Multiple Gingival Recessions Research Articles

Xenogeneic collagen matrix for the treatment of multiple gingival recessions in esthetics areas: a case series with 24-month follow-up

Introduction: Multiple gingival recessions (GR) are often associated with high hypersensitivity and esthetics concerns due to exposed roots. The collagen matrix (CM) associated with coronally advanced flap (CAF) may be a suitable treatment for multiple GR in esthetic areas. However, there is a lack of long term follow up investigations. Objective: To evaluate a 24-month follow-up of the CM + CAF treatment for multiple RT1 GRs in esthetics areas. Materials and Methods: Six patients presenting 6 adjacent Cairo’s gingival recessions type 1 (RT1) in the anterior maxilla were treated with CM + CAF, and based on these patients a brief statistical analysis was conduct. The evaluated parameters included gingival recession depth (GRD), gingival recession width (GRW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), gingival thickness (GT), and mean root coverage (MRC). Patient-related outcomes measurements (PROMs) were assessed using an oral health impact profile (OHIP-14) questionnaire and visual analogue scale (VAS). Results: There was significant improvement in GRD, GRW, and CAL measurements at 3 months postoperatively (p<0.05). Besides, CAL also increased from 12 months to 24 months’ follow-up (p=0.0023). The MRC percentage was 82%. PD, GT, and KTW presented no statistical difference. PROMs revealed a high score for esthetics (82.2%) and a significant reduction in hypersensitivity and surgical pain/discomfort. Conclusions: Considering the limitations of a case series, the use of CM + CAF on RT1 multiple gingival recessions in esthetic areas demonstrated positive outcomes after 24 months.

Root coverage with tunneling technique or modified advanced flap associated with acellular dermal matrix: results from 6 months randomized clinical trial.

This study compared two surgical techniques using acellular dermal matrix (ADM) for the treatment of multiple gingival recessions. Twenty patients, with bilateral RT1 gingival recessions, were selected. One side received a modified extended coronally advanced flap (MECAF), and the contralateral side a supra-periosteal flap (TUN). The evaluated parameters were probing depth (PD), relative clinical attachment level, gingival index, gingival recession height (GR), width of keratinized tissue, keratinized tissue thickness, and gingival recession area at baseline and 6 months postoperative. Pain was evaluated weekly, using a visual analog scale (VAS) during first month postoperative. Both groups were effective in reducing GR (ΔGR: MECAF 2.28 mm; TUN 1.93 mm), without significant differences. The % of root coverage was numerically superior favoring MECAF (MECAF 61.24%; TUN 56.07%), without significant differences between groups. VAS scale failed to provide differences between groups. Both treatment were effective in root coverage and might be valuable for the treatment of multiple gingival recessions. The use of vertical releasing incisions and a flap design including the papillae did not hamper root coverage. This study compared two techniques for use of ADM in large multiple gingival recessions. Within its limitations, both treatments successfully achieved root coverage and were able to reduce gingival recession. It is expected a partial root coverage when using these techniques in large gingival recessions. The study failed to provide significant differences between groups. The use of modified extended coronally advanced flap may be advisable for the treatment of multiple gingival recessions, specially involving large defects when using ADM, to avoid early matrix exposure.

Long term efficacy of root coverage techniques

Gingival recession is a dramatic soft tissue finding in teeth affected by periodontal disease and remains one of the most common aesthetic concerns associated with periodontal tissue. The etiology of the condition is multifactorial but is commonly associated with alveolar morphology, tooth brushing, mechanical trauma and periodontal disease. With greater understanding of the dynamics of healing along with an awareness of aesthetics various periodontal procedures have been introduced to deal with problems of gingival recession. The long-term stability of the outcomes obtained with the surgical treatment of single and multiple gingival recessions has been evaluated in a few studies. Of the vast repertoire of mucogingival procedures for gingival recession management, long term studies of more than 5 years is present only for coronally advanced flap with or without connective tissue grafts. There are many other novel techniques in literature with little or no evidence to prove its long term efficacy. Various studies published during the last 30 years were identified through a search of the PubMed/Medline, Science Direct and Cochrane Library databases. “Follow up”, “root coverage”, root coverage procedures, root coverage techniques were the key words used for the search. In this review we have grouped the efficacy of various root coverage techniques based on their short and long term follow up. The review emphasises the value of meticulous follow up in order to validate efficacy of root coverage techniques. It also discusses the factors responsible for stability of results.

Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes

ObjectivesTo investigate factors that influence 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG) with enamel matrix derivative (EMD) (tests) or without (controls).Materials and methodsTwenty patients with 150 GR were treated. Logistic regression models were used to identify baseline parameters that could predict 12-month average root coverage (ARC), complete root coverage (CRC), root esthetic coverage score (RES), gain in keratinized tissue width (KTW), and gain in gingival thickness (GT).ResultsThe likelihood of ARC > 85% increased sevenfold (odds ratio [OR] = 7.33; 95% confidence interval [CI] = 2.43–12.12), of achieving CRC: 21-fold (OR = 21.23; 95% CI = 10.21–45.32), and of gaining RES = 10: tenfold (OR = 10.23; 95% CI = 5.78–32.23) in favor of EMD-treated sites. With each 1-mm2 increase in baseline avascular exposed root surface area (AERSA), the odds of failure (ARC ≤ 85%, not achieving CRC and postoperative GT ≤ 2 mm) increased almost fourfold (OR = 3.56; 95% CI = 1.98–10.19), fourfold (OR = 4.23; 95% CI = 1.11–9.02), and nearly sixfold (OR = 5.76; 95% CI = 2.43–12.87), respectively. The greater the baseline GT, the more likely the chance of achieving CRC (OR = 10.23; 95% CI = 8.37–16.23) and RES = 10 (OR = 5.50; 95% CI = 3.34–16.43). All models exhibited fair to excellent discrimination and satisfactory calibration.ConclusionsBased on logistic regression, EMD application improved postoperative ARC, CRC and RES; baseline AERSA predicted 12-month ARC, CRC, and GT gain, whereas baseline GT was a predictor of achieving CRC and perfect RES.Clinical relevanceAdditional use of EMD, lower baseline AERSA, and greater baseline GT significantly increase the odds of obtaining better outcomes 12 months after MCAT + SCTG technique.

Surgical treatment of multiple gingival recessions by the combination of autograftand allogenic lyophilized dura mater: a clinical case

Relevance. Gingival recession is the apical migration of the gingival tissues associated with the exposure of the roots and alveolar bone loss. The prevalence of single recessions in people over 18 years old is 86.7% whereas multiple recessions, i.e. where all teeth are affected, amount up to 28.6%. High prevalence of the pathology necessitates improvement of the approach and tactic of multiple recession treatment in patients with different phenotypes. Nowadays, the use of autograft is the gold standard of multiple recession treatment. However, the technique has its drawbacks. The purpose of the present work was to assess the response to surgery and evaluate the final result of multiple recession treatment in one subject where the combination of autogenic and allogenic grafts was used in the same study design.Materials and methods. The paper presents and describes a clinical case where auto- and allografts were used in one patient to treat multiple gingival recessions.Results. All parameters of the gingival recession assessment showed comparable clinical benefit in all sites of autograft and allograft (dura mater) application. The root coverage was more than 80% around 13 teeth and less than 80% around 11 teeth.Conclusion. The results of the autograft and allograft (dura mater) application were comparable, response to surgery was the same; besides, the allograft (dura mater) is attractive for combined and independent use during surgical treatment of multiple and especially full-mouth recessions.

MODIFIED CORONALLY ADVANCED FLAP APPROACH WITH ISTHMUS DEEPITHELIALIZATION FOR THE TREATMENT OF MULTIPLE RECESSION DEFECTS IN CASES WITH INTERDENTAL TISSUE LOSS

PURPOSE: This presentation demonstrates a modified surgical approach for multiple gingival recessions in sites with interdental papillae loss and a newly developed method for prediction of the possible root coverage MATERIAL/METHODS: A 41 years old patient with a diagnosis of Periodontitis II Stage, Grade A. The main complaint was the hypersensitivity, which has even increased after the initial periodontal therapy and his chief request was to cover the exposed root surfaces. In order to achieve a harmonic gingival display and good esthetics, root coverage on all teeth from 13 to 25 was required. The surgical planning revealed a decreased height of interdental papillae. The analysis of the maximum achievable root coverage demonstrated that the intended line of coverage could not be reached with the available root coverage procedures. A new surgical technique, together with a new measuring protocol for accurate prediction of the achievable level of root coverage were developed. RESULT: One year after treatment, a consistent root coverage was observed with an established proper gingival profile The achieved line of the gingival margin completely coincided with the presurgical planning. The patient was fully satisfied with the esthetic result and the reduction of the hypersensitivity. CONCLUSION: In the limitation of the presented case, the developed new method for prediction of the root coverage and modified surgical approach for cases with interdental papillae loss and preserved isthmus provided a predictable increase of the achievable root coverage. Further research is required to study the efficiency of this newly developed surgical approach.

Intraoral De-Epithelialized Gingival Graft in the Treatment of Multiple Adjacent Gingival Recessions: Case Report with a 1-Year Follow-Up

Intraoral De-Epithelialized Gingival Graft in the Treatment of Multiple Adjacent Gingival Recessions: Case Report with a 1-Year Follow-Up

Treatment of gingival recessions using coronally advanced flap and connective tissue graft: a long-term retrospective analysis.

The aim of this retrospective study was to evaluate the long-term effectiveness of coronally advanced flap (CAF) in combination with connective tissue graft (CTG) in the treatment of gingival recessions. Periodontal charts of 13 patients with single and multiple gingival recessions treated by means of CAF and CTG with a follow-up of 7 years were selected for the study. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), gingival recession depth (GRD), gingival recession width (GRW), height of keratin-ized gingiva (KG), probing depth (PD), and clinical attachment level (CAL) were assessed at baseline, and after 1 and 7 years of follow-up. Complete root coverage (CRC) was evaluated at 1 year and after 7 years of follow-up. A comparison of gingival recessions with or without non-carious cervical lesions (NCCL) was also performed. All clinical variables showed a significant improvement (P < .05) between baseline and after 7 years of follow-up. CRC was achieved in 69.2% and 53.8% of sites after 1 and 7 years of follow-up, respectively. The comparison between gingival recessions with and without NCCL did not show statistically significant differences (P > .05) in terms of all parameters. Within limits of the present study, the combination of CAF and CTG for the treatment of single and multiple recessions yielded positive outcomes in terms of GRD reduction and CRC after 7 years. These findings were independent of the presence of NCCLs.

Impact of Tooth Location on the Treatment of Multiple Gingival Recessions with Connective Tissue Graft Associated with a Coronally Advanced Flap

Objectives: Coronally Advance Flap (CAF) effectiveness has been extensively evaluated, but little information is available regarding the effect of tooth position. This study aimed to evaluate the influence of tooth location on the outcomes of CAF with subepithelial connective tissue graft (SCTG) in the treatment of gingival recessions defects (GRs). Materials and Methods: Nineteen patients who patients with a mean age of 36.3 ±7.6 years (11women, 8 men), each contributing Miller Class I and II GRs, were selected. Forty-four defects were treated with a combination of a CAF and a SCTG. Gingival recession depth (RD), gingival recession width (RW), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline and 12 months postoperatively Results: The mean root coverage from baseline to 1year post-surgery was 89 % for the maxillary GRs and 68 % for the mandibular GRs. RD and RW were decrease in both groups from baseline to 12 months (p&amp;lt;0.001), but there was no statistically significant difference between maxillary and mandibular dentition. Both treatments showed satisfactory esthetic results (RES in maxillary teeth 8.2 ±1.3 and in mandibular teeth 7.6 ± 1.1). Conclusions: The findings of the current study have shown that the CAF is an effective procedure for the treatment of multible GRs. Besides, the two groups (maxillary and mandibular GRs) showed similar significant improvements from baseline to 12 months evaluations. Keywords: Connective tissue, gingival recession, surgical flaps, tooth.

Treatment of Gingival Recession with Microinvasive Surgical Technology

Objective. The purpose of this clinical research was to evaluate the result of microinvasive surgical technology: vestibular incision subperiosteal tunnel access (VISTA) and subepithelial connective tissue graft (SCTG) in multiple gingival recession. Methods. A total of 20 patients with 25 Miller I and 30 Miller III gingival recession teeth were treated with VISTA+SCTG. The data at baseline and 12 months were assessed: probing depth (PD), clinical attachment loss (CAL), gingival recession depth (RD), gingival recession width (RW), width of keratinized tissue (WKT), and gingival biotype (GB), and percentage of root coverage (RC) and complete root coverage (CRC) were calculated. Results. The average root coverage was 1.52 ± 0.70 mm in Miller I and 0.82 ± 0.79 mm in Miller III. The mean root coverage rate was 99.00 % ± 5.00 % in Miller I and 60.73 ± 37.90 % in Miller III. The width of clinical attachment loss of keratinized tissue was significantly improved. Conclusions. VISTA and SCTG are effective in the treatment of both Miller class I and III multiple gingival recessions. Gingival increment in Miller class I is better than that in III. It is the same for maxillary and mandibular teeth.

Clinical evaluation of the treatment of multiple gingival recessions with connective tissue graft or concentrated growth factor using tunnel technique: a randomized controlled clinical trial.

To assess the effectiveness of the combination of tunnel technique (TT) and concentrated growth factor (CGF) for root coverage in treating multiple gingival recessions (GR) and compare with the connective tissue graft (CTG). Forty patients with Miller Class I and II maxillary or mandibular GR were randomly divided into two groups as follows: TT + CTG and TT + CGF. The results at baseline and 6 months were evaluated for the following clinical parameters: complete root coverage (CRC), mean root coverage (MRC), gingival thickness (GT), gingival recession width (RW), gingival recession depth (RD), and keratinized tissue width (KTW). At 6 months, a statistically significant difference was found in RD, RW, MRC, CRC, KTW, and GT compared with the baseline (p < 0.05). MRC was determined 89.52±16.36% in the TT + CTG and 76.60±24.10% in the TT + CGF (p < 0.05). CRC was achieved in 66.7% of the TT + CTG and 47.4% of the TT + CGF (p < 0.05). The increase in KTW and GT was significantly better in the TT + CTG group compared to the TT + CGF (p < 0.05). The study showed that TT + CGF did not improve the results as much as TT + CTG in the treatment of Miller Class I and II GR. However, this finding is not sufficient to advocate the true clinical effects of CGF on GR treatment with TT. CGF could not serve as a direct alternative biomaterial to the gold standard CTG. ClinicalTrials.gov Identification Number: NCT04561947.

Root coverage of multiple gingival recessions treated with coronally advanced flap associated with xenogeneic acellular dermal matrix or connective tissue graft: a 6-month split-mouth controlled and randomized clinical trial

This study aimed to compare xenogeneic dermal matrix (XDM) to connective tissue graft (CTG) associated with coronally advanced flap (CAF) in treating Miller's class I and II (RT1) multiple gingival recession in a split-mouth randomized clinical trial. Fifteen patients with bilateral Miller's class I and II multiple recessions were selected. The patient's side receiving each treatment was randomly allocated to receive XDM or CTG. The clinical parameters were measured at baseline and 6 months of follow-up. At 6 months, no significant difference in the root coverage (RC) (95.28 ± 6.89% for CTG and 92.68 ± 7.35% for XDM) and the keratinized tissue (KT) gain (0.91 ± 0.46 mm for CTG and 0.74 ± 0.39 mm for XDM) was observed between groups (p > 0.05). The CTG group presented higher complete root coverage (CRC) than XDM (60% and 33%, respectively) (p = 0.045). Multiple logistic regression indicated that the XDM (p = 0.01) and the XDM and KT interaction (p = 0.02) negatively interfered in the CRC. A 1-mm increase in the baseline KT when using XDM increases almost 6 times the chance of achieving CRC, and XDM reached a similar CRC probability to CTG when the receptor area presented at least 2 mm of KT. Both treatments were effective for treating multiple gingival recession; similar KT gain, GR reduction, and RC were obtained for CTG and XDM, while CTG promoted higher CRC than XDM. Moreover, the amount of KT at baseline was determinant for CRC when treating multiple gingival recession with XDM. XDM produces limited CRC in sites with a reduced amount of KT. Brazilian Clinical Trials Registry (REBEC) number RBR-56NZQ6.

Treatment Modalities for Multiple Gingival Recession– A New Prospects

This case series reports the various treatment modalities to treat the multiple recessions. Gingival recession is a widespread clinical manifestation affecting single or multiple root surfaces at all teeth types. Periodontal reconstructive surgery consists of various mucogingival procedures. The primary goal of these procedures is to benefit periodontal health through the reconstruction of lost hard and soft tissues, or by preventing its additional loss, and also enhancing the esthetic appearance. Platelet-rich fibrin is a second generation platelet concentrate and is defined as an autologous leukocyte and platelet-rich fibrin biomaterial. Care was taken not to extend the incisions till the tip of the interdental papilla. A full thickness mucoperiosteal flap was reflected, extending beyond the mucogingival junction. A wide range of surgical techniques has been proposed for the treatment of the gingival recessions, each with its advantages and disadvantages. To provide predictable and long-term results, it is of paramount importance that the surgical technique is individually selected, taking into account several crucial factors such as the size of the defect, the width of the keratinised gingiva apical to the defect and the thickness of the flap.

Clinical Outcomes and Gingival Blood Flowmetry of Two Types of Subepithelial Connective Tissue Graft for Root Coverage in Multiple Gingival Recessions: A Preliminary Study.

This randomized split-mouth preliminary clinical trial aimed to evaluate periodontal parameters and gingival blood flowmetry, comparing sites that received subepithelial connective tissue graft from the palate after deepithelialization (DE) or obtained with parallel incision (PI). Periodontal parameters were evaluated at baseline and 6 months postoperative. Gingival blood flows were analyzed by laser Doppler flowmetry (LDF) at baseline and 2, 7, and 14 days postoperative. Statistical and LDF analyses were performed with R version 3.5.1 and MATLAB software, and clinical parameters through ANOVA and Wilcoxon signed-rank tests. LDF showed superior decrease in power spectral density (PSD) for DE after 2 days. After 7 days, PSD returned to initial values only for PI, and DE had not returned to the initial values by day 14. Despite major initial revascularization challenges for DE sites, both grafts promoted satisfactory root coverage in the treatment of multiple gingival recessions.

Clinical Outcomes and Gingival Blood Flowmetry of Two Types of Subepithelial Connective Tissue Graft for Root Coverage in Multiple Gingival Recessions: A Preliminary Study

This randomized split-mouth preliminary clinical trial aimed to evaluate periodontal parameters and gingival blood flowmetry, comparing sites that received subepithelial connective tissue graft from the palate after deepithelialization (DE) or obtained with parallel incision (PI). Periodontal parameters were evaluated at baseline and 6 months postoperative. Gingival blood flows were analyzed by laser Doppler flowmetry (LDF) at baseline and 2, 7, and 14 days postoperative. Statistical and LDF analyses were performed with R version 3.5.1 and MATLAB software, and clinical parameters through ANOVA and Wilcoxon signed-rank tests. LDF showed superior decrease in power spectral density (PSD) for DE after 2 days. After 7 days, PSD returned to initial values only for PI, and DE had not returned to the initial values by day 14. Despite major initial revascularization challenges for DE sites, both grafts promoted satisfactory root coverage in the treatment of multiple gingival recessions.

Root coverage stability: A systematic overview of controlled clinical trials with at least 5 years of follow-up.

ObjectivesTo systematically assess the long‐term outcome (≥5 years) of root coverage procedures reported in controlled clinical trials.Material and MethodsLiterature search was performed according to the PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) controlled (CT) or randomised controlled clinical trials (RCT); (c) root coverage procedure with ≥5 years follow‐up; and (d) clinical treatment effect size and/or patient‐related outcome measures (PROMs) reported.ResultsFour CT and 14 RCT with a follow‐up of 5–20 years fulfilled the eligibility criteria; sample size per study ranged from 8 to 70 patients contributing with 18–149 sites. Coronally advanced flap (CAF) and CAF + connective tissue graft (CTG) were the prevalent treatments (i.e., in 24 and 38% of the groups, respectively), while other flap designs and adjuncts (i.e., enamel matrix derivative, bone graft, collagen membrane) were represented only once. For single Miller class I/II gingival recessions (GR), CAF + CTG appeared advantageous compared to other techniques, and provided low residual recession depths (i.e., ≤0.5 mm), and complete root coverage in ≥2/3 of the patients; similar tendency was observed for multiple GR. No data on Miller class III/IV GR is available. No meta‐analysis was feasible due to lack of similarity in the clinical and methodological characteristics across the trials and observed comparisons of interventions.ConclusionsCAF + CTG appears to be the ‘gold standard’ technique for the treatment of single and multiple Miller class I/II GR also in regard to long‐term (i.e., ≥5 years of follow‐up) treatment outcomes. There is little information regarding the performance, on the long‐term, of other techniques and adjuncts.

Platelet-Rich Fibrin in Single and Multiple Coronally Advanced Flap for Type 1 Recession: An Updated Systematic Review and Meta-Analysis.

Background and Objectives: The aim of the present systematic review and meta-analysis was to investigate the efficacy of leukocyte–platelet-rich fibrin (L-PRF) in addition to coronally advanced flap (CAF) for the treatment of both single and multiple gingival recessions (GRs) compared to the CAF alone and to the adjunct of connective tissue graft (CTG). Root coverage outcomes using platelet concentrates have gained increased interest. In particular, it has been suggested that adding L-PRF to CAF may provide further benefits in the treatment of GRs. Materials and Methods: An electronic and manual literature search was conducted to identify randomized controlled trials (RTCs) investigating root coverage outcomes with CAF + L-PRF. The outcomes of interest included mean root coverage (mRC), recession reduction, keratinized tissue width (KTW) gain, gingival thickness (GT) gain, and patient-reported outcome measures (PROms) such as pain perception and discomfort. Results: A total of 275 patients and 611 surgical sites were analyzed. L-PRF in adjunct to single CAF seems to show statistically significant results regarding clinical attachment level (CAL) with a weighted means (WM) 0.43 95% CI (−0.04, 0.91), p < 0.0001, GT (WM 0.17 95% CI (−0.02, 0.36), p < 0.0001, and mRC (WM 13.95 95% CI (−1.99, 29.88) p < 0.0001, compared to single CAF alone. Interesting results were obtained from the adjunct of PRF to multiple CAF with respect to multiple CAF alone with an increase in the mRC WM 0.07 95% CI (−30.22, 30.35), p = 0.0001, and PPD change WM 0.26 95% CI (−0.06, 0.58), p < 00001. On the other hand, no statistically significant data were obtained when L-PRF was added to single or multiple CAF combined with CTG according to the included outcomes such as mRC (p = 0.03 overall). Conclusions: L-PRF is a valid alternative to CAF alone. L-PRF compared to CTG in single and multiple CAF showed statistically significant results regarding pain perception and discomfort PROms (p < 0.0001). However, CTG remains the gold standard for treating gingival recession.

Management of Multiple Gingival Recessions Using Zucchelli’s Modified Coronally Advanced Flap Technique with or withoutPlatelet Rich Fibrin Membrane – A Case Report

Gingival recession is the apical migration of the gingival margin with exposure of root surfaces. Fulfilling functional and esthetic demands of patients with multiple gingival recessions remains a major therapeutic challenge. While treating adjacent multiple recession defects in esthetic areas, selection of appropriate surgical procedure that restores optimal esthetic and functional stability is of paramount importance, which allows the clinician to gain optimal structural correction of the soft tissue deficiency yet does not compromise the soft tissue architecture and esthetics. Zucchelli and De Sanctis have described a modified coronally advanced flap design for the treatment of multiple gingival recessions, which allows for optimal flap adaptation and satisfactory root coverage. Platelet Rich Fibrin demonstrates the additional biologic effects, where its growth factors enhance the wound healing mechanism and are postulated as promoters of tissue regeneration. This case report presents bilateral multiple gingival recessions treated with Zucchelli’s modified coronally advanced flap with or without the use of Platelet Rich Fibrin.

Patient-centered comparative outcome analysis of platelet-rich fibrin-reinforced vestibular incision subperiosteal tunnel access technique and Zucchelli's technique.

Background:Multiple gingival recession (MGR) coverage, especially in esthetic area, demands a high patient satisfaction. Coronally advanced flap modifications, namely Zucchelli's technique (ZT) and vestibular incision subperiosteal tunnel access (VISTA), are techniques, recommended in the correction of MGR.Aim:The purpose was to comparatively analyze the ZT and VISTA technique reinforced with the platelet-rich fibrin membrane in the management of MGR.Materials and Methods:This split-mouth, randomized study comprised 16 consenting, systemically healthy participants. The bilateral Miller's multiple class I and II lesions were managed with ZT and VISTA technique and had a follow-up period of 18 months. Gingival thickness (GT), mean percentage of root coverage, and patient-centered outcome scales, including patient comfort score, patient esthetic score, and hypersensitivity score, were the primary outcome measures. Further clinical parameters assessed were gingival index, probing depth, clinical attachment level, and width of keratinized gingiva.Statistical Analysis and Results:Paired t-test and unpaired t-test were used for intragroup comparison and intergroup analysis, respectively. While both the techniques exhibited high root coverage percentage (VISTA: 93.95% and ZT: 96.84%), statistically significant difference was noted with patient esthetic score and surgical mortality score in VISTA.Conclusion:Both ZT and VISTA were effective in terms of root coverage and GT augmentation in MGR management. From the patient's perspective, they preferred VISTA technique over ZT, stating its minimal postoperative morbidity and improved esthetic outcome. Hence, within the limitations of this study, the VISTA technique was found to be a superior alternative compared to that of ZT in MGR management.

Treatment of multiple gingival recessions with xenogeneic acellular dermal matrix compared to connective tissue graft: a randomized split-mouth clinical trial.

PurposeThe aim of this study was to compare the efficacy of the tunnel technique for root coverage using a new xenogeneic acellular dermal matrix vs. connective tissue grafting (CTG) for the treatment of multiple maxillary adjacent recessions (recession type 1) at 12 months postoperatively.MethodsThis study enrolled 12 patients with at least 3 contiguous, bilateral, symmetrical maxillary gingival recessions (i.e., at least 6 recessions per patient). In total, 74 recessions were treated using the modified coronally advanced tunnel (MCAT) technique combined with a novel porcine-derived acellular dermal matrix (PADM) at 37 test sites or CTG at 37 control sites. The following clinical parameters were measured: recession height, clinical attachment level, width of keratinized tissue, probing depth, recession width, gingival thickness, mean root coverage (MRC), and complete root coverage (CRC). Comparisons between test and control groups were made for pain visual analog scale scores at 14 days.ResultsAt 12 months, the MCAT with PADM (test) yielded a statistically significant improvement in all clinical parameters studied. MRC was significantly higher on the control sides (80.6%±23.7%) than on the test sides (68.8%±23.4%). Similarly, CRC was 48.7%±6.8% on the control sides (CTG), in contrast to 24.3%±8.2% on the test sides (PADM). Statistically significant differences were observed in favor of the control sides for all clinical parameters studied. Nevertheless, the MCAT in adjunction with PADM was clearly superior at reducing mean and maximum patient-reported postoperative pain intensity and pain duration in the first week after surgery.ConclusionsThe use of PADM to treat multiple recessions improved clinical parameters at 12 months, but these outcomes were nevertheless poorer than those observed for CTG. However, PADM reduced morbidity, particularly the pain experienced by patients.Trial RegistrationClinicalTrials.gov Identifier: NCT03162016