Gingival Recession Defects Research Articles

Clinical efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) for treatment of multiple gingival recession defects: a systematic review, meta-analysis and meta-regression.

This study investigated the efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) compared to other methods for treating multiple adjacent gingival recessions (MAGRs) through a systematic review and meta-analysis. A systematic literature search was performed through June 2023, to identify clinical trials investigating VISTA for root coverage on MAGRs. A meta-analysis with meta-regression model was employed on the primary outcomes of mean and complete root coverages (MRC, CRC), comparing VISTA with other techniques. Clinical efficacy of various graft materials was assessed. Fourteen studies were included, 8 of which met the criteria for quantitative assessment. The cumulative MRC (88.15% ± 20.79%) and CRC (67.85% ± 21.72%) of VISTA were significantly higher compared to the tunneling technique (SMD = 0.83 (95% CI [0.36, 1.30], p < 0.01). The baseline recession depth showed a negative correlation with CRC, whereas baseline keratinized gingiva width exhibited a positive correlation with this outcome. The VISTA technique, particularly with acellular dermal matrix (ADM) or connective tissue graft (CTG) materials, offers superior outcomes compared to the tunneling technique. The capacity of platelet-rich fibrin (PRF) to substitute for connective tissue graft (CTG) in VISTA-root coverage was noteworthy, provided there is adequate keratinized tissue width. VISTA in concert with acellular dermal matrix or CTG resulted in improved root coverage, surpassing the outcomes achieved through tunneling. PRF emerged as a viable alternative to CTG, when used in conjunction with VISTA, demonstrating comparable mean root coverage. This is particularly evident in situations where sufficient keratinized gingiva is available and when patient comfort is taken into consideration.

Leukocytic platelet rich fibrin (L-PRF) versus subepithelial connective tissue graft (SCTG) using tunneling technique in treatment of gingival recession: Randomize controlled clinical study

Introduction: Gingival recession is a problem encountered daily in clinical practice, its etiology is often a multifactorial one. Surgical treatment is the only method to reverse this condition. Objective: to evaluate the effectiveness of leukocytic platelet rich fibrins (L-PRF) versus subepithelial connective tissue graft (SCTG) in the management of recession defects Miller’s class I or II (RT1) using the tunnel technique (TUN). Methods: 20 systemically healthy patients were allocated randomly to TUN with L-PRF (group A), and TUN with SCTG (group B). Probing depth, clinical attachment level, recession depth, width of keratinized tissue, gingival thickness, and recession esthetic score and wound healing index are clinical variables measured at baseline,14 days, 3 months, and 6 months postoperatively. Results: Significant improvement in mean CAL, and RD for both groups, and significant difference in GT and WKT for group B as well as higher RES. A significant difference was also recorded in group A for WHI Conclusions: Both grafting modalities in combination with tunnel technique improved gingival phenotype switching. Although SCTG gives higher esthetic and functional results including better color matching, tissue contour and increased width of keratinized tissue, L-PRF has superior healing properties and can be used as an alternative to treat multiple gingival recession defects where the need of second surgical site is eliminated.

Amniotic membrane versus platelet-rich fibrin in treatment of gingival recession- a randomized control trial

ObjectiveTo determine the efficacy of latelet-rich fibrin (PRF) and Amniotic membrane (AM) along with the coronally advanced flap (CAF) technique in treating Miller’s class I gingival recession (GR) defects. Material and methodsA total of 32 sites with Miller’s class I GR defects were distributed into Group A (CAF + PRF, n = 16) and Group B (CAF + AM, n = 16). Clinical parameters like gingival index (GI), plaque index (PI), gingival bleeding index (GBI), gingival sulcus depth (GSD), relative attachment level (RAL), and gingival marginal level (GML) were measured at baseline and at 3, 6 and 9 months after surgical intervention. ResultsPRF and AM with CAF were effective treatment modalities for treating Miller’s class I GR defects, with an average root coverage value of 2.00 ± 0.75 mm in Group A and 1.5 ± 0.3 mm in Group B. Complete coverage (100 %) was obtained in 57 % sites of group A and 49 % sites of group B. At the 9-month follow-up, there was a significant increase in relative attachment levels in both groups when compared to baseline. ConclusionIn the present study it was observed that there was a clinically and statistically significant improvement in root coverage with both groups. PRF-treated sites showed > 50 % complete coverage and hence were superior. AM showed comparable results to PRF and could be used as an alternative.

Comparison of Clinical Efficacy of Bio-Resorbable Xenogeneic Peritoneal Membrane with Connective Tissue Graft in the Management of Gingival Recession Defects: A Randomized Controlled Clinical Trial.

This randomized controlled trial was aimed to determine the clinical efficacy of xenogeneic collagen membrane derived from porcine peritoneum (XCM) in combination with a coronally advanced flap (CAF) in the management of gingival recession defects and to compare the outcomes to those of connective tissue graft (CTG). 12 systemically healthy individuals presenting with 30 isolated/multiple Cairo's RT 1/2 gingival recession defects in maxillary canines and premolars, were randomly treated either with CAF+XCM or CAF+CTG. Recession height (RH), gingival biotype (GB), gingival thickness (GT), width of keratinized gingiva (WKG) and attached gingiva (WAG) were recorded at baseline, 3, 6 and 12 months. Patient perception for pain, esthetics and modification of root coverage esthetic score (MRES) were also documented. From baseline to 12 months, both groups showed a significant reduction in mean RH (CAF+CTG: 2.73±0.79mm to 0.33±0.61mm and CAF+XCM: 2.73±0.88mm to 1.20±0.77mm). At 12 months, CAF+CTG sites had a MRC of 85.60±28.74%, whereas CAF+XCM sites had a MRC of 55.13±31.22%. CAF+CTG treated sites had significantly better outcomes, with greater number of sites achieving complete root coverage (n=11) and higher MRES scores than porcine peritoneal membrane group (P<0.05). Int J Periodontics Restorative Dent. doi: 10.11607/prd.6232.

The Connective Tissue Graft Wall Technique for treating Patients with Cairo’s RT3 Gingival Recession and Intrabony defects: A Case Series

The Connective Tissue Graft Wall Technique for treating Patients with Cairo’s RT3 Gingival Recession and Intrabony defects: A Case Series

Influence of ternion of soft tissue attributes on gingival recession and root coverage outcome – A retrospective analysis

The independent influence of Keratinized Tissue Width (KTW) and Gingival Biotype (GB) on root coverage outcomes have been reported over the years. These parameters along with Recession Depth (RD) might act as a triad and assessing this ternion would be beneficial in determining prognosis and devising treatment plan for gingival recession. The aim of this retrospective analysis is to evaluate a possible association between KTW, GB and RD and their influence on Gingival Recession and root coverage outcome.45 isolated gingival recession defects were assessed for KTW (&amp;#60;2mm, &amp;#62;2mm), GB (thin vs thick) and RD (1-4mm). Primary outcome was to establish an association between the above-mentioned parameters. Secondary outcome was to find the percentage Root Coverage (%RC) obtained after coronally advanced flap procedure. To evaluate the relationship of KTW vs GB, GB vs RD and KTW vs RD, chi-square test was used. To analyse the intra-parametric correlation and the association between all three parameters, Pearson correlation test and ANOVA were carried out respectively.The Chi-square test results revealed a statistically significant association of p&amp;#60;0.03 for the relationship of KTW vs GB and GB vs RD and p&amp;#60;0.001 for KTW vs RD. Pearson correlation test showed a positive correlation between KTW and GB (.320), negative correlation between GB and RD (-.046), and KTW and RD (-.136). ANOVA showed a p-value of 0.041 inferring that any change in KTW and GB significantly influenced RD. Sites with &amp;#60;2mm KTW, thin GB and deeper RD, which can be referred to as negative ternion, exhibited 43.8% mean RC while sites with &amp;#62;2mm KTW, thick GB and shallow RD, which can be referred to as positive ternion had 94.7% mean RC. There is a definitive association between Keratinized Tissue Width, Gingival Biotype and Recession Depth. A ternion of these parameters greatly influences the outcome of root coverage procedures.

Comparative evaluation of platelet rich fibrin matrix (PRFM) membrane and platelet rich fibrin (PRF) membrane using the vestibular incision subperiosteal tunnel access (VISTA) approach technique for the treatment of multiple gingival recession in humans: A double-blind, parallel-group, randomized controlled clinical trial

Background: In this evolutionary era of dentistry, newer techniques have evolved for complete coverage of multiple recession defects (MRDs). Since 2012, MRDs have been treated using the vestibular incision subperiosteal tunnel access (VISTA) approach and a variety of regenerating membranes with varying degrees of success. Platelet‑rich fibrin matrix (PRFM) membrane has shown a robust release of growth factors and was known to enhance the healing process. Thus, in this study we have evaluated the effectiveness of platelet-rich fibrin matrix (PRFM) with that of platelet-rich fibrin (PRF) membrane using the vestibular incision subperiosteal tunnel access (VISTA) technique in Miller Class I and II multiple gingival recession defects. Methods: This randomized, parallel designed, controlled, clinical study was conducted in 20 subjects (10 male and 10 female) having class I/II MGR defects either buccally or labially. The test group was treated with VISTA and PRFM membrane while the control group was treated with VISTA and PRF membrane. The clinical measurements such as plaque index, papillary bleeding index, probing pocket depth, relative attachment level (RAL) and relative gingival marginal level (R-GML), width of keratinized gingiva (WKG), gingival recession (REC) and gingival thickness (GT) were measured at baseline, three and six months. A Student’s paired t-test was utilized to analyse data from the day of surgery to six months. Results: Ten patients in the test group (89.23±15.04) and 10 patients in the control group (85.06±17.71) showed marked root coverage compared to baseline. Conclusions: Both test and control groups showed statistically significant enhancement in root coverage. However, no statistically significant difference was found when a comparison was made between the two groups in terms of PD, relative RAL, R-GML and REC reduction, gain in WKG, and increase in GT. Trial registration: CTRI/2021/07/035240, registered 29 July 2021.

The effect of smoking on clinical and biochemical early healing outcomes of coronally advanced flap with connective tissue graft: Prospective cohort study.

This study aimed to determine the effects of smoking on early (≤3 months) clinical outcomes and relevant molecular biomarkers following root coverage surgery. Eighteen smokers and 18 nonsmokers, status biochemically verified, with RT1 gingival recession defects were recruited and completed study procedures. All patients received coronally advanced flap plus connective tissue graft. Baseline and 3 month recession depth (RD), recession width (RW), keratinized tissue width (KTW), clinical attachment level (CAL), and gingival phenotype (GP) were recorded. Root coverage (RC) percentage and complete root coverage (CRC) were calculated. Recipient (gingival crevicular fluid) and donor (wound fluid) site VEGF-A, HIF-1α, 8-OHdG, and ANG levels were determined. There were no significant intergroup differences for any baseline or postoperative clinical parameters (P>0.05), except for whole mouth gingival index (increased in nonsmokers at 3 months; P<0.05). Compared to baseline, RD, RW, CAL, KTW, and GP significantly improved postoperatively, without significant intergroup differences. There were no significant intergroup differences for RC (smokers=83%, nonsmokers=91%, P=0.069), CRC (smokers=50%, nonsmokers=72%, P=0.177), and CAL gain (P=0.193). The four biomarker levels significantly increased postoperatively (day 7; P≤0.042) in both groups and returned to baseline (day 28) without significant intergroup differences (P>0.05). Similarly, donor site parameters were not different between groups. Strong correlations, consistent over time, were found between biomarkers implicated in angiogenesis (VEGF-A, HIF-1α, and ANG). The early (3 month) clinical and molecular changes after root coverage surgery utilizing a coronally advanced flap plus connective tissue graft are similar between smokers and nonsmokers.

Comparative evaluation of pinhole surgical technique with and without A-PRF in the treatment of multiple adjacent recession defects: A clinico radiographic study.

To evaluate and compare efficacy of pinhole surgical technique (PST) alone and with advanced platelet rich fibrin (A-PRF) in the management of bilateral multiple adjacent gingival recession defects (MAGRD). One hundred and sixty five MAGRD were randomly assigned to control group (treated with PST) and test group (PST with A-PRF). Clinical parameters of gingival recession depth (GRD), gingival recession width (GRW), width of keratinised gingiva (WKG), complete root coverage (CRC) and gingival thickness (GT) on ST-CBCT was measured at 2, 4 and 6 mm apically from the gingival margin. Also, root coverage aesthetic score and patient satisfaction ratings were recorded at baseline, 6 and 12 months postoperatively. Substantial reduction in GRD (Test: 1.29 ± 0.69 mm and Control 0.98 ± 0.30 mm) (p < 0.001) and GRW (Test: 2.03 ± 0.90 mm and control 1.73 ± 0.99 mm) (p < 0.05) with associated gain in WKG and GT was observed (p < 0.001). Mean GT values were increased in both the groups at 2, 4 and 6 mm from the crest. Comparison of Test and Control groups yielded significant reductions in GRD (-0.17 ± 0.56 mm) and WKG (0.73 ± 1.07 mm) favoring the Test group (p < 0.05). Similar increase in GT was observed with better results in Test than control group. (p < 0.001). Both groups exhibited sound clinical outcomes with test group offering better resolution of MAGRD in comparison to control group. Also, it enhances clinical and therapeutic end results in terms of attaining reduction in GRD and GRW along with greater gain in KTW and GT. PST as a minimally invasive approach has numerous benefits, some of which include the absence of scarring and improved aesthetics linked to faster wound healing. The addition of A-PRF enhances the intended therapy outcomes, which is beneficial for both patients and professionals in the field of periodontics.

Clinical effectiveness of periosteal pedicle graft for the management of gingival recession defects-a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of periosteal pedicle graft (PPG) in terms of root coverage and patient related outcomes. To the best of our knowledge this is the first systematic review with meta-analysis on PPG. A comprehensive search was performed using electronic and hand searches upto January 2023. Primary outcomes were Recession depth Reduction (Rec Red), mean root coverage (mRC) and complete root coverage (CRC). Secondary outcomes were gain in width of keratinized gingiva (WKG) and patient reported outcome measures (PROMs). Meta-analysis was performed when possible. The risk bias assessment was done using RevMan5.4.1 and Joanna Briggs institute scale for the included RCTs and case series respectively. A total of 8 RCTs and 2 case series (538 recession sites) were included based upon the predefined inclusion and exclusion criteria. The follow up period ranged from 6 months to 18 months. Results demonstrated that mRC of PPG + Coronally advanced flap (CAF) was 87.7% for localized gingival recession defects (GRDs) and 84.83% for multiple GRDs. An overall gain in WKG (Weighted Mean =1.49 ± 0.27 mm) was observed among all the included studies in the PPG + CAF group with mean difference (-0.10 (95% CI [-0.52, 0.33], p = 0.66)). Sub-group meta-analysis comparing PPG + CAF with sub-epithelial connective tissue graft (SCTG) + CAF resulted in similar outcomes in terms of Rec Red (0.10 (95% CI [-0.56 to 0.77], p = 0.76)) and gain in WKG (-0.03 (95% CI [-0.25 to 0.18], p = 0.76)). In terms of PROMs systematic review revealed better patient satisfaction with PPG + CAF than SCTG + CAF. PPG + CAF is a viable treatment modality for management of GRDs. The primary and secondary outcomes achieved utilizing PPG + CAF were found to be comparable to other conventional techniques including the gold standard i.e., SCTG.

A meta-analysis of amnion membrane in gingival recession.

This systematic review was conducted to evaluate the effects of Amniotic Membrane (AM) as compared with other treatment modalities on the clinical outcomes, in gingival recession defects. Only Randomized controlled clinical trials published before 2020 were included. Studies were divided into 5 subgroups (1) Coronally advanced flap (CAF)+AM v/s Chorion membrane (CM) (2) CAF+AM v/s CAF+PRF (3) CAF+AM v/s CAF+Collagen membrane (4) CAF+AM v/s CAF (5) CAF+AM v/s CAF+ Subepithelial connective tissue graft (SCTG). Studies were evaluated for Recession Depth (RD) (Primary outcome); Clinical Attachment Level (CAL), Recession Width (RW) and Width of Keratinized Gingiva (WKG) (Secondary outcomes). The inverse variance approach was utilised in fixed or random effect models for the meta-analysis, which were chosen based on heterogeneity. Results suggested that the use of AM membrane showed comparable results in improving RD, RW, or CAL in the treatment of Miller Class-I and Class-II gingival recession compared to the other treatment modalities. However, CAF+AM resulted in statistically significant improvement in RD and RW than CAF+SCTG, though CAL gain was statistically more with CAF+SCTG. However, increase of WKG was found to be statistically significantly more in all the other treatment modalities as compared to CAF+AM. With properties like self-adherence, bioavailability and presence of growth factors AM with CAF can produce good aesthetic root coverage comparable to SCTG and PRF, where width of keratinized gingiva is adequate.

Comparative evaluation between collagen membrane (PerioCol®) and periosteum membrane in the treatment of gingival recession defects of maxillary anterior teeth: a clinical study

Abstract Background: The most common mucogingival defect is gingival recession (GR), which is characterized by apical displacement of the gingival margin from the cementoenamel junction and root exposure. Several techniques are available for treating GR and are collectively termed root coverage (RC) procedures. This study presents 3 months’ results of a randomized clinical trial comparing RC in areas of isolated GR by coronally advanced flap (CAF) with periosteum membrane and PerioCol® membrane. Materials and Methods: Twenty recession sites were selected for the study and further divided into two groups (Test group 1 [C AF + Periosteum membrane] and Test group 2 [CAF + Guided tissue regeneration membrane]) and completed the 3-month follow-up. Result: Satisfactory result obtained after three months in both the cases but CAF+Periosteum showed better and fast healing. Conclusion: Both treatment modalities showed a significant improvement in clinical parameters at 3 months postoperatively.

Efficacy of Tunnel Technique (TUN) versus Coronally Advanced Flap (CAF) in the Management of Multiple Gingival Recession Defects: A Meta-Analysis.

We systematically assessed the efficacy of tunnel technique (TUN) vs. coronally advanced flap (CAF) in the management of multiple gingival recession defects in adults. Five databases were searched until September 2021 for randomized controlled trials (RCTs) assessing TUN vs. CAF; grafts of interest were acellular dermal matrix (ADM) and connective tissue graft (CTG). Primary outcomes were root coverage (RC) and complete root coverage (CRC). Secondary outcomes were clinical attachment level (CAL), keratinized tissue width (KTW), probing depth (PD), and recession coverage (REC). Effect measures were risk ratio (RR) or mean difference (MD) with their confidence intervals (95% CI). Inverse variance methods and random-effects model meta-analyses were used. Subgroup analyses by the type of graft were performed. Quality of evidence was assessed using GRADE methodology. Five RCTs (n = 173) were included, with a follow-up of 6 months for all outcomes. In comparison to CAF, TUN did not significantly reduce CRC (RR 0.65; 95% CI 0.002-176.7; p = 0.51) and did not increase RC (MD 0.99%; 95% CI -6.7 to 8.6; p = 0.80). In comparison to CAF, TUN showed no significant reduction of secondary outcomes. Subgroup analyses by type of graft showed no differences in comparison to primary analyses for primary and secondary outcomes. Three RCTs had a high risk of bias, and five RCTs had very low quality of evidence for all outcomes. In adults with gingival recessions, TUN had similar primary and secondary outcomes in comparison with CAF. Subgroup analyses by the type of graft did not affect main conclusions. More RCTs with better design are needed to further characterize the effects of TUN vs. CAF in the treatment of multiple gingival recession defects.

Advanced Platelet-Rich Fibrin and Connective Tissue Graft for Treating Marginal Tissue Recessions: A Randomized, Controlled Split-Mouth Study.

This study aimed to evaluate and compare the clinical outcomes of advanced platelet-rich fibrin (A-PRF) and connective tissue graft (CTG) in treating marginal tissue recessions. Fifteen patients with isolated bilateral maxillary gingival recessions were recruited for the study, with 30 defects. The defects were classified as Miller's class I/II gingival recession on the canine or premolar region. Patients were randomly divided into two groups, each receiving one of the two treatment techniques (A-PRF or CTG) on a different side of the maxilla in a split-mouth design. Clinical parameters such as recession height (RH), recession width (RW), probing pocket depth (PPD), clinical attachment level (CAL), a width of attached gingiva (WAG), and keratinized tissue height (KTH) were evaluated at baseline, 3, and 6 months. Changes in biotype, Recession Esthetic Score (RES), and Visual Analogue Score-Esthetics (VAS-E) were also evaluated at 6 months. Ethics approval number (Helsinki): PHRC/HC/877/21 and registered at the Clinical Trials Registry under the number NCT05267015 Results:At the end of 6 months, there was a statistically significant reduction in RH and RW in both groups, with the mean RC% of 69.2±22.91, and 88.66±33.18 in Groups I and II, respectively. Intergroup analysis showed statistically significant differences in recession parameters between groups at 3 and 6 months, with better outcomes for the CTG group. This study demonstrates that A-PRF and CTG effectively manage gingival recession defects. However, CTG resulted in better clinical outcomes in terms of reduction in recession height and width.

Treatment of Gingival Recession Defects with Pouch and Tunnel Technique Using Connective Tissue Graft and Lyophilized Chorion Membrane in Smokers.

BACKGROUND The chorion membrane has been used for several decades as an allograft in tissue repair and various periodontal regenerative procedures. The present study, conducted at a single center in India, aimed to evaluate and compare the clinical outcomes of 26 gingival recession sites in chronic smokers treated using a pouch and tunnel technique with connective tissue graft (CTG) and lyophilized chorion membrane (LCM). MATERIAL AND METHODS The study included 22 smokers with 26 sites of recession defect, with Miller's class I and class II gingival recession, which were allotted into control and test groups. The control group (13 sites) was treated with CTG, and the test group (13 sites) was treated with LCM. Clinical parameters like recession depth, recession width, relative clinical attachment level (RCAL), relative gingival position, width of attached gingiva, and width of keratinized gingiva were recorded at baseline and 6 months postoperatively. Visual analogue scores for pain and wound-healing index scores were assessed in the first week after surgery. RESULTS All clinical parameters showed significant improvements from baseline to 6 months postoperatively in the control and test groups. Recession width, RCAL, width of attached gingiva, and width of keratinized gingiva demonstrated significant differences, whereas mean root coverage percentage and recession depth did not show any significant differences between the study groups at 6 months postoperatively. CONCLUSIONS This study supports the role of LCM allograft as a scaffold to promote soft tissue regeneration and has demonstrated a favorable role for its use in root coverage procedures in patients who smoke.

Evaluation of a New Porcine Collagen Matrix for the Treatment of Buccal Gingival Recessions: A 12-Month Pilot Prospective Human Study Model.

A 12-month prospective consecutive case series study was conducted to evaluate the effectiveness of a novel porcine collagen matrix to correct moderate to severe buccogingival recession defects. A total of 10 healthy patients (8 women and 2 men; age range: 30 to 68 years) with 26 maxillary and mandibular recession gingival defects > 4 mm deep were included. Healthy maturation of gingival tissues with natural color and texture matching the adjacent soft tissue areas were observed at all reevaluation visits. Complete root coverage was not achieved in all cases, possibly due to severe buccal bone loss in most of the selected cases, which negatively impacted the results. Nevertheless, when a novel porcine collagen matrix was used, a mean root coverage of 63.15% was achieved, and gains in clinical attachment level and keratinized tissue height were seen. Future randomized clinical trials are needed to further explore the potential of porcine collagen matrix for treatment of localized gingival recession defects.

MANAGEMENT OF CLASS III GINGIVAL RECESSION POST APICOECTOMY USING TWO STAGE PERIODONTAL PLASTIC SURGERY- A MICROSURGICAL APPROACH

Gingival recession associated with root surface exposure is a complex phenomenon that may present numerous therapeutic challenges to the clinician. Many patients seek treatment because of concerns about esthetic appearance, root sensitivity, or fear of early loss of the affected teeth. The most common cause for gingival recession is abrasive, traumatic tooth brushing habits and buccally positioned teeth. Multiple periodontal plastic surgery approaches are documented for the treatment of gingival recession defects. These treatment approaches generally includes the manipulation of patient tissues to augment the soft tissues and cover the exposed roots surfaces. The combination of sub epithelial connective tissue graft with a coronally positioned ap has been shown to demonstrate the highest success with predictable results.

Effectiveness of Titanium Prepared Platelet Rich Fibrin Membrane vs Platelet Rich Fibrin Membrane in the Treatment of Multiple Gingival Recession Defects using M-VISTA Technique: Protocol for a Randomised Clinical Trial

Introduction: The focus of root coverage procedures is now shifting to minimally invasive surgical approaches. Periodontists are being required to adopt newer and more unique procedures to thoroughly cover the exposed roots. Due to the sensitivity of various techniques and the fact that it involves a wide variety of operations and their variants, periodontal plastic surgery provide a substantial challenge. A variety of minimally invasive techniques and platelet concentrates which are abundant in growth factors have been assimilated that provide the added benefit of better and rapid healing. Aim: This study aims to evaluate the effectiveness of TitaniumPrepared Platelet Rich Fibrin (T-PRF) and Platelet Rich Fibrin (PRF) membrane in Miller’s Class-I and Class-II multiple Gingival Recession (GR) using Modified-Vestibular Incision SupraPeriosteal Tunnel Access (M-VISTA) technique. Materials and Methods: The planned protocol would be randomised clinical trial and will be performed over a period of two years. Twenty-two patients will be selected according to the inclusion criteria, each having multiple GR (&gt;2 mm, Class I or II recession) on buccal/labial aspects of teeth in maxilla or mandible, and would be randomly distributed into the two groups (control and test). The M-VISTA technique would be carried out for root coverage using T-PRF (test group) and PRF (control), respectively as regenerative materials and their effectiveness will be compared by measuring the Pocket Probing Depth (PPD), Clinical Attachment Level (CAL), Relative Gingival Marginal Level (RGML), Recession Depth (RD) and Width of Keratinised Gingiva (WKG). Student’s paired and unpaired t-tests will be used to evaluate data from the baseline to 3 and 6 months for each group. Expected Results: The authors expect better results of root coverage using the M-VISTA technique in combination with T-PRF (test group). Better results in terms of PPD, CAL, RGML, RD, and increase in thickness of attached gingiva are expected. Conclusion: Combined effect of using T-PRF in the M-VISTA procedure is expected to improve the periodontal parameters including, the soft tissue outcomes and the plaque and bleeding index.

Evaluation of root biomodification as an adjunct to platelet-rich fibrin versus amniotic membrane and coronally advanced flap in class I and class II gingival recession defects: A randomized controlled study

Evaluation of root biomodification as an adjunct to platelet-rich fibrin versus amniotic membrane and coronally advanced flap in class I and class II gingival recession defects: A randomized controlled study

I-PRF Incorporated Absorbable Collagen Membrane for GTR based Recession Coverage : A Case Report

Introduction: Gingival recession defects in the esthetic zone demands a concurrent correction of all the involved teeth in a single surgery. Wound healing is a complex phenomenon and the concurrent use of collagen membrane and Injectable Platelet rich fibrin (I-PRF) will greatly enhance the process. Thus the aim of this case report is to evaluate the effectiveness of Coronally advanced flap (CAF) with collagen and I-PRF in the management of gingival recession management. There was 90% mean root coverage and good patient esthetic satisfaction. Thus CAF with collagen and PRF is an effective treatment modality in the management of multiple gingival recessions.