Connective Tissue Graft Procedure Research Articles

Effectiveness of Tunnelling Modification Technique Using Platelet-rich Fibrin and Connective Tissue Graft in Gingival Recession: A Systematic Review

Background Gingival recession is a concern in aesthetic and functional perspective. The tunneling technique (TT) is one of the effective root coverage treatments in some gingival recession defects and is associated with favorable outcomes. This paper aims to evaluate the effectiveness of platelet-rich fibrin (PRF) and connective tissue graft (CTG) in gingival recession treatment with TT. Methods This systematic review used the PRISMA method and electronic bibliographic searches were conducted on seven databases (Google Scholar, Wiley, Pubmed, Sage, Ovid Technologies, Quintessence Publishing, Springer) from December 2018 to January 2023. The search focused on randomized clinical trials (RCTs) that reported TT outcomes in the treatment of Miller class I and II recession with a minimum of six months follow-up. Results Three out of 399 studies met the inclusion criteria. The three selected studies presented PRF and CTG use in multiple gingival recessions to evaluate tissue condition and clinical parameters before and after the surgical procedure. The clinical parameters evaluated were probing pocket depth (PPD), recession width (RW), width of keratinized gingiva (WKG), and vertical depth of recession (VDR). TT with PRF and TT with CTG is effective in treating gingival recession. PRF is well accepted by patients with a less invasive procedure compared to the CTG procedure. However, TT with CTG showed better results in all parameters at follow-up. Conclusions TT with PRF can be used as an alternative to treat some gingival recession defects. However, TT with CTG produced better clinical results in recession closure.

Dental Soft Tissues and Palatal Masticatory Mucosa from the Periodontal and Radiographic Perspectives: A Review Article

This review article delves into the advancements in the assessment and management of palatal masticatory mucosa, with a particular emphasis on the thickness of the palatal mucosa and its implications for periodontal and peri-implant surgeries. It highlights the pivotal role of cone beam computed tomography (CBCT) in evaluating Thickening of the palatal mucosa, despite its inherent limitations in soft tissue visualization. The paper discusses the evolution of mucogingival surgery, including the classification of marginal tissue recession and soft tissue grafts, and examines the histology of palatal mucosa. It also evaluates the indications, predictability, and clinical as well as aesthetic outcomes of free gingival graft (FGG) & connective tissue graft (CTG) procedures. Various methodologies to measure palatal mucosa thickness are explored, alongside strategies to overcome CBCT's limitations in soft tissue assessment. The review underscores the significance of a comprehensive understanding of palatal masticatory mucosa's anatomy and histology, alongside the surgical techniques available for managing mucogingival deficiencies. It aims to enhance the predictability and aesthetics of periodontal and peri-implant surgeries through advancements in diagnostic and surgical techniques, coupled with a deeper understanding of tissue biology.

Https://scholarhub.ui.ac.id/jdi/vol30/iss1/1/

Fenestration term is derived from the Latin word ‘fenestra’ means ‘window’. Gingival fenestration is not found in routine while its actual occurrence is assumed to be higher. Additionally, if these mucogingival defects persist for a longer duration it may lead to adverse outcomes like compromised esthetics, hypersensitivity, plaque and calculus deposition, and susceptibility to dental caries. Present cases of gingival fenestration were successfully treated by using full-thickness flap elevation with connective tissue graft placement. Two cases were presented with the accumulation of plaque and calculus and having gingival fenestration to the respective sites. After phase 1 therapy, full thickness flap was raised and a connective tissue graft was placed beneath the fenestrated area. The successful results were obtained in both cases in terms of complete closure of gingival fenestration defects and well-adapted margins with adjacent tissues at one year of follow-up. Full thickness flap with connective tissue graft procedure resulted in complete closure of gingival fenestration in both cases with no recurrence at one-year follow-up and can be used as a successful and predictable treatment modality for the management of such cases.

Covering the Uncovered: Complete Root Coverage of Gingival Recession using Sub-Epithelial Connective Tissue Graft

Gingival recession is defined as the displacement of marginal tissue apical to cementoenamel junction, exposing the root surface. It is caused by traumatic toothbrushing, periodontitis, high frenal attachment, and injudicious orthodontic tooth movement. It leads to dentinal hypersensitivity, aesthetic problem, root caries, cervical abrasion and difficulty in oral hygiene maintenance. This can be managed by root coverage procedure which can be achieved by various surgical techniques. This case report shows successful management of Miller’s Class II gingival recession using sub-epithelial connective tissue graft procedure that was followed up for six months without any complications.

Outcome measurements following palatal soft tissue graft harvesting: A review.

BackgroundFree gingival graft (FGG) and connective tissue graft (CTG) are two of the most commonly techniques performed in periodontal and peri-implant plastic surgery. Although several outcome measurements have been proposed for evaluation of palatal wound healing and patient morbidity, a comprehensive review about these variables is lacking. The objective of this review is to present comprehensive information about outcome measurements related to postoperative palatal wound healing and postoperative patient-reported morbidity after FGG or CTG procedures. Material and MethodsAn electronic search of English language dental literature in the Medline database via PubMed access was conducted from May 1994 to May 2020 following the PRISMA guidelines. Electronic search strategy complemented by hand search of impacting related dental journals, and the reference list of all included studies were used to complete data collection considering only clinical trials. Finally, inclusion criteria were applied to identify articles after full-text evaluation. ResultsA total of 111 articles were identified. After the exclusion of 34 articles based on title and abstract evaluation, 77 articles were full text screened. Following, 46 articles were excluded since they evaluated other surgical areas. Finally, 31 studies were selected and included for final evaluation. Outcome measurements were classified in variables collected by indexes and systems assessed professionally and patient-centered measurements. Visually-assessed measurements include indexes, photographs, bleeding and use of laboratory-aided measurements. Patients-centered outcomes comprise pain, discomfort and quality-of life, among others. ConclusionsThe most commonly used outcome measurements related to postoperative palatal wound healing are hydrogen peroxide test, tissue color match, visual inspection, and bleeding evaluation. Pain perception, analgesic consumption, discomfort sensation, burning sensation, and changes in feeling habits are the most commonly used outcome measurements related to postoperative patient-reported morbidity. Key words:Morbidity, patient comfort, periodontics, tissue harvesting, wound healing.

Evaluation of Connective Tissue Grafts Versus Free Gingival Grafts

Root coverage is one of the important aims of periodontal therapy. The aim of the study was to evaluate the connective-tissue grafts (CTG) and free gingival grafts (FGG) in root coverage procedures. A retrospective study of sample size 32 was conducted. These patients underwent a root coverage procedure done using grafts. The details on which graft was obtained from patient records were reviewed and analysed between June 2019 to March 2020. Excel tabulation was done, analysed and transferred to SPSS for statistical analysis. The p value was set at 0.05. In the study, it was found that CTG was used in 56.25% of the patients and FGG was used in 43.75% of the patients undergoing root coverage procedure. It was found that Free gingival grafts (25%) were placed more commonly in females when compared to connective tissue grafts (18.75%). However, in males, connective tissue grafts (37.5%) were placed more commonly than free gingival grafts. (18.75%) The prevalence of connective tissue graft was more when compared to free gingival graft at 36-55 years of age. Connective tissue graft was done more commonly in the age group of 15-35 years. Prevalence of connective tissue grafts was more in males than in females. Within the limits of the study, it was found that connective tissue graft (CTG) procedures performed more than free gingival graft (FGG) procedures following the gold standard for root coverage in gingival recession treatment.

Aesthetic‐And patient‐related outcomes following root coverage procedures: A systematic review and network meta‐analysis

Aim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self-reported morbidity (post-operative pain/discomfort). A comprehensive literature search was performed. A mixed-modelling approach to network meta-analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient-reported satisfaction and post-operative pain/discomfort (visual analogue scale (VAS) of 100). Twenty-six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p=.005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p=.01) and CAF+Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p=.04)) were significantly associated with higher RES than CAF. No significant difference between CAF+CTG and TUN+CTG was detected (0.09 (95% CI [-0.54, 0.72], p=.77)). Addition of CTG resulted in less natural tissue texture (-0.21 (95% CI [-0.34, -0.08]), p=.003) and gingival colour (-0.06 (95% CI [-0.12, -0.03], p=.03)) than CAF. CTG techniques were associated with increased morbidity. Connective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG-based techniques were also correlated with a greater patient satisfaction and morbidity.

Miller Class III root coverage with coronary tissue repositioning associate with conjunctive graft

Miller Class III root coverage with coronary tissue repositioning associate with conjunctive graft

Allografts and Xenografts for Periodontal Plastic Surgical Procedures

The selection of surgical techniques and grafting materials is undoubtedly a critical component in the treatment of gingival recession defects. In order to provide top quality care, dental professionals are always in pursuit of treatment modality that provides maximal efficacy and predictability with minimal patient morbidity. The subepithelial connective tissue graft procedure, the gold standard, has been consistently proven to show excellent root coverage, but limited palatal tissue availability and potential morbidity associated with the harvesting process push dental practitioners to seek an alternative. The same holds true for peri-implant tissues—while autogenous grafts have served our purpose well, alternatives that can achieve similar results while avoiding a second intraoral wound (the donor sites) are preferred. The purpose of this review of recent studies is to evaluate the effectiveness and predictability of allografts and xenografts for root coverage procedures and around dental implants. The electronic database search was limited to the past 5 years and to the studies addressing root coverage procedures in the Miller class I and II gingival recession (even though the 2017 International Workshop suggested a new classification, the majority of research projects use the classic Miller classification). Search was also made for studies addressing soft tissue treatment around implants that were published during the same period. A total of 30 human clinical trials involving allografts (mainly acellular dermal matrix and placental membranes) and xenografts (porcine-derived collagen matrix) for treatment of gingival recession and a total of 19 clinical studies using allografts and xenografts to improve soft tissue quality around implants were selected. Based on the selected studies, acellular dermal matrix in combination with various flap designs appears to produce results similar to autogenous grafts in terms of mean root coverage and width of keratinized tissue. Other grafting materials, while less effective compared to autogenous grafts, still show some promise especially in patient-centered outcomes. For soft tissue quality improvement around implant sites, allografts and xenografts in general provide satisfactory clinical results. Multicenter, randomized clinical studies with large numbers of individuals and long-term outcomes may provide the most realistic answer for this topic.

Er-Yag Laser Root Preparation During Subepithelial Connective Tissue Graft Procedures.

Areas of gingival recession cause either an esthetic problem and or root sensitivity. Obtaining predictable root coverage has become an important part of periodontal therapy. A deep, long – standing recession promoted by ANUG was treated using subepithelial connective tissue graft technique combined with decontamination of root surface by using Er:YAG laser. Our clinical findigs suggest that this technique is a predictable procedure to treat gingival recession and promote root decontamination.

CLINICAL EVALUATION OF CONNECTIVE TISSUE GRAFT IN THE TREATMENT OF SINGLE \r\nGINGIVAL RECESSION DEFECTS OF PATIENTS WITH THIN GINGIVAL BIOTYPE\r\n

Ponte Academic JournalJan 2019, Volume 75, Issue 1 CLINICAL EVALUATION OF CONNECTIVE TISSUE GRAFT IN THE TREATMENT OF SINGLE GINGIVAL RECESSION DEFECTS OF PATIENTS WITH THIN GINGIVAL BIOTYPEAuthor(s): Eylem Ayhan AlkanJ. Ponte - Jan 2019 - Volume 75 - Issue 1 doi: 10.21506/j.ponte.2019.1.2 Abstract:Objectives: The connective tissue graft (CTG) is considered to be the most performed procedure in the treatment of gingival recession defects. The purpose of this study was to evaluate the clinical efficacy of (CTG) in the treatment of Miller class I and II single gingival recession defects of patients with thin gingival biotype.Material and methods: 14 systemically healthy patients (8 females and 6 males); aged 30 to 55 years were treated. The clinical parameters plaque index (PI), gingival index (GI), gingival thickness (GT), probing depth (PD), recession height (RH), recession width (RW), and amount of attached gingiva (AG) were recorded at baseline and re-measured at 6 months. Results: CTG procedure resulted in statistically significant decreases in PD, RH, RW, and increases in AG at 6 months (p<0.05). There was also a significant gain in the CAL (p<0.05). The mean percentage root coverage at the final evaluation was 95%.Conclusion: Within the limits of present study it can be concluded that CTG has favourable results in the treatment of Miller Class I and II single gingival recession defects of patients with thin gingival biotype. Download full text:Check if you have access through your login credentials or your institution Username Password

Evaluation of the effect of dose-dependent platelet-rich fibrin membrane on treatment of gingival recession: a randomized, controlled clinical trial.

Miller's class I gingival recessions (GR) have been treated using coronally advanced flap (CAF) with platelet-rich fibrin membrane (PRF membrane) or connective tissue graft (CTG).Objective:The aim of this study was to evaluate the effect of different multiple layers of PRF membranes for the treatment of GR compared with the CTG procedure.Material and Methods:Sixty-three Miller class I GR were treated in this study. Twenty-one GR selected randomly were treated with two layers of PRF membranes+CAF in 2PRF+CAF (test group-1), four layers of PRF membranes+CAF in 4PRF+CAF (test group-2), and CTG+CAF in the control group. The plaque index (PI), gingival index (GI), probing depth (PD), keratinized tissue thickness (KTT), clinical attachment level (CAL), recession depth (RD), recession width (RW), and keratinized tissue height (KTH) measurements were performed at baseline and 1, 3, and 6 months after surgery. The post-operative discomfort of patients, assessed with the visual analog scale (VAS) and healing index (HI), was recorded after surgery.Results:PI, GI, and PD scores were similar for all patients at all times. RD and RW scores were similar for each patient at 1 month, but these values were significantly increased in the subsequent periods in test group-1. The increase in KTT was significantly higher in the control group compared with the test groups. Similar root coverage scores were obtained in the test group-2 and control groups, and these scores were significantly higher compared with test group-1.Conclusions:The PRF membrane+CAF technique may be an alternative to the CTG+CAF technique for postoperative patient comfort. However, PRF membranes should use as many layers as possible.

Low-level laser therapy as an adjunct to connective tissue graft procedure in the treatment of gingival recession defects: A systematic review and meta-analysis.

The aim of this study was to systematically evaluate the effectiveness of low level laser therapy (LLLT) as an adjunct to connective tissue graft (CTG) procedure for the treatment of gingival recession (GR). The addressed PICO question was; "In patients with Miller Class I or II recession defects (Population), what is the effect of LLLT as adjunct to CTG (Intervention) in comparison to CTG alone (Comparison) on gingival recession depth (Outcome)" Electronic databases were searched up to December 2017. Primary outcomes included gingival recession depth (GRD), whereas secondary outcomes were width of keratinized tissue (WKT) and relative clinical attachment level gain (RCAL). The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model. Four randomized clinical studies were included. Two studies showed significantly greater improvements with LLLT whereas, 2 studies showed comparable outcomes between LLLT and CTG group. Considering the effects of adjunctive LLLT as compared to CTG, a high degree of heterogeneity for GRD (Q value = 9.40, P = .02, I2 =68.11%) and WKT ((Q value = 16.04, P = .001, I2 =81.31%) was noticed among both the groups. Meta-analysis showed a statistically significant GRD (WMD= -0.61, 95% CI= -1.23 to 0.004, P = .05) for LLLT + CTG treatment versus CTG alone only. LLLT improves clinical and patient-centered outcomes of CTG procedures for the treatment of GR remains debatable. However, due to the small number of included studies and high heterogeneity in the laser parameters, precautions must be exercised when interpreting the results of the present systematic review. Gingival recessions in dentistry are of major esthetic concern. Minimal gingival recessions can be treated by flap operations, but the predictability and stability of the outcomes is debatable. In the present review, low level laser therapy (LLLT) adjunct to connective tissue graft (CTG) depicted a significant improvement in the predictability and stability of root coverage outcomes compared with CTG alone.

Root Coverage Procedures for Multiple Recession Defects

The demand for root coverage in multiple gingival recession defects has increased in recent years. Compared to isolated recession, multiple gingival recession defects are much more challenging due to various limiting factors and require more sophisticated surgical techniques. This review aims to address recent progress in the management of multiple recession defects. The subepithelial connective tissue graft (SCTG) procedure, while effective, is limited due to tissue availability and patient preference to avoid a donor harvest site. Different surgical techniques and biological materials have been studied in an attempt to find ideal alternatives. Based on the studies reviewed, the SCTG procedure still remains the gold standard in terms of percent root coverage. Acellular dermal matrix allograft in conjunction with different flap designs has shown comparable, satisfactory results up to 1 year postoperatively. Other materials such as porcine collagen matrix and enamel matrix derivative also show some promise. Well-designed studies with long-term outcomes are still needed.

Connective Tissue Graft for Gingival Recession in Mandibular Incisor Area: A Case Report.

We report a case of gingival recession in the mandibular incisor region requiring a connective tissue graft. The patient was a 17-year-old girl who visited the Tokyo Dental College Chiba Hospital in 2014 with the chief complaint of gingival recession in the lower incisor region. She had received orthodontic treatment for 5 years and noticed the gingival recession on completion of active orthodontic treatment in 2013. Gingival recession in tooth #31 extended 3 mm beyond the muco-gingival junction (MGJ) and was clinically diagnosed as Miller Class II recession; probing depth was 6 mm. Following initial periodontal therapy, a connective tissue graft procedure was implemented. The connective tissue was harvested from the left palate. Healing was uneventful, and the grafted site showed a favorable outcome at 6 months postoperatively. We are continuing to carefully monitor the condition of periodontal tissue.

Gingival recession coverage: Do we still need autogenous grafts?

A variety of periodontal plastic surgical techniques have been proposed to obtain root coverage of gingival recession defects. All of the available root coverage procedures are able to provide significant root coverage for Miller Class I and II recession-type defects. However, only the subepithelial connective tissue graft in conjunction with a coronally advanced flap appears consistently effective across all clinical parameters, and is therefore currently considered the gold standard for gingival recession therapy. The major shortcomings of connective tissue graft procedures include patient morbidity associated with the second surgical site and limited availability of palatal donor tissue. More recently, 3D collagen matrices of human and porcine origin have been introduced as possible alternatives to autogenous connective tissue grafts in recession coverage procedures. This paper aims to give an overview on the possible use of collagen matrices as soft tissue substitutes and a possible alternative to connective tissue grafts in the surgical treatment of gingival recession defects.

Clinical evaluation of expanded mesh connective tissue graft in the treatment for multiple adjacent gingival recessions in the esthetic zone.

Background:Multiple approaches have been used to replace lost, damaged or diseased gingival tissues. The connective tissue graft (CTG) procedure is the golden standard method for root coverage. Although multiple sites often need grafting, the palatal mucosa supplies only a limited area of grafting material. To overcome this limitation, expanded mesh graft provides a method whereby a graft can be stretched to cover a large area. The aim of this study was to evaluate the effectiveness and the predictability of expanded mesh CTG (e-MCTG) in the treatment of adjacent multiple gingival recessions.Materials and Methods:Sixteen patients aged 20–50 years contributed to 55 sites, each site falling into at least three adjacent Miller's Class 1 or Class 2 gingival recession. The CTG obtained from the palatal mucosa was expanded to cover the recipient bed, which was 1.5 times larger than the graft. Clinical measurements were recorded at baseline and 3 months, 12 months postoperatively.Results:A mean coverage of 1.96 mm ± 0.66 mm and 2.22 mm ± 0.68 mm was obtained at the end of 3rd and 12th month, respectively. Twelve months after surgery a statistically significant increase in CAL (2.2 mm ± 0.68 mm, P < 0.001) and increasing WKT (1.75 ± 0.78, P < 0.001) were obtained. In 80% of the treated sites, 100% root coverage was achieved (mean 93.5%).Conclusions:The results of this study demonstrated that multiple adjacent recessions were treated by using e-MCTG technique can be applied and highly predictable root coverage can be achieved.

Dimensional Changes During Early Healing After a Subepithelial Connective Tissue Graft Procedure

The subepithelial connective tissue graft (CTG) is a popular means to treat gingival recession and augment keratinized tissue. Studies exist that examine long-term outcomes of this procedure; however, changes in tissue dimensions during early healing (0 to 21 days postoperatively) are unknown. The aim of this study is to examine bucco-lingual tissue dimension (gingival tissue thickness [GT]) changes during early CTG healing using a non-invasive technique. Thirteen patients who had treatment planned for CTG on a single tooth were recruited for the study. Using a customized acrylic stent, GT was measured preoperatively, at surgery completion, and at 3, 7, 14, and 21 days postoperatively. CTG was performed using an envelope technique. GT changes were analyzed by repeated-measures analysis of variance. All CTG procedures were considered successful with no postoperative complications. GT increased 1.5 mm immediately after surgery (baseline) compared to the preoperative measurement. GT increased on average 96%, 47%, and 2% compared to baseline at days 3, 7, and 14, respectively. Day 3 and day 7 measurements were significantly different from baseline (P <0.001). At day 21, GT decreased 15% compared to baseline, with an average increase of 1.29 mm from preoperative measurements. The early postoperative healing of CTGs used for root coverage exhibits a significant but transient increase in bucco-lingual tissue dimension. The observed increase in bucco-lingual tissue dimension subsides by the end of the second postoperative week.

Does the Use of Combined Surgical/Restorative Approaches Enhance the Clinical Outcomes of Recession‐Type Defects With Non‐Carious Cervical Lesions?

Focused Clinical Question In patients presenting recession-type defects and non-carious cervical lesions (NCCLs), does the use of a root coverage procedure associated with the restoration of the NCCL provide superior improvements on recession depth and esthetics than the use of the root coverage procedure alone? Clinical Scenario A 25-year-old female was referred for a root coverage graft on the maxillary right canine. Clinical examination revealed that the canine had a gingival recession associated with root abrasion and cervical resin composite restorations on both premolars. The patient reported that these restorations were performed 1 year earlier as a result of soft-tissue loss and abrasion. Additional loss of gingiva on both premolars had occurred during this period. The treatment options were discussed with the patient, and it was decided to replace both restorations and attempt root coverage using a connective tissue graft procedure (1-7).

Subepithelial Connective Tissue Graft with Growth Factor for the Treatment of Maxillary Gingival Recession Defect

Gingival recession is a challenging defect for clinicians to treat effectively. A number of recent systematic reviews have identified the connective tissue graft (CTG) in combination with coronally advanced flaps (CAFs) as the most consistently effective treatment for Miller Class I and II defects across all outcome measures. Recent advances in recombinant growth factor technology may provide opportunities for improved outcomes in conjunction with CAF + CTG procedures. In this prospective consecutive case series, recombinant human platelet-derived growth factor BB (rhPDGF-BB) was combined with CTGs for the treatment of Miller Class I or II gingival recession defects. Improved outcomes were seen for keratinized tissue gains and percent root coverage at 6 months postsurgery when compared to historic norms. All other outcome parameters appeared equivalent between the two treatment approaches. The addition of rhPDGF-BB appeared to improve early wound healing as well.