Amount Of Root Coverage Research Articles

Comparison of chorion allograft and subepithelial connective tissue autograft in the treatment of gingival recession- A randomized controlled clinical trial.

To compare the clinical outcomes of subepithelial connective tissue graft and chorion membrane along with coronally advanced flap in the treatment of gingival recession. A total of 12 patients with 24 sites showing isolated bilateral Miller's class I and II gingival recessions were randomly allocated into two treatment sites. One site, connective tissue graft, (n=12 sites) while on the contra-lateral site, chorion membrane (n=12 sites) was used with coronally advanced flap. Clinical parameters: probing depth, recession depth, recession width, width of keratinized gingiva, relative attachment level, thickness of keratinized gingiva were recorded at the baseline, 3 months, and 6 months. The amount of root coverage was evaluated after 6 months. Statistically significant differences were observed between test and control sites in terms of recession depth, recession width, width of keratinized gingiva and thickness of keratinized gingiva at 6 months. The test sites presented 66.17±18.85% and the control site showed 87.17±18.33% of root coverage at 6 months. Very limited amount of recession coverage with chorion membrane and did not serve as an alternative to connective tissue graft. CTRI/2017/12/010964.

Modified Tunnel Double Papilla Procedure for Root Coverage in the Anterior Mandible.

Free connective tissue grafts, barrier membranes, pedicle flaps, soft tissue allografts, and xenografts have been described for root coverage and augmenting the zone of attached gingiva. The present report evaluated a modified tunnel surgical procedure for root coverage of mandibular anterior teeth where a connective tissue graft was combined with a tunnel and double papilla flap. Fourteen patients with 18 consecutive Miller Class I or II gingival recession defects in the anterior mandible were treated with a connective tissue graft combined with a tunnel and double papilla flap procedure. The following parameters were recorded at baseline and every 6 months postsurgery for up to 19 months: probing depth (PD), vertical recession dimension (RD), keratinized tissue width (KT), and recession width (RW). Statistical analysis consisted of descriptive statistics, analysis of variance with repeated measures, and t test. Statistical analysis proved significant differences between pre- and postoperative values. Mean percentage of root coverage was 83.28% (standard deviation: 22.897), while complete root coverage was obtained in 55% of sites. Baseline values differed between Class I and II recession defects. Clinical attachment level gain, KT gain, and amount of root coverage were statistically significantly larger in Class II defects, while the degree of residual recession and percentage of root coverage were similar in both recession classes. A statistically significant interaction between recession class, independent variable, and pre- and postoperative vertical recession defects (dependent variables) was recorded (P = .004). Within the limitations of the sample size, the reported procedure showed predictable root coverage with color match combined with an increased zone of keratinized tissue.

Comparative evaluation of multiple recession coverage procedures with mucogingival area as a prognostic factor: A randomized controlled clinical trial

Background: Denuded root surface may give rise to dentin hypersensitivity, deterioration in the esthetic appearance, and inability to perform proper oral hygiene procedure. Hence, various surgical procedures have been proposed to overcome the problem of gingival recession. Hence, the aim of the study was to perform recession coverage procedures and thereafter to compare the height, width, and thickness of the interdental papilla postoperatively.Materials and Methods: Thirty patients were selected with Miller's Class I/Class II localized gingival recession in the maxillary or mandibular anterior region (age 20–50 years) with the presence of buccal gingival recession (≥2 mm). The baseline measurements of height, width, and thickness of the interdental papilla were measured with a standardized vernier caliper, and width of keratinized gingiva, probing pocket depth, and clinical attachment level were measured with a UNC 15 probe. Mucogingival surgical procedures were performed and evaluated postoperatively up to 6 months.Results: The amount of root coverage was significantly correlated with the interdental papilla.Conclusion: This study indicates that the various recession coverage procedures did not affect the papilla dimension however, recession coverage was seen with lower height of the interdental papilla.

Evaluation of prognostic factors affecting root coverage in patients before planned orthodontic treatment

During orthodontic dental arch expansion, especially in cases of teeth with gingival recessions, further loss of soft tissues and progression of recession might be observed. <b>Aim.</b> The aim of this study was to evaluate determinants of root coverage, increase in the width of keratinised tissue and gingival thickness after soft tissue augmentation procedures in patients before planned orthodontic treatment. <b>Material and methods.</b> 16 patients with the mean age of 28.18 (±6.58) years with 122 type I and II gingival recessions were enrolled in the study. Total, 32 soft tissue augmentation procedures with a coronally advanced flap (CAF) and tunnel technique (TUN) together with a connective tissue graft (CTG) were performed. The clinical and aesthetic parameters were assessed at baseline and 6 months postoperatively. <b>Results.</b> CAF was performed more often in upper teeth and type I gingival recession, in contrast to TUN. The mean percentage root coverage on CAF sides was 98.48%, while on TUN sides it was 81.71%. Complete root coverage was achieved in 87.3% and 61.2% of gingival recessions, respectively. A multivariate linear regression showed that the amount of root coverage was significantly affected by baseline recession height (GR), recession type, type and position of a tooth and surgical modality. The increase in the width of keratinised tissue (WKT) was related to the baseline width of keratinised tissue, type and position of a tooth, whereas the increase in gingival thickness (GT) was associated with baseline gingival thickness, tooth position and gender. Best aesthetics was observed on the TUN sides. <b>Conclusions.</b> Baseline characteristics of a surgical site (GR, WKT, GT), recession type, position and type of a tooth, and treatment modality may be helpful in the prognosis of recession coverage, increase in the width of keratinised tissue and gingival thickness in orthodontic patients.

Clinical comparison of coronally-advanced flap plus amniotic membrane or subepithelial connective tissue in the treatment of Miller's class I and II gingival recessions: A split-mouth study.

Background. The aim of the present study was to compare coronally advanced flap (CAF) plus amniotic membrane (AM) to CAF with connective tissue graft (CTG) in the treatment of Miller’s class I and II gingival recessions.Methods. Eleven healthy subjects with thirty Miller’s class І and ІІ gingival recessions ≥3 mm, were selevted for this research and randomly assigned to two groups in a split-mouth design. In the control group gingival recessions were treated with CAF and CTG; however, in the test group the lesions were treated with (AM) and CAF. The clinical parameters, including recession depth (RD), recession width (RW), keratinized tissue width (WKT), probing depth (PD) and clinical attachment level (CAL), were measured at baseline and 1, 3 and 6 months postoperatively. Statistical significance was set at P < 0.01.Results. Position changes of RD, RW, CAL, and MGJ were significant between baseline and one month after surgery (P < 0.01) in both the test and control groups and these values remained unchanged at 3- and 6-month follow-ups. There were no statistically significant differences in PD and WKT between baseline and 1-, 3- and 6-months intervals postoperatively. The mean root coverage values after 6 months were 75.5% and 63.1% for two groups, respectively. The mean recession depth reductions were 2.63±0.63 mm and 2±1.4 mm in the test and control groups, respectively. Conclusion. The results of this research showed that application of AM instead of connective tissue decreased surgical operation time and patient discomfort but the amount of root coverage was not significantly different between the two methods.

The Adjunctive Effect of Platelet-Rich Fibrin to Connective Tissue Graft in the Treatment of Buccal Recession Defects: Results of a Randomized, Parallel-Group Controlled Trial.

Platelet-rich fibrin (PRF) is an autologous preparation that has encouraging effects in healing and regeneration. The aim of this trial is to evaluate the effectiveness of coronally advanced flap (CAF) + connective tissue graft (CTG) + PRF in Miller Class I and II recession treatment compared to CAF + CTG. Forty patients were treated surgically with either CAF + CTG + PRF (test group) or CAF + CTG (control group). Clinical parameters of plaque index, gingival index, vertical recession (VR), probing depth, clinical attachment level (CAL), keratinized tissue width (KTW), horizontal recession (HR), mucogingival junction localization, and tissue thickness (TT) were recorded at baseline and 3 and 6 months after surgery. Root coverage (RC), complete RC (CRC), attachment gain (AG), and keratinized tissue change (KTC) were also calculated. All individuals completed the entire study period. At baseline, mean VR, HR, CAL, KTW, and TT values were similar (P >0.05). In both groups, all parameters showed significant improvement after treatment (P <0.001), and except TT (P <0.05), no intergroup difference was observed at 6 months after surgery. The amount of RC and AG, but not KTC and CRC, was higher in the PRF-applied group (P <0.05). According to the results, the addition of PRF did not further develop the outcomes of CAF + CTG treatment except increasing the TT. However, this single trial is not sufficient to advocate the true clinical effect of PRF on recession treatment with CAF + CTG, and additional trials are needed.

Esthetic root coverage of Miller′s Class II recession with laterally positioned flap

Gingival recession is one of the common soft tissue problems faced by dentists and patients. Marginal gingival recession specially in the anterior teeth is of common concern due to functional and aesthetic problems. The exposed root surfaces cause deterioration in the esthetic appearance, dentin hypersensitivity, and inability to perform proper oral hygiene procedures. Various surgical techniques have been introduced to correct gingival recession defects. This article presents a case which was successfully managed by lateral pedicle technique for root coverage in single teeth in the lower anterior region. In this procedure the soft tissues adjacent to the recession area was positioned over the defect. This technique resulted in an esthetically healthy periodontium alongwith good patient's acceptance. The outcome of this procedure resulted in a clinically significant amount of root coverage.

Fibrin glue application in conjunction with tetracycline hydrochloride root conditioning and semilunar coronally repositioned flap in the treatment of gingival recession

The purpose of this case report is to present the results of Fibrin Adhesive System (FAS) application, a topical biological tissue adhesive in the treatment of maxillary buccal recessions. A 40-year-old male patient presented with a pair of class I buccal recession defects on maxillary cuspids. Clinical parameters were recorded at baseline, 1 month, and 3 months. Semilunar coronally repositioned flap (Tarnow's technique), root debridement, root conditioning with tetracycline hydrochloride solution and one of the defect was treated with FAS application. Significant recession, height reduction, and attachment gain were observed with the FAS application defect site. About 50% of root coverage was noted in the FAS-treated defect and almost no root coverage in the defect site with no FAS application. Semilunar coronally repositioned flap with FAS application is an effective procedure for root coverage in anterior teeth. The addition of FAS improves the amount of root coverage, especially in relatively shallow defects.

A Comparative Study of Root Coverage Using Two Different Acellular Dermal Matrix Products

Gingival recession remains an important problem in dental esthetics. A new dermal matrix material has been introduced, but its effectiveness has not been studied and compared to current dermal matrix material. The aim of this study is to compare the healing associated with a coronally advanced flap for root coverage in areas of localized tissue recession when using Alloderm (ADM) and Puros Dermis (PDM). A split-mouth design was used for this study, with 52 contralateral sites in 14 patients with Miller Class I or III facial tissue recession. Twenty-six sites were treated with coronally advanced flap using PDM, and 26 sites were treated with coronally advanced flap using ADM, all followed for 6 months. Clinical measurements of vertical recession, keratinized tissue, probing depths, and attachment levels were made initially, at 3 months, and at 6 months. Both groups had significant improvement in the amount of recession coverage with means of 2.83 mm for the PDM and 3.13 mm for the ADM. The percentage of root coverage was 81.4% for the PDM and 83.4% for the ADM; differences between the materials were not statistically significant. Based on the results of this study, there was no statistical or clinical difference in the amount of root coverage, probing depth, or keratinized tissue in coronally advanced flaps for root coverage with either of the two acellular dermal matrix materials. Both materials were successful in achieving root coverage.

Influence of gingival biotype on the amount of root coverage following the connective tissue graft

Purpose: The integrity of interproximal hard/soft tissue has been widely accepted as the key determinant for success or degree of root coverage following the connective tissue graft. However, we reason that the gingival biotype of an individual, defined as the distance from the interproximal papilla to gingiva margin, may be the key determinant that influence the extent of root coverage regardless of traditional classification of gingival recession. Hence, the present study was performed with an aim to verify that individual gingival scalloping pattern inherent from biotype influence the level of gingival margin following the connective tissue graft for root coverage. Methods: Test group consisted of 43 single-rooted teeth from 21 patients (5 male and 16 female patients, mean age: 36.6 years) with varying degrees of gingival recession requiring connective tissue graft; 20 teeth of Miller class Ⅰ and 23 teeth of Miller class Ⅲ gingival recession, respectively. The control group consisted of contralateral teeth which did not demonstrate apparent gingival recession, and thus not requiring root coverage. For a biotype determination, an imaginary line connecting two adjacent papillae of a test tooth was drawn. The distance from this line to gingival margin at mid-buccal point and this distance (P-M distance) was designated as “gingival biotype” for a given individual. The distance was measured at baseline and 3 to 6 months examinations postoperatively both in test and control groups. The differences in the distance between Miller class Ⅰ and Ⅲ were subject to statistical analysis by using Studentʼs t-test while those between the test and control groups within a given patient were by using paired t-test. Results: The P-M distance at 3 to 6 months postoperatively was not significantly different between Miller classⅠ and Miller class Ⅲ. It was not significantly different between the test and control group in a given patient, either, both in Miller classⅠ and Ⅲ. Conclusions: The amount of root coverage following the connective tissue graft was not dependent on Millerʼs classification, but rather was dependent on P-M distance, strongly implying that the gingival biotype of a given patient may play a critical impact on the level of gingival margin following connective tissue graft. (J Korean Acad Periodontol 2009;39:111-118)

Modeling mucosal dimensions after implantation of a bio-absorbable membrane for surgical root coverage

The aim of this study was to model alterations of mucosal thickness after implantation of a bio-absorbable membrane for surgical root coverage employing guided tissue regeneration. Periodontal conditions around 31 recession sites in 14 patients were assessed for up to 12 months after surgery. Mucosal thickness was modeled in a multivariate, three-level (occasion, tooth, subject) time series model. The amount of root coverage was studied in a bivariate multilevel model of change and mean recession to avoid mathematic coupling. Predictions of gingival thickness were, at the outset, strongly related to baseline gingival width. At maxillary teeth, gingival thickness at all measurement locations peaked 3 months after surgery with negative relations to baseline gingival width. Thereafter, thickness gradually decreased but remained higher (0.3-0.5 mm, 95% confidence interval 0.05-0.9 mm) than before surgery, while positive correlations with baseline gingival width were re-established. At mandibular teeth, gingival thickness did not change so dramatically, while thickness of lining mucosa underwent similar changes as at maxillary teeth. In contrast to previous publications, modeling change of recession depth and mean recession did not yield better results in deeper sites when applying a bivariate multilevel model that avoids mathematic coupling.