Root Coverage for Single Deep Gingival Recessions: Outcomes Based on a Decision-Making Algorithm.

João B. César Neto,Marília C. Cavalcanti,Claudio M. Pannuti,Ricardo T. Sekiguchi,Dimitris N. Tatakis,Giuseppe A. Romito

doi:10.1155/2019/1830765

João B. César Neto, Marília C. Cavalcanti + Show 4 more

Open Access

https://doi.org/10.1155/2019/1830765

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Abstract

Aim The aim of this study is to report root coverage outcomes in single deep gingival recessions (GR) following a proposed decision-making algorithm. Materials and Methods A retrospective, practice-based study included single deep (≥5 mm) Miller Class II and III defects. The step-by-step decision-making algorithm led to a choice among three different flap designs (coronally advanced flap (CAF), double papilla envelope flap (DPE) or modified lateral sliding flap (LSF)) used with a connective tissue graft. Recession depth (RD) at 6 months follow-up and the corresponding root coverage (RC) were the primary outcomes assessed. Results Sixteen GR defects were included, with baseline RD of 6.7 ± 1.8 mm. Six months postoperatively, RD was significantly reduced to 1.2 ± 0.8 mm (p < 0.05). Mean RC was 81.7 ± 13.0%, without significant differences between Miller Class II (87.1 ± 9.2%; n=9) and Class III (74.6 ± 14.5%; n=7) GRs (p=0.07). Postoperatively, keratinized tissue width increase was greater for LSF (3.5 ± 1.1) and DPE (4.2 ± 1.4 mm) than for CAF (1.9 ± 0.9 mm). Conclusions Following the proposed decision-making algorithm, root coverage outcomes for GR defects ≥5 mm were comparable to outcomes reported for shallow defects. Prospective clinical trials are needed to validate the proposed approach and techniques. Practical Implications The proposed algorithm allows the clinician to select the appropriate surgical technique for treatment of single deep gingival recessions with good predictability.

Highlights

Gingival recession (GR) is a common periodontal condition that can negatively impact esthetics, plaque control, and hypersensitivity [1]
Miller Class II and III defects. e step-by-step decision-making algorithm led to a choice among three different flap designs (coronally advanced flap (CAF), double papilla envelope flap (DPE) or modified lateral sliding flap (LSF)) used with a connective tissue graft
Keratinized tissue width increase was greater for LSF (3.5 ± 1.1) and DPE (4.2 ± 1.4 mm) than for CAF (1.9 ± 0.9 mm)

Summary

Introduction

Gingival recession (GR) is a common periodontal condition that can negatively impact esthetics, plaque control, and hypersensitivity [1]. In patients with good oral hygiene, longitudinal evidence indicates that untreated GR defects tend to increase in depth over time [4]. Despite the extensive literature on GR treatment, adequate evidence is lacking on outcomes at specific sites other than maxillary canines and premolars or on the effect of site characteristics, such as root prominence and vestibular depth [9]. Most of the existing literature has explored treatment of 2–4 mm deep GRs, providing limited evidence on deeper defects. Despite the lack of consensus on the definition of a “deep” GR defect, evidence indicates that increasing GR. E aim of this retrospective, practice-based case series study is to evaluate the outcomes of treating deep (≥5 mm) GR defects when following a step-by-step clinical decisionmaking algorithm which incorporates assessment of GR dimension, residual vestibular depth, and potential compromising factors

Materials and Methods

Results

Clinical Outcomes

Conclusions