Buccal Gingival Recession Research Articles

Coronally Advanced Flap for the Treatment of Buccal Gingival Recessions With and Without Enamel Matrix Derivative. A Split‐Mouth Study

The coronally advanced flap (CAF) is a predictable method for achieving root coverage in buccal gingival recessions. The use of enamel matrix derivative (EMD) has already been tested in treating intrabony defects. No clinical comparative study has been published evaluating the CAF in combination with EMD in treating buccal gingival recessions. This split-mouth study was performed to assess the efficacy of EMD to improve the results of a root coverage procedure. Fourteen pairs of Miller Class I and II bilateral comparable defects were selected in 12 patients. In each patient, one site was randomly assigned to the test group and the contralateral site to the control group. The treatment consisted of a CAF procedure with (test) or without (control) EMD. Gingival recession (REC), clinical attachment level (CAL), probing depth (PD), and extension of keratinized tissue (KT) were recorded at baseline and 6 months postsurgery. The average initial REC was 3.71 mm (SD +/- 1.68) for the test group, and 3.50 mm (SD +/- 1.56) for the control group. The 2 groups were statistically homogeneous. The mean root coverage was 3.36 mm (SD +/- 1.55), corresponding to a value of 91.2% for the test group, and 2.71 mm (SD +/- 1.20), equal to 80.9% for the control group. The differences between the 2 groups were not statistically significant. The mean CAL gain was 3.57 mm (SD +/- 1.55) for the test group and 2.79 mm (SD +/- 1.19) for the control group. No changes of PD and KT were found. This study suggests that EMD does not seem to significantly improve the clinical outcomes of gingival recession treated by means of CAF, even though the test group showed slightly better results in terms of root coverage and CAL. Further studies with a larger number of teeth and higher statistical power are needed to support this conclusion.

Gingival recession and toothbrushing in an Italian School of Dentistry: a pilot study.

The aim of this pilot study was to evaluate the prevalence of gingival recession at buccal tooth surfaces in a student population of Bologna University Dental School. A total of 55 subjects, attending the 1st and 5th year of the course were examined. The clinical examination involved assessment of plaque, calculus, width of keratinized gingiva, buccal probing depth and buccal gingival recession. Information about toothbrushing behavior was collected in an interview. The multiple regression analysis showed that level of education (p=0.002), toothbrushing technique (p=0.013) and toothbrushing frequency (p=0.016) are significant contributors to gingival recession. Notwithstanding the limits of a preliminary study, a higher prevalence of buccal recession is observed in the final year students, which have also a significantly lower % of buccal surfaces with calculus (p=0.014). In addition, it clearly appears that there is the necessity to investigate other factors connected with toothbrushing (pressure, time, toothpaste quantity) in order to provide an oral hygiene education without undesired effects.

Long-term stability of the mucogingival complex following guided tissue regeneration in gingival recession defects.

The purpose of the present study was to evaluate the stability of soft tissue conditions in gingival recession defects treated with guided tissue regeneration (GTR). The study population was selected among those patients who had been treated with GTR procedures for Miller's class I or II, deep (> or =3 mm), buccal gingival recession defects. Defects were included only when they had revealed recession depth reduction > or =2 mm and root coverage > or =60% at 6 months following GTR treatment. These defects were regarded as successfully treated and scheduled for further monitoring. 20 patients, 11 male and 9 female, aged 23 to 57 years (mean age: 33.2 years), each contributing 1 defect, were selected. 9 patients were smokers (> or =10 cigarette per day). Recession depth (RD), probing depth (PD), clinical attachment level (CAL), and width of keratinized gingiva (KG) were assessed immediately before surgery, at 6 months post-surgery (baseline examination), and at 4 years post-surgery (4-year examination). At baseline examination, RD reduction was 3.6+/-0.9 mm (mean root coverage: 80%). CAL gain amounted to 4.2+/-1.3 mm, 60% of the defects showing CAL gain > or =4 mm. KG increased from 1.9+/-1.2 mm at presurgery examination to 3.1+/-0.9 mm at baseline examination. At 4-year examination, no significant changes from baseline RD, CAL and KG recordings were observed. Differences in baseline-4 year changes between smokers and non-smokers were not statistically significant. The results of the present study demonstrate that clinical outcome achieved following GTR procedure in gingival recession defects can be maintained over periods up to 4 years.

Effect of Topical Application of a Fibrin-Fibronectin Sealing System on Healing Response Following Periodontal Surgical Procedures

The purpose of these controlled clinical trials was to evaluate the effect of a fibrin-fibronectin sealing system (FFSS) application on periodontal wound healing. Treatment outcomes following periodontal surgery were investigated by selecting different surgical procedures where wound stability was affected by defect anatomy, surface treatment, flap management and adjunctive application of wound-stabilising devices. In each patient, treatment modalities were randomly assigned according to a split-mouth design. In the first trial, 11 patients presenting with a pair of moderate to severe supra-alveolar defects were treated with flap debridement surgery with or without tetracycline HCl (TTC) root conditioning and FFSS application. In the second trial, 11 patients presenting with a pair of buccal gingival recession defects were treated with coronally positioned flap procedure and TTC root conditioning with and without FFSS application. In the third trial, 8 patients presenting with a pair of buccal gingival recession defects were treated with coronally positioned flap procedure, TTC root conditioning and teflon membrane with and without FFSS application. Conventional probing recordings, including probing depth, clinical attachment level and recession depth, were made immediately before surgery and 6 months postsurgery. Overall, the results indicated that periodontal healing following surgery resulted in a clinically and statistically significant improvement in the defect, and that the adjunctive application of FFSS produced limited to no enhancement of treatment outcome.

Comparative Study of a Bioresorbable and a Non‐Resorbable Membrane in the Treatment of Human Buccal Gingival Recessions

Twelve patients with bilateral comparable gingival recessions were treated using a split mouth design, to compare the relative success of root coverage by two regenerative procedures. The areas of recession treated were Class I or II according to Miller's classification and caused either an esthetic problem and/or root sensitivity. The symmetrical defects, on the maxillary canines, 4 mm or deeper, were randomly assigned in each patient to surgical procedures with either a bioresorbable matrix barrier (test) or a non-resorbable expanded polytetrafluoroethylene membrane (control). Gingival recession, clinical attachment level, probing depth, and extension of keratinized tissue were measured at baseline and at 6 months postsurgically. Both procedures resulted in significant root coverage (P < 0.0001) and attachment gain (P < 0.0001). The gingival recession decreased from 4.75 +/- 0.22 mm to 0.83 +/- 0.24 mm and from 4.75 +/- 0.22 mm to 0.75 +/- 0.22 mm, corresponding to a mean root coverage of 82.4% and 83.2%, at the test and control sites respectively. The average clinical attachment gain was 4.33 +/- 0.44 mm at the test sites compared to 4.42 +/- 0.48 mm for the non-resorbable barrier. No significant changes were found for probing depth and keratinized tissue. Data analysis did not demonstrate any significant difference between the two procedures for any of the variables included. However, a questionnaire given to each patient revealed the single-step surgery to be the patients' choice.

Effects of Tetracycline HCl Conditioning and Fibrin‐Fibronectin System Application in the Treatment of Buccal Gingival Recession With Guided Tissue Regeneration

A split-mouth clinical trial was designed to evaluate the effect of treating deep wide buccal gingival recession with guided tissue regeneration using expanded polytetrafluoroethylene membrane combined with tetracycline HCl (TTC) root conditioning and fibrin-fibronectin sealing system (FFSS) application. Eight patients, aged 25 to 57 years, each presenting two similar mucogingival defects, were selected. The two bilateral recessions were randomly assigned in each patient to either test or control treatment procedure. After initial therapy, each patient was examined for assessment of plaque, gingivitis, recession depth (RD), probing depth (PD), probing attachment level (PAL), and keratinized tissue width (KT). The test procedure included the elevation of mucoperiosteal flap at the buccal aspect of the alveolar process. The root was debrided and demineralized with 100 mg/ml TTC solution for 4 minutes using a burnishing technique with cotton pellets. A teflon membrane was secured and a film of FFSS was applied between the membrane and the root surface. The buccal flap was sutured to completely submerge the membrane. Control treatment included gingival flap surgery with barrier membrane alone. After 6 weeks, the membrane was removed. Healing was evaluated 6 months after surgery. Both test and control procedures resulted in highly significant recession reduction (3.0 mm +/- 1.1 and 2.6 mm +/- 1.2, respectively) and attachment gain (3.6 mm +/- 1.7 and 2.6 mm +/- 1.1, respectively). Mean root coverage was of 67% in the TTC + FFSS treated sites and 60% in membrane-only treated sites. However, only treatment with TTC + FFSS significantly reduced PD and increased KT (P < 0.05). When treatments were compared, changes in PD and PAL were significantly greater in TTC + FFSS treated sites (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Healing Response of Human Buccal Gingival Recessions Treated With Expanded Polytetrafluoroethylene Membranes. A Retrospective Report

Twenty-four (24) deep wide buccal gingival recessions were treated with ePTFE membrane according to guided tissue regeneration principles (GTR). Factors affecting the surgical outcome of the regenerative procedure were retrospectively analyzed. In 16 cases, the barrier membrane was used in conjunction with tetracycline root conditioning and fibrin-fibronectin system application, and 8 cases were treated with the membrane alone. Healing response was evaluated 12 months after surgery. Since no difference was observed between the two treatment protocols, all available data were grouped. Mean recession depth was reduced from 4.6 mm to 1.3 mm postoperatively, which represents an average root coverage of 71.7%. Fifty percent (50%) of the cases showed clinical attachment gain greater than or equal to 4 mm and a mean increase of keratinized tissue of 1.0 mm was observed. Baseline recession depth and extent of membrane exposure at the reentry procedure significantly influenced the amount of newly-formed tissue under the membrane. Recession reduction positively correlated with the preoperative recession depth and the regenerated tissue gain. Treatment was also affected by tooth location, recession reduction, and attachment gain, being significantly greater in upper than lower archs. Results suggest that GTR technique represents a predictable procedure to improve the soft tissue conditions of deep mucogingival defects. Randomized controlled trials of other forms of management of mucogingival defects as compared to the GTR technique will be necessary to fully evaluate the utility of the GTR technique.

The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene.

The aim of this study was to evaluate the prevalence and the development/progression of attachment loss and gingival recession at buccal tooth surfaces in a population sample with a high standard of oral hygiene. An additional aim was to study the relationship between attachment loss and gingival recession. The subject sample examined comprised 225 regular dental care attendants at 12 community dental clinics in Sweden. All subjects were subjected to a baseline examination in 1977-78 and were re-examined after 5 years and 12 years. The clinical examinations involved assessment of plaque, gingivitis, probing depth, probing attachment loss and gingival recession. A full-mouth set of intraoral radiographs was obtained at each examination and used for determination of the height of periodontal bone support. The results of the cross-sectional and longitudinal analyses performed showed that in subjects with a high standard of oral hygiene (i) buccal gingival recession was a frequent finding, (ii) the proportion of subjects with recession increased with age, (iii) the prevalence as well as the incidence of recessions within the dentition showed different patterns depending on age, (iv) sites with recession showed susceptibility for additional apical displacement of the gingival margin and (v) loss of approximal periodontal support was associated with gingival recession at the buccal surface.

Site-related streptococcal attachment to buccocervical tooth surfaces. A correlative micromorphologic and microbiologic study.

Scanning electron (SEM) microscopy of epoxy replicas made from dental impressions has shown that in buccal gingival recession the root surfaces are devoid of cementum, leaving the dentin exposed. In this study replication techniques were applied to correlate the micromorphology of the buccocervical region with early streptococcal attachment. The subjects were 27 healthy young adults. The buccocervical surfaces of all the premolars were meticulously cleaned. The subjects fasted for 2 h before impression-taking. Replicas were made from impressions in hydrophilic A-silicone, and streptococcal attachment was visualized by light microscopy of mitis-salivarius agar replicas incubated anaerobically for 48 h. The surface micromorphology was documented by SEM of corresponding epoxy replicas. Colonization only 2 h after cleaning was very sparse. Sites with healthy or inflamed gingivae had markedly different colonization patterns in the sulcular region. In 4 subjects with a total of 12 sites where gingival recession, undetected clinically, was disclosed by SEM, representative colonies were retrieved and identified microbiologically to species level. Two healthy sites per subject were also sampled. Streptococcus mutans and S. sobrinus were identified from eight sites with exposed root dentin. S. oralis predominated on the enamel surfaces. The method offers a valuable complement to in situ and in vitro microbiologic studies of exposed dentin and a novel technique for sampling clinical isolates of streptococci.