Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial

Andrea Pilloni,Patrick R Schmidlin,Anton Sculean,Mariana A Rojas,Philipp Sahrmann

doi:10.1007/s00784-018-2537-4

Andrea Pilloni, Patrick R Schmidlin + Show 3 more

Open Access

https://doi.org/10.1007/s00784-018-2537-4

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Abstract

ObjectivesThe aim of this randomized controlled clinical trial was to evaluate the possible advantages of adjunctive hyaluronic acid (HA) application in the coronally advanced flap (CAF) procedure in single Miller class I/recession type 1 (RT1) gingival recession treatment.Material and methodsThirty patients with one recession were enrolled; 15 were randomly assigned CAF + HA and 15 to CAF alone. The recession reduction (RecRed), clinical attachment level gain (CAL-gain), changes in probing pocket depth (PPD) and in the width of keratinized tissue (KT), complete root coverage (CRC), and mean root coverage (MRC) were calculated after 18 months. Post-operative morbidity (pain intensity, discomfort, and swelling) was recorded 7 days after treatment using visual analogue scale (VAS).ResultsAfter 18 months, RecRed was statistically significantly higher in the test group (2.7 mm [1.0]) than in the control group (1.9 mm [1.0]; p = 0.007). PPD were found to be slightly but statistically significantly increased in both groups. No statistically significant difference was found for KT gain between treatments. CRC was 80% for test and 33.3% for control sites (p < 0.05). A MRC of 93.8 ± 13.0% for test and 73.1 ± 20.8% for control sites was calculated (p < 0.05). The test group reported lower swelling and discomfort values 7-days post-surgery (p < 0.05). Statistically significant difference was not found for pain intensity.ConclusionsThe adjunctive use of HA was effective in obtaining CRC for single Miller class I/RT1 gingival recession sites.Clinical relevanceAdjunctive application of HA in the coronally advanced flap procedure may improve the reduction of the recessions and increase the probability of CRC in Miller class I recessions.

Highlights

Gingival recession is a common clinical finding in patients with high standards of oral hygiene and can be found in more than 90% of patients [1,2,3]
Gingival recession therapy still poses a certain challenge for clinicians, as it has in past years [5]
Seven females and eight males were treated with coronally advanced flap (CAF) + hyaluronic acid (HA)

Summary

Introduction

Gingival recession is a common clinical finding in patients with high standards of oral hygiene and can be found in more than 90% of patients [1,2,3]. The ultimate goal of root coverage procedures is the complete coverage of the recession defect with an esthetic appearance comparable to adjacent healthy soft tissues in combination with physiological probing pocket depths [6, 7]. Several surgical techniques have already provided good results and have been shown to attain root coverage at individual recession sites with a variety of different methods [7,8,9,10]. Connective tissue grafts (CTG) and enamel matrix derivatives (EMD) in conjunction with a coronally advanced flap (CAF) have been shown to provide the highest probability of obtaining complete root coverage (CRC) in Miller classes I and II single gingival recessions as compared to CAF alone [7].

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