Gingival Recession Defects Research Articles

Advanced platelet-rich fibrin versus connective tissue graft in maxillary gingival recession management.

Platelet concentrates have gained significant attention in periodontology due to their regenerative properties. This randomized clinical trial was aimed to compare the clinical efficacy of advanced platelet-rich fibrin (A-PRF) and connective tissue graft (CTG) in the management of recession defects. The objectives were to compare changes in recession height and root coverage percentage between the groups. Systemically healthy individuals presenting Cairo's RT1/RT2 gingival recession defects in the maxilla (n = 40) were treated with either A-PRF or CTG in combination with coronally advanced flap (CAF). Clinical parameters were measured at baseline, 3 months, and 6 months. Mean and complete root coverage percentages were calculated at 3 and 6 months. In both the test (CAF + A-PRF) and control (CAF + CTG) groups, a statistically significant reduction in mean recession height was seen from baseline values of 2.90 ± 0.55mm and 3.15 ± 0.87mm to 0.80 ± 0.95mm and 0.15 ± 0.48mm at 6 months, respectively (p < 0.001). In the test group, 10 sites had complete root coverage at 6 months with mean root coverage of 73.76 ± 29.58%. In the control group, 18 of 20 sites had complete root coverage with mean root coverage of 93.35 ± 23.1%. The control sites had a significantly greater reduction in recession height and higher mean and complete root coverage percentages at 6 months (p < 0.05). The study findings suggest that, the CTG had resulted in superior outcomes than A-PRF along with CAF. Question: To compare the efficacy of advanced platelet-rich fibrin (A-PRF) with connective tissue graft (CTG) in the management of gingival recession defects. Both interventions showed satisfactory healing. At 6 months, the CTG group demonstrated superior results than the A-PRF group. Meaning: CTG has a greater therapeutic potential than A-PRF in the management of gingival recessions. Platelet-derived membranes are widely used in various dental therapies due to their healing properties. Limited studies have been conducted using the novel platelet preparations in the management of receding gums. This study compared the effects of advanced platelet-rich fibrin membrane with conventional soft tissue harvested from the palate in the treatment of gum recession. Twenty-three patients requiring gum augmentation were recruited and treated with either platelet-derived membrane (test group) or tissue harvested from their palate (control group). Clinical parameters were measured at baseline (before intervention), 3 months, and 6 months. Both treatment modalities resulted in significant gum coverage at the end of 6 months. On comparison, the control sites had significantly greater improvements in all the measured clinical parameters indicating that tissue obtained from the palate had superior therapeutic potential.

Effect of suturing in root coverage via coronally advanced flaps: A systematic review.

To analyze the evidence about the influence of the suturing technique and material in terms of the percentage of mean root coverage (%MRC) following root coverage therapy in teeth diagnosed with single/localized gingival recession defects (GRD) via a monolaminar coronally advanced flap. The protocol of this systematic review was registered in PROSPERO (CRD42024514043). A literature search was conducted to identify investigations that fulfilled the eligibility criteria. Variables of interest were extracted, subsequently categorized, and qualitatively analyzed. A total of 15 randomized clinical trials, including 301 localized GRD in non-molar sites classified as Miller class I-II/RT1, in 253 patients were included. The studies reporting the combination of sling and single interrupted sutures, or interrupted sutures alone showed an MRC of 70.2%±16.6%, and 74.1%±0.75%, respectively. The highest MRC was observed in the studies using polyglactin 910 with a pooled value of 76.6% ± 15.3%, and monofilament materials, with a pooled MRC of 74.8%±7.1%. When the suturing diameter was evaluated, the highest pooled MRC with values of 79.1%±9.8% was observed with the use of 5-0. For the treatment of single/localized GRD in non-molar sites via a monolaminar coronally advanced flap, the use of a combination of sling and single interrupted sutures, or single interrupted sutures, polyglactin 910 or monofilament materials, and material diameter of 5-0 showed a higher MRC as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters. There were no differences in the percentage of root coverage achieved between the use of sling and single interrupted, versus single interrupted sutures alone on the treatment of single/localized GRD in non-molar sites. Polyglactin 910 and monofilament sutures resulted in a higher percentage of root coverage achieved as compared to expanded polytetrafluoroethylene, and silk with/without dressing. The use of 5-0 material diameter showed the highest percentage of root coverage achieved. This study was primarily aimed at evaluating how different suturing techniques and materials could affect the percentage of root coverage in single/localized recession defects, without the use of soft tissue substitutes or autogenous soft tissue grafts. After the pooled analyses of 15 randomized clinical trials that fulfilled the inclusion criteria, we observed that the adequate selection of suturing techniques, materials, and size could lead to a higher percentage of root coverage. Specifically, the use of single interrupted with or without sling sutures at the most coronal portion, Polyglactin 910 or monofilament materials, and size of 5-0 showed a higher percentage of root coverage as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.

Diagnostic reproducibility of the 2018 Classification of Gingival Recessions: Comparing photographic and in-person diagnoses.

To assess how the diagnostic reproducibility of the 2018 Classification of Gingival Recession Defects (GRD) could be applied when comparing in-person chairside measurements with photographic measurements. Thirty-four GRD were photographed and evaluated by 4 masked operators. For each case, the operators measured twice recession type (RT), recession depth (RD), keratinized tissue width (KTW), gingival thickness (GT), detectability of the cemento-enamel junction (CEJ), and presence of root steps (RSs), chairside, and on photographs. Intraclass correlation coefficient (ICC) with 95% confidence intervals (CI) was calculated for RD and KTW; Kappa with 95% CI was used for GT, CEJ, and RS; quadratic weighted Kappa with 95% CI was used for RT. RD, KTW, and RT showed excellent overall intra-operator agreement (>0.93), and from good to excellent overall inter-operator agreement (>0.80), for both clinical and photographic measurements. Agreements were lower for GT, CEJ, and RS. Overall clinical and photographic agreements were within 0.1 difference for every variable, except for inter-operator agreement for RS which was 0.72 for clinical measurements and 0.45 for photographic measurements. The lowest overall agreement between clinical versus photographic measurements existed for CEJ (0.28) and RS (0.35). Variables composing the 2018 Classification of GRD are reproducible, both clinically and on photographs, with comparable agreements. The overall agreement was higher for KTW, RD, and RT, and lower for GT, CEJ, and RS, for both clinical and photographic measurements. The comparison between chairside and photographic evaluations indicated fair to excellent agreement for most variables, with CEJ and RS showing fair agreement. As digital diagnostics evolve to facilitate clinical diagnostic measurement, we aimed to assess the effectiveness of intraoral photography for diagnosing gingival recession defects (GRD) according to the 2018 Classification of GRD, compared to traditional clinical examination. Standardized photographs of thirty-four GRD cases were captured. Four masked operators evaluated the same gingival recessions twice in a clinical setting and twice using photographs. Measurement repeatability within and between operators was calculated for both clinical and photographic settings, and the two settings were compared. Continuous measurements such as recession depth and keratinized tissue width, as well as the evaluation of interproximal attachment height (recession type), showed excellent agreement both clinically and photographically. Agreement was lower for gingival thickness and the detectability of tooth anatomical landmarks, such as the cemento-enamel junction and the presence of root steps. Overall, the agreement between chairside and photographic evaluations was generally good, but lower when evaluating tooth anatomical landmarks. The variables composing the 2018 Classification of GRD are reproducible in both clinical and photographic settings, with comparable levels of agreement. However, there was consistently worse agreement for gingival thickness and when evaluating tooth anatomical landmarks.

The influence of tobacco smoking on the outcomes achieved by root coverage procedures: An updated systematic review.

This updated version of a systematic review (SR) originally published in 2009 evaluated the effect of smoking on the clinical outcomes achieved with root coverage (RC) procedures in the treatment of gingival recession (GR) defects. This SR includes randomized controlled trials, controlled clinical trials, and case series with a minimum follow-up of 6 months. Eligible studies involved GR defects without interproximal tissue loss submitted to RC procedures, as well as outcome measures from smokers (i.e., those smoking 10 or more cigarettes per day at baseline) and nonsmokers, recorded separately. Three electronic databases were searched up to March 31, 2024. Random effects meta-analyses were conducted thoroughly. A total of 12 studies reporting on 181 smokers and 162 nonsmokers, submitted to different RC procedures, were included. Half of these trials were originally included in the 2009 SR, whereas the other half (six studies) were included in this update. Nonsmokers experienced greater reductions in GR and gains in clinical attachment level compared to smokers. Pooled estimates comparing smokers and nonsmokers who received coronally advanced flap (CAF) alone and subepithelial connective tissue graft (SCTG) + CAF showed that nonsmokers achieved greater mean root coverage (MRC) in both treatments. Significant differences in MRC of 10.85% (95% CI, 1.92 to 19.77) and 22.04 (95% CI, 14.25 to 29.83), favoring nonsmokers, were identified for CAF and SCTG + CAF, respectively. Similarly, nonsmokers treated with SCTG + CAF displayed superior number of sites exhibiting complete root coverage (CRF) when compared with smokers (risk ratio, 4.12; 95% CI, 1.73 to 9.80). Smoking negatively impacts the outcomes of RC procedures, particularly those achieved by SCTG-based procedures. Smoking was linked to poorer RC outcomes. These outcomes highlight the critical need to integrate smoking cessation into periodontal treatment plans.

Treatment of Localized Gingival Recession with an Enamel Matrix Protein-Coated Xenogeneic Dermal Matrix: A Randomized Controlled Trial.

This study aims to evaluate the influence of the additional use of enamel matrix derivate (EMD) in the treatment of gingival recession defects using a coronally advanced flap (CAF) and a xenogeneic dermal matrix (XDM) by means of digital and clinical assessment methods. In this prospective randomized controlled study, recession height and area, width and thickness of keratinized gingiva, pocket probing depth, and clinical attachment levels were measured at the baseline and followed up for one year. Fifteen patients (n = 15) with 24 gingival recession defects were treated between 2019 and 2021. On average, the digitally assessed root coverage of the control group (CAF + XDM) was not significantly different compared to the test group (CAF + XDM + EMD), with 69 ± 28% and 36 ± 32%, respectively (p = 0.094). One year postoperatively, there were no differences found regarding keratinized tissue width (KTW) between the control group and test group (p = 0.690). However, the control group showed superior results in the thickness of keratinized gingiva (p = 0.044). The present study showed that there were no statistically significant differences in the root coverage results in the CAF + XDM + EMD group compared to the CAF + XDM group. The adjunctive use of EMD to a CAF and XDM in the treatment of gingival recession defects does not appear to have any clinical benefit.

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.

A Single-Step Root Coverage Procedure Using Modified Bridge Flap Technique and De-epithelialized Gingival Unit Graft: A Prospective Clinical Study.

The mucogingival conditions associated with the recession defects at the mandibular anterior region, not only make plaque control difficult to be performed by the patient but also pose a problem in passively advancing the tissues at the recipient site. This surgical technique is used to treat multiple recession defects in the mandibular anterior region. Twenty-five sites in 17 subjects (11 women and 6 men) underwent modified bridge flap and de-epithelized gingival unit graft (d-GUG) as a single-step treatment modality to cover the denuded root surface, as well as increase the width of keratinized gingiva in recession type 1 gingival recession defects in the mandibular anterior region. Nearly 60% of sites in our study showed complete root coverage, with a mean root coverage percentage of 88.08%. Furthermore, keratinized tissue width, keratinized tissue thickness as well as vestibular depth showed statistically significant increases as compared to baseline levels. Thus, the modified bridge flap technique using d-GUG within the limitations of our study design, showed promising results in terms of recession coverage as well as management of the difficult mucogingival conditions at the mandibular anterior region.

Comparative Evaluation of Autologous Fibrin Glue and Conventional Sutures in the Treatment of Gingival Recession Using Connective Tissue Graft - A Randomised Controlled Clinical Trial.

The combination of the coronally positioned flap with connective tissue grafting in treating gingival recession defects has been shown to demonstrate the highest success rate. The aim of the present study was to compare and evaluate the efficiency between autologous fibrin glue (AFG) and conventional absorbable sutures in the treatment of marginal tissue recessions using connective tissue grafts (CTGs) and the coronally advanced flap (CAF) technique. Twenty Miller's class I and II recession sites in maxillary or mandibular areas in chronic periodontitis patients were treated as group I (test): CTG + CAF + AFG; and group II (control): CTG + CAF with conventional absorbable sutures. Clinical parameters in both groups were recorded at baseline (t0) and six months (t1) postoperatively in terms of gingival recession height (RH), root coverage esthetic score (RCES), visual analogue scale (VAS), and healing index (HI). The RH, RCES, VAS, and HI were significantly reduced at the end of six months compared to baseline ( P < 0.005) in both groups; however, there was no statistical difference between the groups, indicating the equivalent efficacy of AFG and conventional sutures in healing. All the treated sites were found to have appreciable root coverage with satisfactory post-operative healing. Hence, it may be suggested that both AFG and absorbable sutures are equally efficient in post-surgical soft tissue healing.

Evaluating the efficacy of laterally positioned flap in the management of Miller's Class I and II gingival recession: A 6 months follow-up study

Background: The goal of the study is to evaluate the clinical effectiveness of a laterally positioned flap (LPF) six months after it was used to correct Miller's Class I and II gingival recession abnormalities. Materials and methods: The LPF approach was used to treat 10 Miller's Class I or II gingival recession defects of height ≥3 mm (n = 10) on the labial surface of anterior teeth. At baseline, 3 months, and 6 months after surgery, clinical measures including probing pocket depth (PPD), clinical attachment level (CAL), width of attached gingiva (WAG), and height of gingival recession (HGR) were measured, and percentage of root coverage was calculated. Data were gathered, and repeated-measures ANOVA with the post hoc Bonferroni test was used for statistical analysis. Results: All clinical parameters such as PPD, CAL, WAG, and HGR showed improvement. All of the evaluated clinical measures showed statistically significant changes at post-operative 3 and 6 months compared to baseline values. With a p-value of &lt;0.001, the HGR decreased from 3.21 ± 0.52 mm to 0.23 ± 0.65 mm at three months and to 0.36 ± 0.78 mm at six months. At six months, the average level of recession coverage was 97.93%. Conclusion: Employing the LPF technique led to substantially improved gingival recession coverage, which effectively covered isolated deep narrow defects.

¨[Original in spanish] Update of techniques for the treatment of periodontal recessions.

Background: Along the years, a remarkable variety of periodontal surgical protocols has been proposed, the focus of which has shifted from the mere resolution of a soft tissue defect to the performance of predictable and minimally invasive procedures. Initially, the free gingival graft was used. Subsequently, many different techniques were experimented, including those using soft tissue substitutes, such as the Alloderm membrane. Nowadays, the association of the connective tissue graft with the coronally advanced flap is considered the gold standard. Finally, the Pinhole technique, being a more conservative method in terms of tissue preservation and aesthetic outcome, was proposed. Objectives: The aim of this review was the comparison of the updated techniques for the treatment of multiple periodontal recessions, affecting both maxilla and mandible. The procedure outcome was assessed in terms of complete root coverage, recession reduction, gain in height and volume, aesthetic outcome, patient’s post-operative pain and morbidity of donor and recipient sites. Material and methods: Electronic and hand searches were performed to collect split- mouth studies, randomized controlled clinical trials, case series, pilot studies, periodontal books, case studies, systematic reviews and meta-analysis, including maxillary and mandibular multiple gingival recession defects of all four Miller’s classes, for its extensive evidence. Results: Thirty-four publications were included and data regarding the surgical techniques outcome were extracted from eighteen articles. The clinical evaluation analyzed the amount of complete root coverage, recession reduction and gain in height and volume, while the patient’s perspective was expressed in terms of aesthetic satisfaction and possible postoperative complications. Procedures in the last ten years showed better results in all the above-mentioned factors. Conclusion: Procedural predictability and long-lasting treatment stability embody the factors driving the technique election process and adding value to more updated procedures. Progress was observed both at an aesthetic level, by reducing the discrepancies between the surgical region and the surrounding tissue, and at a postoperative level, by reducing patient discomfort. The challenges inherent to this branch could soon find answers thanks to its prompt evolution, which allows for further advances to be conceived.

Assessing the Reliability of Miller's Classification and Cairo's Classification in Classifying Gingival Recession Defects: A Comparison Study.

Background and Objectives: Gingival recession results in adverse aesthetics and root sensitivity, and there is a need to treat and prevent its further progression. To overcome these problems, various advances have been made by clinicians in treating gingival recession based on the type of gingival recession. Miller's classification has been used for a long time to classify the type of recession. However, certain limitations have been found with use of Miller's classification such as a lack of clarity in the method for measuring soft and hard tissue loss in the interproximal area. Cairo classification was proposed to overcome limitations of Miller's classification to classify gingival recession. Cairo's classification is a treatment-oriented classification based on buccal and interproximal attachment loss. Therefore, the study was conducted to assess and compare the reliability of Miller's and Cairo's classifications in determining gingival recession. Material and methods: A total of 220 buccal gingival recession defects were included in the study based on the inclusion and exclusion criteria. Four examiners were included in the study. Two examiners classified the recession defects according to Miller's classification and the other two examiners classified recession defects according to Cairo's classification at baseline and at a 1-week interval. Statistical analysis was conducted using SPSS software version 25.0 using Cohen's kappa correlation coefficient and Chi-square test statistics to determine the intra- and inter-rater agreement among the examiners for the two gingival recession classification systems. A p value of <0.05 was considered statistically significant. Results: The intra-rater agreement for Cairo's classification was 0.86 and 0.82, whereas for Miller's classification, it was found to be 0.68. The inter-rater reliability agreement for Cairo's classification was 0.82 and 0.8, whereas for the Miller's classification, it was 0.56 and 0.67. Conclusions: Within the limitations of the study, it was found that Cairo's classification is clearer and more reliable than Miller's classification in the assessment of gingival recession.

Efficacy of amniotic membrane with coronally advanced flap in the treatment of gingival recession: an updated systematic review and meta-analysis

ObjectivesThis systematic review aims to evaluate the efficacy of combining the amniotic membrane (AM) with the coronally advanced flap (CAF) in the treatment of Miller class I and II gingival recession (GR).MethodsThe protocol of this updated PRISMA-compliant systematic review was registered in PROSPERO (CRD42023431501). The following treatment outcomes were recorded; recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and clinical attachment level (CAL). We searched the following databases: MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Science Direct.ResultsTwo independent reviewers screened the selected articles. Twenty-two eligible articles were extracted, with 689 sites of GR in 481 patients. No statistically significant difference was found in RD, RW, WKG, and CAL between (AM&CAF) in comparison to control groups. However, the subgroup analysis showed statistically significant differences in RD between the (AM & CAF) group v/s (CAF) alone (P = 0.004). Moreover, the subgroup analysis of the WKG showed statistically significant differences between (AM & CAF) v/s (CAF&CM) (p = 0.04). Additionally, a statistically significant difference was found in the subgroup analysis of CAL between both (AM & CAF) group v/s (CAF) alone (p = 0.0009).ConclusionWith the limitations of this meta-analysis due to short follow-up periods (6 months), the AM can be considered a viable treatment option for GR defects with satisfactory treatment outcomes comparable to other previously investigated treatment modalities.Clinical significanceWhile AM showed various beneficial properties as an ideal membrane for the coverage of GR, future studies are required to completely understand the potential application of AM in the treatment of GR.

Novel Membrane for the Treatment of Multiple Gingival Recession Defects-RCT

Objective Evaluation and comparison of Collagen Matrix Ossixreg Volumax and Subepithelial connective tissue graft SCTG in combination with modified coronally advanced flap MCAF in the treatment of Miller Class I and II multiple gingival recession defects MARDs.Methods Twelve patients presenting adjacent Miller Class I and II maxillary and mandibular gingival recession defects participated in this randomized controlled study. A total of sixty defects were received n 30 either Ossix Volumax collagen matrix VCMX and MCAF test group or MCAF and Subepithelial connective tissue graft control group n 30. Parameters like gingival recession depth gingival recession width probing depth clinical attachment level and keratinized tissue width were checked at baseline 6 weeks 3 months and at 6 months after treatment. P value lt0.05 was considered statistically significant.Results The percentage of complete root coverage was 80 for the test group and 60 for the control group. The percentage of mean recession coverage for the test group was 60 and the control group was 85. Adjacent gingival recession was successfully treated with MCAF and Ossixreg Volumax or with MCAF and SCTG. The use Ossixreg Volumax was more comfortable during the postoperative period.Conclusion We suggest the use of Ossixreg Volumax as a promising collage matrix for the treatment of MARDs.

Clinical and Aesthetic Evaluation of Minimally Invasive Surgical Therapy for the Treatment of Gingival Recession Defects - A Systematic Review of Randomized Clinical Trials

Background: The concept of minimally invasive dentistry has seamlessly blended into the various fields of dentistry including periodontics. The past three decades have witnessed a paradigm shift from conventional surgical procedures to microsurgery in the field of periodontal plastic surgery. This entails the integration of microsurgical principles, refined surgical skills and magnification devices along with microsurgical instruments. This systematic review of the randomized clinical trials attempts to address the clinical question whether the application of minimally invasive surgical procedures for gingival augmentation and root coverage procedures for the treatment of gingival recession translate into superior clinical and patient oriented results as compared to conventional root coverage procedures. Materials and Methods: Science Direct and Ovid databases, PubMed, Scopus, and Product literature were accessed to review relevant literature evaluating minimally invasive surgery for treatment of gingival recession defects (GRDs). The search covered 13 studies published in medical and dental journals in English with a relevant impact factor and had a follow up of at least 6 months, up to and including June 2023. The results were based on parameters such as complete root coverage (CRC, expressed as percentage), mean root coverage (MRC, expressed as %) width of keratinized tissue (WKT), and variables such as esthetics and pain postsurgery. Results and Conclusion: The 13 studies pooled in 342 patients who underwent root coverage procedures for treatment of GRDs. The test group (microsurgical) and the control group (macrosurgical group) both resulted in overall improvement in parameters like MRC and CRC, WKT etc. at least 6 months postsurgery; however, statistical difference in between both the groups in these parameters was seen in only three studies. There was marked improvement found in the test group after surgery with respect to esthetics (root coverage aesthetic score) and pain scores (Visual Analog Scale score) as compared to the control group. This compels us to infer that although both conventional and microsurgical procedures are successful as root coverage procedures, microsurgical procedures are minimally invasive and produce superior esthetic and comfort parameters for the patient and are therefore highly recommended in surgical procedures.

Comparative Evaluation of Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique with other Tunneling Techniques: Protocol for a Systematic Review and Meta-analysis

Introduction: Gingival recession is defined as the displacement of the gingival margin apical to the Cementoenamel Junction (CEJ). The aim is to achieve complete root coverage. The increasing demand for aesthetics by patients has led dentists to adopt newer and more novel techniques. Since Allen first introduced the tunneling technique in 1994, several procedural adjustments have been suggested. The “Vestibular Incision SubperiostealPeriosteal Tunnel Access (VISTA)” technique was introduced by Zadeh HH and offers the benefit of being minimally invasive. Need for the study: This systematic review aims to guide clinicians in selecting the best possible root coverage procedure for better patient-centered outcomes. Aim: The aim is to compare the “VISTA technique” with other tunneling techniques in the treatment of multiple gingival recession defects. Materials and Methods: Up until December 2023, the authors will search PubMed, the Cochrane Library, and Embase without any language constraints. Additionally, reviewers will handsearch and examine the bibliographies of relevant publications, search trial registries for active trials, and look for potentially relevant research. The keywords to be used for the search include VISTA technique, tunneling technique, root coverage procedure, and multiple gingival recession. Randomised Controlled Trials (RCTs) using an open or blinded assessment of outcomes will be included. Full journal publications will also be included. Exclusions will be made for brief abstracts (typically meeting reports), non randomised studies, research on experimental pain, studies based on animal models, and observational studies. The eligibility of each study will be independently determined by three review authors (SS, PD, RO). They will then extract the data and independently assess the Risk of Bias (RoB) for each study using the established Cochrane methodology. The evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE), and a summary of findings will be tabulated. The Preferred Reporting Items for Synthematic Reviews and Meta-Analyses (PRISMA) guidelines will be followed for present review.

Comparative Evaluation of Coronally Advanced Flap with and without Amniotic Membrane in the treatment of Localised Miller’s Class I and Class II Gingival Recession Defects: A Randomised Controlled Trial

Introduction: Gingival recession is the exposure of the root surface of the tooth, characterised by the displacement of the gingival margin apically from the Cementoenamel Junction (CEJ). Various techniques have been suggested for treating recession, such as Free Gingival Graft (FGG), Connective tissue grafts, laterally or Coronally Advanced Flaps (CAF), and Guided Tissue Regeneration (GTR)-based procedures. Different membranes have been used for GTR, one of which is the amnion membrane. Aim: To evaluate root coverage using Coronally Advanced Flap (CAF) with and without amniotic membrane in the treatment of localised gingival recession. Materials and Methods: A randomised controlled trial was conducted at Pandit Deendayal Upadhyay Dental College and Hospital, Solapur, Maharashtra, India from March 2017 to February 2018. In this study, 30 teeth were treated, with 15 teeth undergoing CAF with amniotic membrane (Group IITest Group) and 15 teeth treated with CAF without amniotic membrane (Group I-Control Group). Probing Depth (PD), Clinical Attachment Level (CAL), Relative Attachment Level (RAL), Recession Width (RW), Recession Depth (RD), Width of Keratinised Gingiva (WKG), Width of Attached Gingiva (WAG), and gingival biotype were assessed between baseline and after three months. Statistical analysis was performed using paired t-test, independent t-test, and Mann-Whitney U-Test. Statistical Package for Social Sciences (SPSS) software version 20.0 was used for analysis. The α error of 5% (p-value=0.05) and β error of 20% were taken into consideration. Results: The mean age of the study population was 30.36±4.55 years, with 18 males and 12 females. There was a decrease in RD, RW, PD, and a gain in CAL and RAL in both groups after three months compared to the baseline values. Additionally, there was an increase in WKG, WAG, and a significant change in the thickness of the gingival biotype from thin to thick in both groups at the end of three months. On inter group comparison, the changes in PD (p-value=1.00), RD (p-value=1.00), RW (0.176), CAL (0.664), RAL (1.00), WKG (p-value=0.313) were not statistically significant at the end of three months. WAG was higher in Group II compared to Group I (p-value=0.014*), and the mean root coverage was greater in Group II (15.62%) than in the control group (11.642%) (p-value=0.005) at the end of three months. There was a statistically significant difference (p-value=0.005*) in Group II (15.62%) compared to the control group (11.642%). Conclusion: Amniotic membrane in combination with CAF proves to be a successful option for root coverage in localised recession defects. However, histological evidence and a greater number of future longitudinal studies are necessary to study the efficacy of this approach.

Clinical Outcome of Root Coverage Following the Treatment of Multiple Gingival Recession Defects Treated with Vista in Combination with PRF and Zuucchelli’s Technique: A Case Series

Background: Mucogingival treatment for gingival recession coverage is very specific and is more predictable when done with a specific technique. Different surgical approaches should be focused more on the basis of their effectiveness, efficacy and efficiency meeting the needs of patient’s aesthetic and functional demand. Aim: The purpose of this case series is to combine the biological properties of PRF and compare both the techniques VISTA and Zucchelli’s to predict the clinical outcome of gingival recession coverage. The case series describe the treatment of gingival recession with bilateral Miller’s class I and II recession (RT1 and RT2) defects extend from canine to premolars by using Vestibular incision sub periosteal tunnel access (VISTA) technique and Zucchelli’s technique with PRF. Clinically gingival recession and width of keratinized gingiva was assessed at the follow up time interval 1 month and 3 months. Based on the clinical outcome, both VISTA and Zucchelli’s technique are reliable for the treatment of multiple gingiva recession defect. It also improves the root coverage, and gingival phenotype. The use of PRF with Zucchelli’s and VISTA technique is a substitute in terms of regeneration and enhanced wound healing process.

A comparative study of cyanoacrylate-based tissue adhesive and surgical sutures on marginal flap stability following coronally advanced flap

IntroductionThe present study evaluated the biomechanical characteristics of cyanoacrylate-based tissue adhesive (TA) compared to surgical sutures in coronally advanced flap (CAF) procedures using an ex-vivo model.Material and methodsThirty-six half-pig mandibles were divided into three groups, n=12 each: (I) CAF fixed with sutures (sling and tag suture technique), (II) CAF fixed with TA, and (III) CAF fixed with sutures and TA. At mandibular premolars, gingival recession defects extending 3 mm apical to the cemento-enamel junction (CEJ) were created. CAF procedures were performed using a split-full-split approach, with coronal advancement of the flap to 1 mm above the marked CEJ and stabilization according to the respective groups I–III. Marginal flap stability against pull-of forces (maximum tensile force) was measured with a universal material testing machine until the CEJ became visible.ResultsThe comparison between groups I–III demonstrated a significantly increased maximum tensile force for the TA (II) compared to the suture group (I) (p<0.001). A significantly increased maximum tensile force was found for the suture and TA (III) compared to the suture group (I) (p<0.001). There was also a significantly increased maximum tensile force in the suture and TA (III) compared to the TA group (II) (p<0.001).ConclusionThe results suggest that cyanoacrylate-based TA can increase marginal flap stability compared to sutures in CAF procedures.Clinical relevanceCyanoacrylate-based TA can be considered a useful and valuable adjunct to conventional suturing techniques in periodontal plastic surgery, especially in cases where high flap stability is required. The results of this ex-vivo study can only be transferred to the clinical situation with limitations. Clinical long-term follow-up data must be generated.

Treatment of single gingival recessions using biofunctionalized collagen matrix: A case series.

Connective tissue graft substitutes have been used widely to overcome autogenous graft limitations. Nevertheless, they do not provide comparable results in the treatment of periodontal and peri-implant soft tissue defects. Based on the principles of tissue-engineered materials, injectable platelet-rich fibrin (i-PRF) has been combined with collagen matrices (CMs) to enhance their clinical efficacy. To the best of our knowledge, this is the first case series demonstrating the use of i-PRF for the biofunctionalization of a volume-stable collagen matrix (VCMX) as an adjunct to coronally advanced flap (CAF) to treat single gingival recession (GR) defects. The study included 10 patients. Bleeding on probing, probing depth, GR height, clinical attachment level, esthetics, and dentin hypersensitivity were evaluated. After 6 months, a significant GR reduction (RecRed: 2.15 ± 0.7mm; p = 0.005) and percentage of root coverage (% RC) of 81.13% were observed. Additionally, 40% of the sites showed complete root coverage. Gingival thickness increased 0.64mm. Patient-centered evaluations demonstrated dentin hypersensitivity and esthetics improvements by the end of follow-up. VCMX biofunctionalized with i-PRF associated with CAF technique showed promising clinical outcomes in the treatment of single RT1 GR defects.

Marine Collagen Matrix Carrier with Injectable Platelet-Rich Fibrin in Management of Gingival Recession Defects

Background. The gold standard in the management of gingival recession (GR) defects has been connective tissue graft (CTG) with coronally advanced flap (CAF). But patient morbidity associated with graft harvesting is a major drawback and has led to the development of various substitute biomaterials which have been tried and tested. Aim. Our study is aimed at checking the efficacy of marine collagen matrix (MCM) impregnated with injectable platelet-rich fibrin (I-PRF) with modified CAF in the treatment of Miller’s class I and II recession defects. Case Description. Six patients with ten GR defects in maxilla were treated with CAF + MCM + I-PRF. Clinical parameters like recession height (RH), recession width (RW), root coverage (RC%), width of attached gingiva (WAG), keratinized tissue height (KTH), probing pocket depth (PPD), clinical attachment level (CAL), gingival biotype (GB), plaque index (PI), and visual analogue score (VAS-E) esthetic scores were evaluated up to six months. There was significant root coverage observed at three- and six-month follow-ups. Conclusion. The proposed treatment was effective in the management of GR defects and improvement in soft tissue biotype without the morbidity associated with soft tissue harvest.