Predictor factors for long-term outcomes stability of coronally advanced flap with or without connective tissue graft in the treatment of single maxillary gingival recessions: 9years results of a randomized controlled clinical trial.

Abstract

To assess the clinical outcomes 9years after the surgical treatment of single maxillary gingival recessions and identify predictors for long-term gingival margin stability. Twenty-five gingival recessions (Miller Class I and II) were randomly treated with Coronally Advanced Flap (CAF) plus Connective Tissue Graft (CTG) or CAF alone. Outcomes included complete root coverage (CRC), recession reduction (REC), keratinized tissue (KT) gain and dentin hypersensitivity, and were evaluated at 6months, 1 and 9years. Multilevel analysis was performed to identify predictors for long-term gingival margin stability. Baseline gingival recession was 2.4±0.8mm and 2.4±1.0mm in the CAF+CTG and in the CAF-treated sites, respectively (p=0.693). The chance to gain and preserve CRC over time is equal to 70% in the CAF+CTG group (Relative Risk [RR]=1.70, 95% CI [0.84-3.45]; adjusted RR=1.48, 95% CI [0.61-3.62]). Using the CTG, an increase in KT was recorded 9years after the surgery (p=0.019). An OR of 0.12 (p=0.022) of not achieving CRC was observed in cases with non-carious cervical lesions (NCCL) compared to cases without NCCL. Both treatment modalities demonstrated stability over time. Additional use of CTG provided a greater increase in KT. The presence of NCCL negatively affected CRC and REC.