Relative Gingival Recession Research Articles

Xenogeneic Acellular Dermal Matrix for the Treatment of Multiple Gingival Recessions Associated with Partially Restored Noncarious Cervical Lesions.

This study evaluated the use of a xenogeneic acellular dermal matrix (XADM) combined with a modified coronally advanced flap (MCAF) and partial resin composite filling (anatomic crown plus 1 mm of the root surface) to treat multiple Type 1 gingival recessions associated with B+ noncarious cervical lesions (NCCLs). The study included 24 recessions in 10 patients. Bleeding on probing, probing depth, combined defect height, relative gingival recession, clinical attachment level, esthetics, and dentin hypersensitivity were recorded. After 6 months, the treatment provided statistically significant outcomes: It reduced the combined defect height by 2.02 ± 0.65 mm, increased clinical attachment level by 1.96 ± 0.83 mm, and increased keratinized tissue thickness by 0.46 ± 0.47 mm, and shallow probing depths were seen. Significant dentin hypersensitivity reduction and esthetic improvements were observed. Therefore, XADM associated with MCAF and partial restoration might be a promising alternative to autogenous grafts used to treat multiple gingival recessions associated with B+ NCCLs.

Single versus multiple adjunctive Er,Cr:YSGG application to scaling and root planing in periodontal maintenance patients with residual periodontal pockets

The aim of this study was to compare the clinical results between single and multiple Er,Cr:YSGG laser applications as an adjunct to scaling and root planing (SRP) in periodontal maintenance patients with residual periodontal pockets. This study was a split-mouth, double-blind, randomized clinical trial with 17 periodontal maintenance patients who presented two single-rooted teeth with probing depth (PD) of 5–9 mm and bleeding on probing (BOP). The teeth were randomly assigned to group A (single Er,Cr:YSGG application + SRP) and group B (multiple Er,Cr:YSGG application + SRP). Presence of plaque, BOP, PD, relative probing attachment level (RPAL), and relative gingival recession (RGR) was evaluated at baseline, 3 months, and 6 months after treatment by one calibrated examiner. The results showed no statistically significant differences in PD reduction between groups at 3 months (group A: 1.06 ± 1.09 mm vs. group B: 1.00 ± 1.12 mm) and 6 months (group A: 1.18 ± 1.47 mm vs. group B: 1.00 ± 1.22 mm) compared with the baseline. At 3 months after treatment, the RPAL in group A had a gain (0.65 ± 1.06 mm) while group B was at a loss (0.06 ± 0.83 mm). At 6 months, the RPAL changes between 2 groups showed no statistically significant differences. Only in group B, wherein RGR had a statistically significant increase at 3 months (1.00 ± 0.94 mm) and 6 months (0.71 ± 0.69 mm) after treatment. However, this showed no statistically significant difference when compared with group A. Both single and multiple adjunctive Er,Cr:YSGG applications to SRP in periodontal maintenance patients with residual periodontal pockets demonstrated PD reduction. Only the single laser application group showed clinical attachment level gain, and the multiple application group resulted in an increased gingival recession. However, there are no statistically significant differences between the two treatment modalities in all clinical parameters at 6 months.

Efficacy of adjunctive Er,Cr:YSGG laser application to scaling and root planing in periodontal maintenance patients with residual periodontal pockets

The aim of this study was to evaluate the efficacy of using Er,Cr:YSGG laser in an adjunct to scaling and root planing (SRP + Er,Cr:YSGG) in periodontal maintenance patients with residual periodontal pockets. This study is a double-blind randomized controlled clinical trial and a split-mouth design. Fifteen periodontal maintenance patients with two single-rooted teeth with probing depth (PD) ≥ 5 mm in two different quadrants were randomly assigned to scaling and root planing (SRP) as a control group or SRP + Er,Cr:YSGG as test group. Plaque index (PI), bleeding on probing (BOP), PD, relative probing attachment level (RPAL), and relative gingival recession (RGR) were evaluated at baseline, 3 months and 6 months after treatment by one calibrated examiner. At 6 months after treatment, PDs were statistically significantly reduced in both SRP (0.9 ± 0.6 mm) and SRP + Er,Cr:YSGG (1.1 ± 0.7 mm) compared with pretreatment PD (p < 0.05). Only SRP + Er,Cr:YSGG demonstrated statistically significant probing attachment level (PAL) gained at 6 months after treatment (0.8 ± 0.6 mm; p < 0.05). Gingival recession (GR) statistically significantly increased in SRP + Er,Cr:YSGG 3 months after the treatment (0.5 ± 0.5 mm; p < 0.05). Nevertheless, there were no statistically significant differences between the 2 treatment modalities regarding PD reduction, PAL gain, or GR at 6 months after treatment. Only SRP + Er,Cr:YSGG demonstrated statistically significant PAL gained at 6 months after treatment (0.8 ± 0.6 mm; p < 0.05); however, there were no statistically significant differences between the 2 treatment modalities regarding PD reduction, PAL gain, or GR at 6 months after treatment in maintenance patients with residual periodontal pockets.

Treatment of Gingival Recession Associated with Non-Carious Cervical Lesions Using Resin Modified Glass Ionomer Cement with Connective Tissue Graft a Randomized Controlled Clinical Trial

Introduction: Gingival recession (GR) is a common aesthetic problem associated with the cervical wear of the tooth structure and dentin hypersensitivity. Recently, periodontal-restorative approaches have been proposed for the management of GR associated with non-carious cervical lesions (NCCLs), which has proven effective. The present study aimed to evaluate this method. Methods: In total, 30 subjects with isolated Millers class I GR associated with NCCL in the maxillary canines and premolars were randomly assigned to group A (CTG) and group B (R+CTG). Clinical parameters, including the probing pocket depth (PPD), relative GR (RGR), keratinized tissue width (KTW), keratinized tissue thickness (KTT), relative clinical attachment level (CAL), cervical lesion height (CLH), and dentin hypersensitivity (DH), were recorded at baseline (BL) and after one and six months. In addition, maximum root coverage (MRC) was evaluated after six months. Results: In both groups, a statistically significant reduction was observed in the PPD, RGR, and CLH after six months (P=0.001). On the other hand, a significant increase was observed in the KTW, KTT, and CAL in both groups (P=0.001). Moreover, the visual analogue pain scores indicated a significant reduction in both groups, while the reduction was considered more significant in group B (P˂0.05) compared to group A. In groups A and B, 69.24% and 61.54% of the sites showed MRC, respectively. Conclusion: According to the results, both groups achieved comparable root coverage, while the presence of restoration led to a greater reduction in dentin hypersensitivity.

Periodontal Evaluation in Noncarious Cervical Lesions Restored with Resin-modified Glass-Ionomer Cement and Resin Composite: A Randomised Controlled Study.

To assess periodontal parameters of noncarious cervical lesions (NCCLs) restored with glass-ionomer cement (RM-GIC) and composite resin at baseline, three and six months. Eighteen patients with bilateral lesions were included in the study. Lesions (1 mm in depth) were randomly restored with each type of restorative material. Probing depth (PD), relative gingival recession (rGR), relative clinical attachment level (rCAL), visible plaque index (VPI) and gingival bleeding index (GBI) were measured. No statistically significant differences were found when comparing within groups (p > 0.05). However, the intergroup analysis demonstrated a decrease in GR and rCAL gain for teeth restored with the resin-modified glass-ionomer cement (RM-GIC). Both materials behaved similarly when in close contact with periodontal tissues and did not influence periodontal parameters.

Treatment of gingival recession by coronally advanced flap in conjunction with platelet-rich fibrin or resin-modified glass-ionomer restoration: A clinical study.

Aims:The aim of this study is to compare the outcome of coronally advanced flap (CAF) along with the use of platelet-rich fibrin (PRF) versus CAF in conjunction with a resin-modified glass-ionomer cement (RmGIC) for the management of Millers Class I and Class II gingival recession coupled with noncarious cervical lesions (NCCLs).Materials and Methods:Single and multiple Miller's Class I and Class II gingival recessions were chosen for the study. Twenty participants with total of 78 sites associated with NCCL bilaterally in the anterior and premolar region of maxilla were selected. Thirty-nine sites were treated with CAF and PRF and the remaining 39 sites were treated with CAF and RmGIC. Clinical parameters such as probing pocket depth, relative gingival recession, relative clinical attachment level, NCCL height, NCCL width, width of keratinized tissue, and keratinized tissue thickness were measured at baseline, 90th, and 180th day in both the groups. The presence or absence of dentin sensitivity (DS) was determined at baseline and 180th day.Results:Both the groups showed optimal root coverage, with statistical significant difference in thickness of keratinized gingiva in Group I when compared to Group II from baseline to 90th day and from baseline to 180th day and also from 90th to 180th day. On comparing the DS between Group I and Group II from baseline to 180th day, Group II showed greater reduction in dentinal hypersensitivity as compared to Group I.Conclusion:The use of PRF along with CAF showed increased thickness of the keratinized tissue and the utilization of RmGIC resulted in decreased DS. Hence, the combination of CAF and PRF or CAF and RmGIC could provide a better treatment option in the management of gingival recession that is of esthetic concern.

Connective Tissue Graft and Crown-Resin Composite Restoration for the Treatment of Gingival Recession Associated with Noncarious Cervical Lesions: Case Series.

The purpose of this case series is to describe a restorative and surgical approach to treat the combined defect (CD)-gingival recession associated with noncarious cervical lesions (NCCL)-through connective tissue graft in combination with partial resin composite filling, restoring the crown zone plus 1 mm of the NCCL. A total of 10 patients were included. Bleeding on probing, probing depth, relative gingival recession, clinical attachment level, CD height, and dentin hypersensitivity were measured. The treatment provided statistically significant gain in clinical attachment level and shallow probing depths. The percentage of the combined defect coverage was 70% ± 20.2%. It can be concluded that this treatment protocol, in the presence of a partial resin composite restoration, can be used successfully to treat CD.

The Influence of Local Anatomy on the Outcome of Treatment of Gingival Recession Associated With Non‐Carious Cervical Lesions

The present study evaluates the influence of local anatomy on the reduction in relative gingival recession (Delta RGR) and gain of clinical attachment level (Delta CAL) achieved by coronally advanced flap alone (CAF), CAF plus restoration (CAF + R), subepithelial connective tissue graft alone (CTG), and CTG plus restoration (CTG + R), to treat Miller Class I gingival recessions associated with non-carious cervical lesions. A total of 78 defects in maxillary canines or premolars were included, and received one of the following treatments: CAF, CAF + R, CTG, or CTG + R. Delta RGR and Delta CAL after 6 months were associated with cervical lesion height (CLH), cervical lesion width, cervical lesion depth (CLD), keratinized tissue width, keratinized tissue thickness, papillae width, papillae height, bone level (BL), and post-surgical position of the gingival margin using stepwise multivariate linear regression. CLH was statistically associated with Delta RGR when CAF (P = 0.02) and CTG + R (P = 0.0002) were analyzed and statistically associated with Delta RGR when overall data (P = 0.005) from both CTG groups were analyzed. CLD was significantly associated with Delta RGR in the CAF group (P = 0.0045). BL was statistically associated with Delta RGR when evaluating the CTG group (P = 0.02). It was also significantly associated with Delta CAL when considering the CTG (P = 0.01) and the overall data (P = 0.04) from CAF (CAF and CAF + R). It can be concluded that CLD may influence Delta RGR when CAF is performed to treat combined defects. Additionally, BL may not negatively influence Delta RGR when the CTG technique is used.

Connective tissue graft plus resin‐modified glass ionomer restoration for the treatment of gingival recession associated with non‐carious cervical lesion: a randomized‐controlled clinical trial

The aim of this clinical study was to evaluate the treatment of gingival recession, associated with non-carious cervical lesions by a connective tissue graft (CTG) alone, or in combination with a resin-modified glass ionomer restoration (CTG+R). Forty patients presenting Miller Class I buccal gingival recessions, associated with non-carious cervical lesions, were selected. The defects were randomly assigned to receive either CTG or CTG+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL) and cervical lesion height (CLH) coverage were measured at baseline and 45 days, and 2, 3 and 6 months after treatment. Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant in BOP, PD, RGR and CAL, after 6 months. The percentages of CLH covered were 74.88 +/- 8.66% for CTG and 70.76 +/- 9.81% for CTG+R (p>0.05). The estimated root coverage was 91.91 +/- 17.76% for CTG and 88.64 +/- 11.9% for CTG+R (p>0.05). Within the limits of the present study, it can be concluded that both procedures provide comparable soft tissue coverage. The presence of the glass ionomer restoration may not prevent the root coverage achieved by CTG.

Cervical restoration and the amount of soft tissue coverage achieved by coronally advanced flap: A 2‐year follow‐up randomized‐controlled clinical trial

The aim of this study was to evaluate the 2-year follow-up success of the treatment of gingival recession associated with non-carious cervical lesions by a coronally advanced flap (CAF) alone or in combination with a resin-modified glass ionomer restoration (CAF+R). Sixteen patients with bilateral Miller Class I buccal gingival recessions, associated with non-carious cervical lesions, were selected. The defects received either CAF or CAF+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL) and cervical lesion height (CLH) coverage were measured at the baseline and 6, 12 and 24 months after the treatment. Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant in BOP, PD, RGR and CAL, after 2 years. The percentages of CLH covered were 51.57 +/- 17.2% for CAF+R and 53.87 +/- 12.6% for CAF (p>0.05). The estimated root coverage was 80.37 +/- 25.44% for CAF+R and 83.46 +/- 20.79% for CAF (p>0.05). Within the limits of the present study, it can be concluded that both procedures provide acceptable soft tissue coverage after 2 years, with no significant differences between the two approaches.

CTG and restoration in treatment of gingival recession associated with a cervical lesion: report of three cases

Purpose: The purpose of this report is to show three cases treated by an intergrated periodontal and restorative dentistry approach. Methods: Three patients with Miller Class gingiva recessions associated with cervical lesions were enrolled for treatment. Ⅰ Two patients received a connective tissue graft and resin modified glass ionomer, and one patient was treated with a con- nective tissue graft, resin restoration. Keratinized gingiva and relative gingival recession were measured. Results: The mean reduction of relative gingival recession was 3.7 mm, and the mean keratinized gingiva increase was 2.5 mm. The percentage of root coverage was 80% in average. No signs of gingival inflammation or bleeding on probing were seen. The patients were satisfied with the final esthetics and had no more dentin hypersensitivity. Conclusions: This report indicates that teeth with Miller Class gingival recession associated with cervical lesions can be Ⅰ successfully treated by a connective tissue graft combined with restorative dentistry. However, longitudinal randomized con- trolled clinical trials must be performed to support this approach. (J Korean Acad Periodontol 2009;39:437-441)

Coronally Positioned Flap Plus Resin‐Modified Glass Ionomer Restoration for the Treatment of Gingival Recession Associated With Non‐Carious Cervical Lesions: A Randomized Controlled Clinical Trial

The aim of this randomized clinical trial was to evaluate the treatment of gingival recession associated with non-carious cervical lesions by a coronally advanced flap alone (CAF) or in combination with a resin-modified glass ionomer restoration (CAF+R). Nineteen subjects with bilateral Miller Class I buccal gingival recessions associated with non-carious cervical lesions were selected. The recessions were assigned randomly to receive CAF or CAF+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL), non-carious cervical lesion height (CLH), and dentin sensitivity (DS) were measured at baseline; 45 days; and 2, 3, and 6 months postoperatively. Keratinized tissue width (KTW) and keratinized tissue thickness (KTT) were measured at baseline and 6 months. The height of the non-carious cervical lesion located on the root and crown were estimated, allowing calculation of root coverage. Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant for BOP, PD, RGR, CAL, KTW, and KTT after 6 months. The percentages of CLH covered were 56.14% +/- 11.74% for CAF+R and 59.78% +/- 11.11% for CAF (P >0.05). The root and crown surfaces affected by the non-carious cervical lesion were 1.67 +/- 0.31 mm and 0.96 +/- 0.29 mm, respectively, for CAF+R and 1.59 +/- 0.37 mm and 1.01 +/- 0.33 mm, respectively, for CAF. The estimated root coverage was 88.02% +/- 19.45% for CAF+R and 97.48% +/- 15.36% for CAF (P >0.05). CAF+R reduced DS significantly compared to CAF (P <0.05). Both procedures provided similar soft tissue coverage after 6 months. Despite the fact that a greater reduction in DS was observed after CAF+R, longitudinal observations are necessary to confirm these results.

Periodontal Surgery and Glass Ionomer Restoration in the Treatment of Gingival Recession Associated With a Non‐Carious Cervical Lesion: Report of Three Cases

Buccal gingival recession is a prevalent problem in populations with a high standard of oral hygiene and is very often associated with a non-carious cervical lesion, complicating treatment. The purpose of this report is to show three cases treated by an integrated periodontal and restorative dentistry approach. Three patients with Miller Class I gingival recessions associated with non-carious cervical lesions were enrolled for treatment. One patient received a coronally positioned flap and a resin-modified glass ionomer restoration, and two patients were treated with a coronally positioned flap, resin-modified glass ionomer restoration, and connective tissue graft. Probing depth (PD), relative gingival recession (RGR), and clinical attachment level (CAL) were measured at baseline and at 6 and 8 months after surgery. After the healing period, all patients showed CAL gain and reduction in RGR. No difference was observed on PDs compared to baseline. No signs of gingival inflammation or bleeding on probing were seen. The patients were satisfied with the final esthetics and had no more dentin hypersensitivity. This report indicates that teeth with Miller Class I gingival recessions associated with non-carious cervical lesions can be successfully treated by an integrated periodontal and restorative dentistry approach; however, longitudinal randomized controlled clinical trials must be performed to support this approach.