures for predicting the long‐term (10‐year) behaviour of the gingival margin.

Materials and Methods

Participants from six randomized clinical trials on root coverage procedures at the University of Michigan were re‐invited for a longitudinal evaluation. Clinical measurements were obtained by two calibrated examiners. A data‐driven approach to model selection with Akaike information criterion (AIC) was carried out via multilevel regression analyses and partial regression plotting for changes in the level of the gingival margin over time and interactions with the early (6‐month) results of soft tissue phenotypic modification.

Results

One‐hundred and fifty‐seven treated sites in 83 patients were re‐assessed at the long‐term recall. AIC‐driven model selection and regression analyses demonstrated that 6‐month keratinized tissue width (KTW) and gingival thickness (GT) influenced the trajectory of the gingival margin similarly in a concave manner; however, GT was the driving determinant that predicted significantly less relapse in the treatments, with stability of the treated gingival margin obtained beyond values of 1.46 mm.

Conclusions

Among a compliant patient cohort, irrespective of the rendered therapy, the presence of at least 1.5 mm KTW and 1.46 mm GT was correlated with the long‐term stability of the gingival margin.

Non-surgical management of tooth hypersensitivity

Tooth sensitivity is a common complaint of patients in dental practices. Studies have demonstrated dentinal hypersensitivity to affect 10-30% of the population. There are various potential causes of tooth sensitivity and a variety of available treatment options. This narrative review will discuss the possible aetiology of this condition, as well as the treatment modalities available. A tailor-made treatment plan that starts with the most non-invasive treatment options and escalates only when those options have proven insufficient in alleviating symptoms should be provided for each patient. Only after all non- and less-invasive methods have failed to reduce the symptoms should more invasive treatment options, such as root-coverage, be considered.

Clinical evaluation of injectable platelet-rich fibrin with connective tissue graft for the treatment of deep gingival recession defects: A controlled randomized clinical trial

AIM

The aim of this study was to determine whether the combined connective tissue graft (CTG) with injectable platelet-rich fibrin (i-PRF) with coronally advanced flap (CAF) improved root coverage of deep Miller Class I or II gingival recessions compared with CTG alone with CAF.

MATERIAL AND METHODS

Seventy-two patients with Miller class I and II gingival recessions were enrolled. Thirty-six patients were randomly assigned to the test group (CAF+CTG+i-PRF [700 rpm for 3 min]) or control group (CAF+CTG). Clinical evaluations were made at 6 months.

RESULTS

At 6 months, complete root coverage was obtained at 88% of the sites treated with CAF+CTG+i-PRF and 80% of the sites treated with CAF+CTG. Difference between the two groups was not statistically significant. At 6 months, the recession depth (RD) reduction and increase in keratinized tissue height (KTH) of the test sites were significantly better compared with the control sites.

CONCLUSIONS

According to the results, the addition of i-PRF to the CAF+CTG treatment showed further development in terms of increasing the KTH and decreasing RD. However, this single trial is not sufficient to advocate the true clinical effect of i-PRF on recession treatment with CAF+CTG and additional trials are needed.

Healing of buccal gingival recessions following treatment with coronally advanced flap alone or combined with a cross-linked hyaluronic acid gel. An experimental study in dogs

Aim

To clinically and histologically evaluate in dogs the healing of gingival recessions treated with coronally advanced flap (CAF) with or without cross‐linked hyaluronic acid (HA).

Materials and methods

Gingival recession defects were surgically created on the vestibular side of both maxillary canines in 8 dogs. After 8 weeks of plaque accumulation, the 16 chronic defects were randomly treated with either CAF alone or CAF and HA‐gel (CAF/HA). Clinical and histological outcomes were evaluated at 10 weeks post‐surgically.

Results

Compared to baseline, the clinical measurements at 10 weeks revealed a statistically significant decrease in gingival recession for both CAF (p < 0.01) and CAF/HA (p < 0.001) groups. Statistically significant differences were found in clinical attachment level (p < 0.05) and width of gingival recession (p < 0.01) favouring the CAF/HA group. Bone formation was statistically significantly greater in the CAF/HA group than in the CAF group (1.84 ± 1.16 mm vs., 0.72 ± 0.62 mm, respectively, p < 0.05). Formation of cementum and connective tissue attachment were statistically significantly higher in the CAF/HA group compared with the CAF group (i.e. 4.31 ± 1.78 mm versus 2.40 ± 1.35 mm and 1.69 ± 0.98 mm versus 0.74 ± 0.68 mm, respectively (p < 0.05)).

Conclusions

The present data have for the first time provided histologic evidence for periodontal regeneration of gingival recession defects following treatment with CAF and HA.

Clinical relevance

The use of HA in conjunction with CAF may represent a novel modality for treating gingival recession defects.

Recombinant human platelet-derived growth factor improves root coverage of a collagen matrix for multiple adjacent gingival recessions: A triple-blinded, randomized, placebo-controlled trial

AIM

To evaluate the efficacy of recombinant human platelet-derived growth factor (rhPDGF)-BB combined with a cross-linked collagen matrix (CCM) for the treatment of multiple adjacent gingival recession type 1 defects (MAGRs) in combination with the coronally advanced flap (CAF).

MATERIALS AND METHODS

Thirty patients were enrolled in this triple-blind, randomized, placebo-controlled trial and treated with either CAF + CCM + rhPDGF, or CAF + CCM + saline. The primary outcome was mean root coverage (mRC) at 6 months. Complete root coverage, gain in gingival thickness (GT), keratinized tissue width, volumetric and ultrasonographic changes, and patient-reported outcome measures were also assessed. Mixed-modelling regression analyses were used for statistical comparisons.

RESULTS

At 6 months, the mRC of the CCM + rhPDGF and CCM alone groups were 88.25% and 77.72%, respectively (p = .02). A significant gain in GT was consistently observed for both treatment arms, and more so for the patients receiving the matrix containing rhPDGF through time (0.51 vs. 0.80 mm, on average, p = .01). The rhPDGF + CCM treated patients presented greater volume gain, higher soft tissue thickness, and a superior aesthetic score.

CONCLUSION

rhPDGF enhances the clinical, volumetric, and aesthetic outcomes of MAGRs above the results achieved with CAF + CCM alone (ClinicalTrials.gov NCT04462237).

Bovine pericardium based non-cross linked collagen matrix for successful root coverage, a clinical study in human

INTRODUCTION

The aim of this study was to clinically assess the capacity of a novel bovine pericardium based, non-cross linked collagen matrix in root coverage.

METHODS

62 gingival recessions of Miller class I or II were treated. The matrix was adapted underneath a coronal repositioned split thickness flap. Clinical values were assessed at baseline and after six months.

RESULTS

The mean recession in each patient was 2.2 mm at baseline. 6 Months after surgery 86.7% of the exposed root surfaces were covered. On average 0,3 mm of recession remained. The clinical attachment level changed from 3.5 ± 1.3 mm to 1,8 ( ± 0,7) mm during the observational time period. No statistically significant difference was found in the difference of probing depth. An increase in the width of gingiva was significant. With a baseline value of 1.5 ± 0.9 mm an improvement of 2.4 ± 0.8 mm after six month could be observed. 40 out of 62 recessions were considered a thin biotype at baseline. After 6 months all 62 sites were assessed thick.

CONCLUSIONS

The results demonstrate the capacity of the bovine pericardium based non-cross linked collagen matrix for successful root coverage. This material was able to enhance gingival thickness and the width of keratinized gingiva. The percentage of root coverage achieved thereby is comparable to existing techniques. This method might contribute to an increase of patient's comfort and an enhanced aesthetical outcome.

Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of multiple Class III-IV recessions in lower anterior teeth: A 3-year randomized clinical trial

BACKGROUND

This study compared clinical and patient-centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of multiple Class III-IV Miller periodontal recession (REC) defects on mandibular anterior teeth.

METHODS

This randomized clinical study evaluated 41 patients at 3 years follow-up. One hundred and fifty-six teeth were divided into two groups: test (CTG-EMD, 79 teeth) and control (CTG only, 77 teeth). Clinical REC, keratinized tissue (KT) width, percentage of root coverage, patient-centered outcomes were compared between the two groups.

RESULTS

At 36 months follow-up, patient level analysis showed that REC in the test group reduced significantly (5.71 ± 0.58 mm to 1.57 ± 0.85 mm) compared with the control group (5.94 ± 0.46 mm to 2.51 ± 0.62 mm) (P < 0.001), while KT width increased in the test group (1.51 ± 0.26 mm to 4.18 ± 0.34 mm) and was significantly greater than the control group (1.65 ± 0.21 mm to 2.90 ± 0.20 mm) (P < 0.001). At 36 months, tooth level analysis (Class III and Class IV groups) found less residual REC and increased KT in the test group compared with the control group (P < 0.01). Significantly less pain was reported at 2, 7, and 14 days follow-up post-surgery in the test group (P < 0.001).

CONCLUSIONS

The addition of EMD to CTG results in improved root coverage outcomes and higher amounts of KT width 36 months after treatment of Class III-IV REC on mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days post-surgery.

Root surface modifiers and subepithelial connective tissue graft for treatment of gingival recessions: a systematic review

BACKGROUND AND OBJECTIVE

Many techniques and flap designs have been used to treat gingival recession by root coverage, but subepithelial connective tissue graft (SCTG) seems to be the gold standard procedure. In an attempt to improve the healing process and increase the success rate of root coverage, some authors have used root modifiers, including different root conditioners, lasers, EMD, recombinant human growth factors and platelet-rich plasma (PRP). The aim of this systematic review was to evaluate the effects of root biomodification in clinical outcomes of gingival recessions treated with SCTG.

MATERIAL AND METHODS

Studies reporting SCTG associated with any form of root surface biomodification for root coverage of gingival recessions (Miller Class I and Class II) were considered as eligible for inclusion. Studies needed to have data of clinical outcomes in a follow up of at least 6 months. Screening of the articles, data extraction and quality assessment were conducted independently and in duplicate.

RESULTS

None of the products evaluated (citric acid, EDTA, PRP, lasers and EMD) showed evident benefits in clinical outcomes. Test and control groups presented similar outcomes related to root coverage and periodontal parameters, with no statistical differences between them. The exception was root biomodification with the neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, which impaired root coverage and had a detrimental effect on clinical outcomes.

CONCLUSION

Based on the present clinical data, the use of root surface modifiers to improve clinical outcomes in gingival recessions treated with SCTG is not justified. More in vivo studies, and randomized clinical trials with larger sample sizes and extended follow up, are necessary.

Platelet-Rich Fibrin in Single and Multiple Coronally Advanced Flap for Type 1 Recession: An Updated Systematic Review and Meta-Analysis

Background and Objectives: The aim of the present systematic review and meta-analysis was to investigate the efficacy of leukocyte–platelet-rich fibrin (L-PRF) in addition to coronally advanced flap (CAF) for the treatment of both single and multiple gingival recessions (GRs) compared to the CAF alone and to the adjunct of connective tissue graft (CTG). Root coverage outcomes using platelet concentrates have gained increased interest. In particular, it has been suggested that adding L-PRF to CAF may provide further benefits in the treatment of GRs. Materials and Methods: An electronic and manual literature search was conducted to identify randomized controlled trials (RTCs) investigating root coverage outcomes with CAF + L-PRF. The outcomes of interest included mean root coverage (mRC), recession reduction, keratinized tissue width (KTW) gain, gingival thickness (GT) gain, and patient-reported outcome measures (PROms) such as pain perception and discomfort. Results: A total of 275 patients and 611 surgical sites were analyzed. L-PRF in adjunct to single CAF seems to show statistically significant results regarding clinical attachment level (CAL) with a weighted means (WM) 0.43 95% CI (−0.04, 0.91), p < 0.0001, GT (WM 0.17 95% CI (−0.02, 0.36), p < 0.0001, and mRC (WM 13.95 95% CI (−1.99, 29.88) p < 0.0001, compared to single CAF alone. Interesting results were obtained from the adjunct of PRF to multiple CAF with respect to multiple CAF alone with an increase in the mRC WM 0.07 95% CI (−30.22, 30.35), p = 0.0001, and PPD change WM 0.26 95% CI (−0.06, 0.58), p < 00001. On the other hand, no statistically significant data were obtained when L-PRF was added to single or multiple CAF combined with CTG according to the included outcomes such as mRC (p = 0.03 overall). Conclusions: L-PRF is a valid alternative to CAF alone. L-PRF compared to CTG in single and multiple CAF showed statistically significant results regarding pain perception and discomfort PROms (p < 0.0001). However, CTG remains the gold standard for treating gingival recession.

De-epithelialized gingival graft versus subepithelial connective tissue graft in the treatment of multiple adjacent gingival recessions using the tunnel technique: 1-year results of a randomized clinical trial

AIM

To compare the clinical efficacy and postoperative morbidity of de-epithelialized gingival graft (DGG) with subepithelial connective tissue graft (SCTG) on treatment of multiple adjacent gingival recessions (MAGRs) with tunnel technique (TUN) and to evaluate histological characteristics of the palatal grafts.

MATERIALS AND METHODS

Twenty-seven patients with MAGRs affecting at least 2 adjacent teeth were treated with either DGG + TUN or SCTG + TUN. Recession depth(RD) and width(RW), probing depth(PD), clinical attachment level(CAL), keratinized tissue height(KTH), gingival thickness(GT), and complete and mean root coverage(CRC, MRC) were evaluated at 6 and 12 months postoperatively. Multilevel analysis was performed to identify patient- and tooth/site-related predictors for the 12-month MRC outcomes. Postoperative patient morbidity and histological characteristics of palatal graft samples obtained during harvesting were investigated.

RESULTS

At the 12-month follow-up, MRC was 91.72% ± 16.59% and 84.72% ± 19.72% in DGG + TUN and SCTG + TUN groups (p = .001). Multilevel regression analysis identified RD, KTH and GT as variables associated with MRC. No significant difference between the groups was observed regarding postoperative patient morbidity parameters. Cellularity was found significantly higher in the SCTG samples compared to the DGG samples (p < .05).

CONCLUSIONS

Although DGG + TUN presented higher MRC and CRC compared to SCTG + TUN in the treatment of MAGRs, treatment method was not a significant predictive factor for the amount of MRC outcomes while RD, KTH and GT were significant predictive factors.

Root coverage stability: A systematic overview of controlled clinical trials with at least 5 years of follow-up

Objectives

To systematically assess the long‐term outcome (≥5 years) of root coverage procedures reported in controlled clinical trials.

Material and Methods

Literature search was performed according to the PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) controlled (CT) or randomised controlled clinical trials (RCT); (c) root coverage procedure with ≥5 years follow‐up; and (d) clinical treatment effect size and/or patient‐related outcome measures (PROMs) reported.

Results

Four CT and 14 RCT with a follow‐up of 5–20 years fulfilled the eligibility criteria; sample size per study ranged from 8 to 70 patients contributing with 18–149 sites. Coronally advanced flap (CAF) and CAF + connective tissue graft (CTG) were the prevalent treatments (i.e., in 24 and 38% of the groups, respectively), while other flap designs and adjuncts (i.e., enamel matrix derivative, bone graft, collagen membrane) were represented only once. For single Miller class I/II gingival recessions (GR), CAF + CTG appeared advantageous compared to other techniques, and provided low residual recession depths (i.e., ≤0.5 mm), and complete root coverage in ≥2/3 of the patients; similar tendency was observed for multiple GR. No data on Miller class III/IV GR is available. No meta‐analysis was feasible due to lack of similarity in the clinical and methodological characteristics across the trials and observed comparisons of interventions.

Conclusions

CAF + CTG appears to be the ‘gold standard’ technique for the treatment of single and multiple Miller class I/II GR also in regard to long‐term (i.e., ≥5 years of follow‐up) treatment outcomes. There is little information regarding the performance, on the long‐term, of other techniques and adjuncts.

Porcine dermal matrix in the treatment of dehiscence-type defects--an experimental split-mouth animal trial

OBJECTIVES

To describe histometrical outcomes (tissue thickness, tissue height) of a porcine dermal matrix (PDX) and subepithelial connective tissue (CTG) in the treatment of dehiscence-type defects.

MATERIAL AND METHODS

In five beagle dogs buccal dehiscence defects were created on both upper canines. The defects were covered in a split-mouth design either with a porcine dermal matrix or subepithelial connective tissue. After 4 months histometrical outcomes were evaluated using a nonparametric Brunner-Langer model.

RESULTS

Neither in the test nor in the control specimen signs of inflammation or foreign body reaction was detected. Histometrically, no significant difference was found for tissue thickness and height between both treatment groups.

CONCLUSIONS

Porcine dermal matrix can be used for grafting of dehiscence-type defects. Augmentation of tissue thickness seems to be comparable to subepithelial connective tissue.

Twenty-five years of recombinant human growth factors rhPDGF-BB and rhBMP-2 in oral hard and soft tissue regeneration

Contemporary oral tissue engineering strategies involve recombinant human growth factor approaches to stimulate diverse cellular processes including cell differentiation, migration, recruitment, and proliferation at grafted areas. Recombinant human growth factor applications in oral hard and soft tissue regeneration have been progressively researched over the last 25 years. Growth factor-mediated surgical approaches aim to accelerate healing, tissue reconstruction, and patient recovery. Thus, regenerative approaches involving growth factors such as recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and recombinant human bone morphogenetic proteins (rhBMPs) have shown certain advantages over invasive traditional surgical approaches in severe hard and soft tissue defects. Several clinical studies assessed the outcomes of rhBMP-2 in diverse clinical applications for implant site development and bone augmentation. Current evidence regarding the clinical benefits of rhBMP-2 compared to conventional therapies is inconclusive. Nevertheless, it seems that rhBMP-2 can promote faster wound healing processes and enhance de novo bone formation, which may be particularly favorable in patients with compromised bone healing capacity or limited donor sites. rhPDGF-BB has been extensively applied for periodontal regenerative procedures and for the treatment of gingival recessions, showing consistent and positive outcomes. Nevertheless, current evidence regarding its benefits at implant and edentulous sites is limited. The present review explores and depicts the current applications, outcomes, and evidence-based clinical recommendations of rhPDGF-BB and rhBMPs for oral tissue regeneration.

Clinical evaluation of alloderm for root coverage and colour match

BACKGROUND

Predictable root coverage and good colour match are the major therapeutic end points in the treatment of gingival recession. Alloderm has been used as a substitute to connective tissue graft, but its colour match in populations with a high degree of melanin pigmentation has not been extensively studied. The aim of this study was to evaluate the effectiveness of an Acellular dermal matrix graft for root coverage procedures and to objectively analyze the post-operative esthetics using a Visual Analog Scale (VAS).

MATERIALS AND METHODS

Both male and female patients were selected, aged 20-50 years presenting with aesthetic problems due to the exposure of recession defects when smiling. A total of 14 patients contributed to 15 sites, each site falling into Miller's class I or class II gingival recession.

RESULTS

A total of 15 sites were treated and a mean coverage of (85.56±21.70 and 83.33±21.82%) was obtained at the end of 3(rd) and 12(th) month respectively. A mean VAS score of 7.93±1.03 and 8.13±0.99 (3(rd) and 12(th) month) and 5.73±0.70 and 6.87±0.83 (3(rd) and 12(th) month) was obtained when the colour match recorded by the patients and an independent observer, respectively.

CONCLUSION

The study showed that acellular dermal matrix graft (alloderm) may be successfully used to treat gingival recession, as adequate root coverage may be predictably obtained. The grafted areas underwent melanization from the 6(th) month onwards and complete blending with the adjacent sites was obtained at 1 year.

Root coverage using porcine collagen matrix with fibroblast growth factor-2: a pilot study in dogs

AIM

The aim of this study was to evaluate the effect of fibroblast growth factor-2 (FGF-2) in combination with porcine collagen matrix (CM) for coverage of gingival recession defects in dogs.

MATERIALS AND METHODS

In five male mongrel dogs, labial gingival recession defects were surgically created in the lower-third incisors bilaterally. The defects were randomly assigned to the CM/FGF-2 group (experimental) or the CM-only group (control). Standardized clinical photographs and silicone impressions were taken at 4 and 16 weeks of healing to calculate the remaining recession area. The dogs were euthanized after 16 weeks for histometric analysis.

RESULTS

At 4 weeks, the recession area of the CM/FGF-2 group was significantly smaller than that of the CM-only group (2.55 ± 0.66 and 4.92 ± 1.05 mm² , respectively, p = 0.023), However, no significant difference was observed at 16 weeks. Histometrically, the amount of newly formed cementum was larger in the CM/FGF-2 group than in the CM-only group at 16 weeks (1.55 ± 0.44 and 0.88 ± 0.51 mm, respectively, p = 0.024).

CONCLUSIONS

The combination of CM/FGF-2 may enhance the early wound healing and may promote cementum formation to a higher extent compared to the use of CM alone.

A comparative clinical study of the efficacy of subepithelial connective tissue graft and acellular dermal matrix graft in root coverage: 6-month follow-up observation

Aims:

The purpose of this study was to compare the clinical efficacy of subepithelial connective tissue graft and acellular dermal matrix graft associated with coronally repositioned flap in the treatment of Miller's class I and II gingival recession, 6 months postoperatively.

Settings and Design:

Ten patients with bilateral Miller's class I or class II gingival recession were randomly divided into two groups using a split-mouth study design.

Materials and Methods:

Group I (10 sites) was treated with subepithelial connective tissue graft along with coronally repositioned flap and Group II (10 sites) treated with acellular dermal matrix graft along with coronally repositioned flap. Clinical parameters like recession height and width, probing pocket depth, clinical attachment level, and width of keratinized gingiva were evaluated at baseline, 90^th day, and 180^th day for both groups. The percentage of root coverage was calculated based on the comparison of the recession height from 0 to 180^th day in both Groups I and II.

Statistical Analysis Used:

Intragroup parameters at different time points were measured using the Wilcoxon signed rank test and Mann–Whitney U test was employed to analyze the differences between test and control groups.

Results:

There was no statistically significant difference in recession height and width, gain in CAL, and increase in the width of keratinized gingiva between the two groups on the 180^th day. Both procedures showed clinically and statistically significant root coverage (Group I 96%, Group II 89.1%) on the 180^th day.

Conclusions:

The results indicate that coverage of denuded root with both subepithelial connective tissue autograft and acellular dermal matrix allograft are very predictable procedures, which were stable for 6 months postoperatively.

Autologous connective tissue graft or xenogenic collagen matrix with coronally advanced flaps for coverage of multiple adjacent gingival recession. 36-month follow-up of a randomized multicentre trial

AIM

To report the 36-month follow-up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions.

MATERIAL AND METHODS

125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed-up for 36 months. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates.

RESULTS

No differences were observed between the randomized and the follow-up population. Average baseline recession was 2.6 ± 1.0 mm. 3-year root coverage was 1.5 ± 1.5 mm for CMX and 2.0 ± 1.0 mm for CTG (difference of 0.32 mm, 95% CI from -0.02 to 0.65 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. No treatment differences in position of the gingival margin were observed between 6- and 36-month follow-up (difference 0.06 mm, 95% CI -0.17 to 0.29 mm).

CONCLUSION

CMX was not non-inferior with respect to CTG in multiple adjacent recessions. No differences in stability of root coverage were observed between groups and in changes from 6 to 36 months. Previously reported shorter time to recovery, lower morbidity and more natural appearance of tissue texture and contour observed for CMX in this trial are also relevant in clinical decision-making.

Creeping attachment: A literature review

OBJECTIVE

Mucogingival surgery has been widely applied in clinics. An interesting phenomenon after mucogingival surgery is the coronal migration of gingival margin, which is described as "creeping attachment." The goal of this review is to summarize the characteristics, significance, mechanism, and manifestation of the creeping attachment after mucogingival surgery and to describe the factors associated with its occurrence.

OVERVIEW

A total of 82 relevant articles were included in the literature review. The characteristics and significance of the creeping attachment after mucogingival surgery were analyzed. The mechanism of the creeping attachment was explored. Different manifestations of and factors associated with creeping attachment were summarized.

CONCLUSIONS

Creeping attachment may occur to obtain additional root coverage after the healing of various mucogingival surgeries. However, this coverage is not always complete nor entirely predictable.

CLINICAL SIGNIFICANCE

Creeping attachment plays an important role in the prognosis of mucogingival surgeries. This review will help clinicians get a thorough recognition and understanding of this phenomenon.

An innovative technique for root coverage using pedicled buccal fat pad

Various etiological factors are associated with gingival recession which may be anatomical, physiologic, or pathologic factors. Several root coverage procedures have been described to manage the gingival recession. However, it has been found that root coverage procedures in Miller's Class III and IV gingival recession have a poor prognosis with current techniques. A newer predictable technique, pedicled buccal fat pad (PBFP) has been introduced in cases of severe gingival recession. The buccal fat pad (BFP) is a specialized capsulated fat tissue that has the property of maintaining its volume and structure over a long period of time. It can also serve as a well vascularized, readily obtainable local flap for reconstructive purposes and increasing the dimensions of keratinized mucosa. The aim of this case report is to establish a new technique for root coverage using pedicled BFP in Miller Class IV recession on the maxillary right first molar.

Platelet Rich Fibrin in double lateral sliding bridge flap procedure for gingival recession coverage: An original study

Background:

Gingival recession is a common occurrence in periodontal disease leading to an unaesthetic appearance of the gingiva. The effect of platelet-rich fibrin (PRF), when used along with double lateral sliding bridge flap (DLSBF), remains unknown. The aim of this study is to evaluate the effect of PRF in conjunction with DLSBF for multiple gingival recessions.

Materials and Methods:

Twenty systemically healthy individuals exhibiting Grade II gingival recession on their mandibular central incisors were recruited in this study. These patients were randomly assigned into two groups: DLSBF and PRF + DLSBF. The clinical parameters that were evaluated in this study were gingiva recession height, gingiva recession width, width of keratinized gingiva, clinical attachment level, and probing depth. PRF was procured from the patient's blood at the time of the surgery and used for the procedure. The follow-up was performed at 12 and 24 weeks postsurgery.

Results:

Statistically significant difference was observed between the clinical parameters at baseline and 12 and 24 weeks within the groups. There was no statistically significant difference, between the groups. Mean root coverage (RC) was 80% ±29.1% in the DLSBF group and 78.8% ±37.6% in the DLSBF + PRF group with no statistically significant difference.

Conclusion:

From the results obtained in this study, the addition of PRF to DLSBF gives no additional benefits to the clinical parameters measured in RC.

Vestibular Incision Subperiosteal Tunnel Access Technique with Platelet-Rich Fibrin Compared to Subepithelial Connective Tissue Graft for the Treatment of Multiple Gingival Recessions: A Randomized Controlled Clinical Trial

BACKGROUND

The aim of this study was to compare the effectiveness of root coverage through vestibular incision subperiosteal tunnel access (VISTA) technique using platelet rich fibrin (PRF) or subepithelial connective tissue graft (SCTG) in multiple gingival recessions.

MATERIALS AND METHODS

A total of 20 patients with multiple gingival recessions were included, and 10 subjects were randomly allocated to test group (VISTA with PRF) and 10 patients to control group (VISTA with SCTG). Clinical parameters were recorded at baseline, 3 months, and 6 months. Patient's response toward the treatment was also assessed by questionnaire.

RESULTS

All the clinical parameters in the study have showed better results in test group when compared to control group after a follow up period of 6 months with statistical significance.

CONCLUSION

The results of the present study suggested that multiple gingival recessions can be successfully treated with both procedures, but better root coverage and a greater increase in keratinized tissue were achieved with the VISTA technique with SCTG. All the patients in both groups felt it was worth undergoing the treatment.

Treatment of multiple gingival recessions with vista technique: A case series

Gingival recession is a common manifestation in most populations. Gingival recession is clinically manifested by an apical displacement of the gingival tissues, leading to root surface exposure. Gingival recession may be a concern for patients for a number of reasons such as root hypersensitivity, erosion, root caries, and esthetics (Wennstrom 1996). Recently, new techniques have been suggested for the surgical treatment of multiple adjacent recession type defects. These are mainly derived from the coronally advanced flap, a supraperiosteal envelope technique in combination with a subepithelial connective tissue graft, or its evolution as a tunnel technique. The current case reports introduce a novel, minimally invasive approach applicable for both isolated recession defects as well as multiple contiguous defects in the maxillary anterior region. Access to the surgical site is obtained by means of an approach referred to as vestibular incision subperiosteal tunnel access.

Late complications after root coverage with two types of subepithelial connective tissue grafts, clinical and histopathological evaluation: A prospective cohort study

AIM

This prospective cohort study evaluated late complications (LC) on recipient sites comparing two types of connective tissue grafts (CTG).

MATERIALS AND METHODS

Participants (n: 60) were treated with coronally advanced flap (CAF) plus CTG harvested by de-epithelialized technique (DE) (n:31) or two-parallel incision (PI) (n:29). Areas were evaluated to identify white discharge associated or not with gingival cul-de-sac. Patients were ordered in groups with (DE+and PI+) or without (DE- and PI-) LC. Biopsies for histopathological analysis in LC areas were proposed.

RESULTS

Six cases exhibited LC, 5 in DE graft (DE+) and 1 in PI graft (PI+) group; 2 were diagnosed at 3 months postoperatively, 3 at 6 months and one at 12 months. The relative risk for LC was 1.7 times greater for DE graft (p: 0.01; CI: 1.10 to 2.72; RR>1). Differences were not observed for clinical outcomes after both types of CTGs (p > 0.05). Biopsies showed deep invagination of the epithelial lining suggesting cyst-like area/ cavity with keratin content and consolidated in fibrous connective tissue. After 24 months biopsied areas presented no recurrence of LC, in non-biopsied patients the clinical condition remained unchanged.

CONCLUSIONS

Considering the limitations of this study, LC on recipient sites demonstrated no statistical difference between two types of CTG.