Abstract
Background: The long-term stability after soft tissue graft for covering gingival recession remains a pivotal goal for both patient and periodontist. Therefore, the aim of this study was to compare the four-year outcomes of the coronally advanced flap (CAF) versus the pouch/tunnel (POT) technique, both combined with connective tissue graft (CTG), for gingival recession treatment. Methods: Forty patients were initially randomly assigned to the control group (CAF + CTG; N = 20) and the test group (POT + CTG; N = 20). Clinical outcomes included mean root coverage (MRC) and complete root coverage (CRC), gingival thickness (GT), and keratinized tissue (KT) gain. Esthetic outcomes were also analyzed using the pink esthetic score (PES) and patient-reported outcome measures (PROMs). All outcomes initially assessed at six months were extended to four years post-surgery. Results: No significant differences were observed between the two patient groups in terms of MRC and CRC. At four years, significantly greater GT and KT gain were noted in the POT + CTG group, and tissue texture enhancement was also more prominent in the test group. Conclusions: The POT + CTG technique allows for long-term clinical coverage of gingival recessions comparable to that of the CAF + CTG technique, but it potentially improves gingival thickness, keratinized tissue and esthetic results.
Highlights
Gingival recession (GR) is defined as an exposure of the root surface of the tooth resulting from an apical migration of the gingival margin beyond the cemento-enamel junction [1,2,3]
According to systematic reviews and meta-analysis [15,16,17,18], coronally advanced flap (CAF) combined with connective tissue graft (CTG) is the most effective technique to treat a single or a multiple recession, and both European Federation of Periodontology(EFP) and American Association of Periodontology(AAP) consensus conferences concluded that this approach should be considered as the gold-standard, whereas conjunction of Enamel Matrix Derivative (EMD) or acellular dermal matrix graft may be considered as alternatives [10,11]
Clinical parameters (RD, keratinized tissue (KT), gingival thickness (GT), complete root coverage (CRC), mean root coverage (MRC), Local plaque score (LPS), and local bleeding percentage) and esthetic features recorded at baseline in the two control groups were perfectly comparable (Table 2)
Summary
Gingival recession (GR) is defined as an exposure of the root surface of the tooth resulting from an apical migration of the gingival margin beyond the cemento-enamel junction [1,2,3]. A recent 20-year follow up report concluded that the CAF + CTG allowed for stable recession coverage and a gain in long-term keratinized tissue (KT) [20]. The aim of this study was to compare the four-year outcomes of the coronally advanced flap (CAF) versus the pouch/tunnel (POT) technique, both combined with connective tissue graft (CTG), for gingival recession treatment. Clinical outcomes included mean root coverage (MRC) and complete root coverage (CRC), gingival thickness (GT), and keratinized tissue (KT) gain. Conclusions: The POT + CTG technique allows for long-term clinical coverage of gingival recessions comparable to that of the CAF + CTG technique, but it potentially improves gingival thickness, keratinized tissue and esthetic results
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