Root Coverage Esthetic Score Research Articles

Root coverage procedures improve patient aesthetics. A systematic review and Bayesian network meta-analysis.

The aim of this study was to perform a systematic review (SR) of randomized controlled trials (RCTs) to explore if periodontal plastic surgery procedures for the treatment of single and multiple gingival recessions (Rec) may improve aesthetics at patient and professional levels. In order to combine evidence from direct and indirect comparisons by different trials a Bayesian network meta-analysis (BNM) was planned. A literature search on PubMed, Cochrane libraries, EMBASE, and hand-searched journals until January 2016 was conducted to identify RCTs presenting aesthetic outcomes after root coverage using standardized evaluations at patient and professional level. A total of 16 RCTs were selected in the SR; three RTCs presenting professional aesthetic evaluation with Root coverage Aesthetic Score (RES) and three showing final self-perception using the Visual Analogue Scale (VAS Est) could be included in a BNM model. Coronally Advanced Flap plus Connective Tissue Graft (CAF+CTG) and CAF+Acellular Dermal Matrix (ADM) and Autologous Fibroblasts (AF) were associated with the best RES outcomes (best probability=24% and 64%, respectively), while CAF+CTG and CAF+CTG+Enamel matrix Derivatives (EMD) obtained highest values of VAS Est score (best probability=44% and 26%, respectively). Periodontal Plastic Surgery (PPS) techniques applying grafts underneath CAF with or without the adding of EMD are associated with improved aesthetics assessed by final patient perception and RES as professional evaluation system.

Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial.

The aim of this study was to assess the clinical efficacy of coronally advanced flap (CAF) with or without connective tissue graft (CTG) for the treatment of multiple adjacent gingival recessions in the upper arch. Thirty-two patients with a total of 74 gingival recessions were randomly allocated to the two groups. Outcome measures, collected by a blind examiner, included complete root coverage (CRC), recession reduction (RecRed), keratinized tissue (KT) gain, increase in gingival thickness (GT), patient satisfaction and root coverage esthetic score (RES). An interaction between treatment and baseline GT was detected. At 1year, CAF+CTG resulted in better outcomes in terms of CRC (p=0.0016) and RecRed (p<0.0001) than CAF alone at sites with thin gingiva (thickness≤0.8mm). No difference was found between CAF alone and CAF+CTG at sites with thick gingiva (>0.8mm). CAF resulted in higher aesthetic scores (RES) than CAF+CTG at sites with thick gingiva. CAF+CTG was associated with greater KT gain (p<0.0001) and greater post-operative morbidity (p<0.0001). Connective tissue graft under CAF results in increased probability of CRC only at sites with thin baseline gingiva. CAF alone is associated with similar clinical outcomes and better aesthetics at sites with thick baseline gingiva.

Efficacy of the lateral advanced flap in root-coverage procedures for mandibular central incisors: a 5-year clinical study.

The aim of this study was to determine the efficacy of the lateral advanced flap in root-coverage procedures for mandibular incisors and to evaluate pain after treatment. A total of 15 patients who required treatment for gingival recessions were selected from the University of Genoa Laser and Restorative Dentistry Department. The inclusion criteria were the presence of at least one 3-mm gingival recession defect of a mandibular incisor and 3 mm or more of keratinized tissue width on the immediately adjacent tooth. One calibrated masked examiner performed the clinical measurements, including recession depth and width, probing depth, clinical attachment level, and keratinized tissue width. Patients were checked 7, 14, and 30 days after surgery and were included in supportive periodontal maintenance every 4 months. Further follow-ups were done at the first, third, and fifth year postsurgery when the same baseline assessment parameters were recorded according to the root-coverage esthetic score (RES). Numeric score recorded pain evaluations showed a mean of 3 at the day of the surgery, 2 in the first day after the surgery, and no significant scores were referred in the following days. Mean recession depth was 3.2 ± 1.3 mm at baseline; at 5 years, RES showed a positive increase of all scores. The laterally coronally advanced surgical technique was very effective in treating isolated gingival recessions. It combined the esthetic and root-coverage advantages of the coronally advanced flap with the increased gingival thickness and keratinized tissue associated with the lateral gingival flap.

Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment of multiple gingival recessions with thin tissue biotype

The objective of this study was to compare acellular dermal matrix graft (ADM) combination with coronally advanced flap (CAF) on complete defect coverage, aesthetics and patient satisfaction with CAF alone for multiple recessions with gingival thickness (GT) <0.8 mm. Forty-eight Miller Class I multiple recessions ≥3 mm were divided into test (CAF + ADM) and control (CAF) groups. At baseline and 12 months, recession height (RH), keratinized tissue height (KT), GT, mean and complete defect coverage were evaluated. Patient satisfaction, root coverage aesthetic score (RES) and the correlation between GT and defect coverage were also assessed. Baseline RH in CAF + ADM and CAF groups was 3.25 ± 0.34 mm and 3.21 ± 0.26 mm, respectively. Mean and complete defect coverage were 94.84% and 83.33% in test group, 74.99% and 50.00% in control group, respectively. Inter-group differences were found to be statistically significant for RH reduction, attachment gain, KT and GT increase, mean defect coverage and RES in favour of test group (p < 0.05). There was a significant positive correlation between GT and mean defect coverage (p < 0.05). Coronally advanced flap in association with ADM can be proposed as a valid approach for the treatment of multiple recessions with thin tissue biotype.

Analysis of the Esthetic Outcome after Root Coverage Procedures Using a Comprehensive Approach

There is a reported gap between the relative satisfaction of the clinician and patient after a root coverage procedure. In addition, there may also be a disparity between objective esthetic evaluation tools and subjective satisfaction. This study included 58 sites in 31 patients who had undergone root coverage procedures. The percentage of root coverage and the root coverage esthetic score system were used as objective measurements. A questionnaire with a five-point ordinal scale was used for subjective evaluation. Initial recession depth and width, Miller classification, tissue biotype, treatment procedures, and follow-up periods were considered as associated factors. After a period of at least 6 months from the procedure, the patient-perceived outcome showed a better match with the root coverage esthetic scoring system than the percentage of root coverage alone. A lower value for objective outcome was obtained for a deeper gingival recession and higher Miller class, but the subjective outcome displayed a steady trend. All four esthetic results were at their lowest after an epithelialized free soft tissue graft. An esthetic outcome according to patient satisfaction was not always consistent with that determined by professional scoring. In addition, partial root coverage may be viewed as a positive outcome by patients and clinicians in cases of deep gingival recession and high Miller class. This study evaluates the esthetic outcome of root coverage procedures using an objective method, including the percentage of root coverage, root coverage esthetic scoring system, and subjective assessment by patient and clinician-based questionnaires. The results will be helpful for the understanding of the differences that exist in esthetic satisfaction.

Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient‐centred outcomes

The aim of this randomized clinical trial (RCT) was to introduce 3D digital measuring methods for evaluating the outcomes after surgical root coverage (RC) and to assess the clinical performance of the tunnel technique with subepithelial connective tissue graft (TUN) versus the coronally advanced flap (CAF) with enamel matrix derivative in the treatment of shallow localized gingival recession defects. Twenty-four patients contributed a total of 47 Miller class I or II recessions for scientific evaluation. Clinical outcomes were evaluated at 6 and 12months. Precise study models gained at baseline and follow-up examinations were optically scanned and virtually superimposed for digital evaluation of clinical outcome measures including percentage of RC and complete root coverage (CRC). Patient-centred outcomes were evaluated with questionnaires. Final aesthetic outcomes were assessed using the root coverage esthetic score (RES). At 12months, RC was 98.4% for TUN-treated and 71.8% for CAF-treated defects (p=0.0004). CRC was observed in 78.6% (TUN) and 21.4% (CAF) of the cases (p=0.0070). Results for patient-centred outcomes were equivalent for both groups but evaluation of the final aesthetic outcomes using the RES revealed a significant difference (9.06 versus 6.92, p=0.0034) in favour of TUN. TUN resulted in significantly better clinical outcomes compared with CAF. The new measuring method provided high accuracy and unforeseen precision in the evaluation of treatment outcomes after surgical RC.

Coronally advanced flap with and without connective tissue graft for the treatment of single maxillary gingival recession with loss of inter‐dental attachment. A randomized controlled clinical trial

The aim of this randomized clinical trial (RCT) was to evaluate the adjunctive benefit of Connective Tissue Graft (CTG) to Coronally Advanced Flap (CAF) for the treatment of gingival recession associated with inter-dental clinical attachment loss equal or smaller to the buccal attachment loss (RT2). A total of 29 patients with one recession were enrolled; 15 patients were randomly assigned to CAF+CTG while 14 to CAF alone. Measurements were performed by a blind and calibrated examiner. Outcome measures included complete root coverage (CRC), recession reduction (RecRed), Root coverage Esthetic Score (RES), intra-operative and post-operative morbidity, and root sensitivity. After 6 months, CAF+CTG resulted in better outcomes in terms of CRC (adjusted OR = 15.51, p = 0.0325) than CAF alone. CRC was observed in >80% of the cases treated with CAF+CTG when the baseline amount of inter-dental CAL was ≤ 3 mm. No difference was detected in term of RecRed. CAF+CTG was associated with longer surgical-time (p < 0.0001), higher number of days with post-operative morbidity (p = 0.0222) and the need for a greater number of analgesics (p = 0.0178) than CAF alone. No difference for final RES score was detected (p = 0.1612). Both treatments can provide CRC in single gingival recession with inter-dental CAL loss. The application of CTG under CAF resulted in predictable CRC when inter-dental CAL was ≤ 3 mm.

Root Coverage Esthetic Score After Treatment of Gingival Recession: An Interrater Agreement Multicenter Study

The root coverage esthetic score (RES) system was proposed for evaluating esthetic outcomes of root coverage procedures. The aim of this multicenter study is to assess the interrater agreement of the RES among expert periodontists. Eleven periodontists were selected in different clinical centers. Each operator had ≥15 years of experience in mucogingival surgery. Each periodontist was trained to use RES before the beginning of the study. Subsequently, baseline and post-treatment (6 months) photographs of 41 Class I and II gingival recessions in 41 patients were separately given to each operator who evaluated the outcomes according to the RES method. A two-way random interclass correlation coefficient and 95% confidence interval (CI) were used to assess the global interrater agreement for RESs. The total interrater agreement for RESs was 0.92 (95% CI: 0.88 to 0.95), which indicated that an almost perfect agreement was achieved. Tested individually by a group of periodontists, the RES seems to be a reliable method for assessing the esthetic outcomes of root coverage procedures.

Acellular Dermal Matrix Seeded With Autologous Gingival Fibroblasts for the Treatment of Gingival Recession: A Proof‐of‐Concept Study

One of the most common esthetic concerns associated with periodontal tissues is gingival recession. There are multiple periodontal plastic surgery approaches documented in the literature for the treatment of such defects. With the tremendous advances being made in periodontal science and technology, tissue engineering could be considered among the latest exciting techniques for recession management. In this split-mouth, controlled, double-masked clinical case series, 20 sites from 10 patients with Miller Class I or II recessions affecting canines or premolars in the maxillary arch were selected. One tooth in each patient was randomized to receive either a subepithelial connective tissue graft (SCTG) (control group) or an acellular dermal matrix allograft (ADMA) seeded with autologous gingival fibroblasts (test group) under a coronally positioned flap. Clinical parameters, including recession depth, probing depth, clinical attachment level, width of keratinized tissue, attached gingiva, and plaque scores, were recorded by a calibrated examiner at baseline and 3 and 6 months. The inflammation of grafted sites was scored, and the healing time was calculated. The final esthetic outcome of treated sites was assessed by the root coverage esthetic score at the end of 6 months. There were no significant differences between test and control sites for all measured clinical parameters. However, the test sites demonstrated less inflammation in the early postoperative period. Within the limits of this case series, the results indicate that an ADMA seeded with autologous gingival fibroblasts by tissue-engineering technology may be explored as a substitute to an SCTG for the treatment of Miller Class I and II recession defects.

Root Coverage Esthetic Score: A System to Evaluate the Esthetic Outcome of the Treatment of Gingival Recession Through Evaluation of Clinical Cases

Generally, esthetic outcomes following root-coverage procedures are not assessed. This article proposes a score for evaluating the esthetic outcome following root-coverage surgery. Thirty-one patients with Miller Class I and II recession defects treated with root-coverage procedures were evaluated. Esthetic outcomes were assessed using the root coverage esthetic score (RES) 6 months after surgery. This score evaluates five variables: level of the gingival margin, marginal tissue contour, soft tissue texture, mucogingival junction alignment, and gingival color. Because complete root coverage was the primary treatment goal, and the other variables were considered secondary, the value assigned for root coverage was 60% of the total score, whereas 40% was assigned to the other four variables. With regard to assessment of the final position of the gingival margin, 3 points were given for partial root coverage, and 6 points were given for complete root coverage; 0 points were assigned when the final position of the gingival margin was equal or apical to the previous recession. One point was assigned for each of the other four variables. Thus, 10 points was a perfect score. Of the 31 treated recession defects, 24 (77%) exhibited complete root coverage at 6 months. The mean amount of root coverage was 89.4% (range, 0% to 100%). The mean RES was 7.8. Five of 24 cases of complete root coverage achieved a perfect score (RES = 10). In one case, RES = 0. The RES system may be a useful tool to assess the esthetic outcome following root-coverage procedures.