Root Coverage Of Gingival Recessions Research Articles

A comparative assessment of root coverage of gingival recession using modified coronally advanced flap using microsurgical and macro surgical techniques

Gingival anatomic factors, chronic trauma, periodontitis, and tooth alignment are the main conditions leading to gingival recession. The present study was conducted to compare the root coverage of localized GR using modified coronally advanced flap (CAF) and root conditioning with 24% EDTA when performed under magnification and without magnification. This study was conducted on 30 patients with Miller’s Class I and II GR. Patients were divided into 2 groups i.e 15 in each group. Group I (Coronally advanced flap with microsurgery ) was test group and group II (Coronally advanced flap with macrosurgical approach) was control. Plaque index (PI), gingival index (GI), pocket probing depth (PD), and clinical attachment level (CAL) width of keratinized gingival, recession width and recession depth was recorded in both groups at baseline 1and 3 months for the test and control group. Visual analog scale (VAS) was used to record pain postoperatively on 3rd and 7th day of the surgery. CAF and root conditioning were done with 24% EDTA. Surgical procedure at test site was carried under magnification 3.5 and at control site was done without magnification.The mean gingival index at baseline in group I was 0.45 and in group II was 0.66, PI was 0.86 in group I and 0.86 in group II, clinical attachment level was 3.02 in group I and 3.34 in group II, PD was 0.76 in group I and 0.74 in group II, width of keratinized tissue 4.20 in group I and 3.26 in group II, recession depth was 2.54 in group I and 2.68 in group II and recession width was 3.60 in group I and 3.68 in group II. There was alteration in mean GI, PI, CAL, PD, width of keratinized tissue, recession depth and recession width between both groups recorded at 1 month. Significant reduction was found in GI, CAL, width of keratinized tissue, recession depth and recession width in both groups (P< 0.05). We found that mean VAS at 3 day in group I was 4.12 and in group II was 1.84 and at 7 day 0.68 in group I and 0.34 in group II.Authors found that microsurgery had less postoperative pain and discomfort when compared to macrosurgical approach. The use of the microscope augments the results, but obtaining an expertise in using needs a lot of practice.

Comparative Evaluation of Root Coverage Between Smokers and Non-Smokers After Surgical Therapy-A Review and Meta-Analysis

Background: Several studies have demonstrated that nicotine induces a pro-inflammatory effect due to the upregulation of receptors of the advanced glycation end product as well as the fibroblastic cell migration in the gingiva is reduced in smokers. Thus, this meta-analysis aims to evaluate and compare the effectiveness of root coverage after surgical therapy in smoker and non-smoker individuals. Methods: A total of 15 articles were included in this study in which the different types of periodontal surgical procedures for root coverage of gingival recession were evaluated in both smokers and non-smokers. The databases are searched from 1997 to 2018. The inclusion criteria included the available evidence and the articles published only in the English language. Result: In this meta-analysis, comparing smokers and non-smokers treated with different types of periodontal surgery, the result showed a statistically significant reduction in probing pocket depth (PPD), whereas, Gingival recession height (GRH), Gingival recession width (GRW) reduction and gain in clinical attachment level (CAL) and Keratinized tissue thickness (KTT) between smokers and non-smokers were not statistically significant. The percentage of complete and mean root coverage showed statistically significant variations when compared with smokers. Conclusion: Periodontal surgical interventions exhibited less favorable healing outcomes and there were significant variations observed in the percentage of mean and complete root coverage in smokers than compared with non-smoker.

Root coverage of gingival recessions with non-carious cervical lesions: a controlled clinical trial.

The non-carious cervical lesion (NCCL) is commonly produced by improper toothbrushing techniques, occlusion trauma, anatomic mal-positioned teeth, and acid erosion, thus sharing the same etiology of gingival recession (GR). The association of a graft to the coronally advanced flap had demonstrated the best long-term outcome for root coverage (RC). However, substitutes for the autogenous graft must be studied. This split-mouth clinical trial investigates the RC and the increase in keratinized tissue (KT) when comparing RC of NCCLs associated with GR with intact roots using an extended coronally advanced flap (ECAF) associated with the acellular dermal matrix graft (ADMG), a connective tissue replacement graft. Seventeen individuals with bilateral GR were included in the study. One side had a NCCL (TG) and the opposite root was intact (CG). All patients were treated with the ECDF associated with ADMG. All clinical parameters were assessed at baseline and 6 months postoperative. Root coverage means (CG, 69.5 ± 19 and TG. 72.2 ± 16.5; p value = 0.849570) were not significantly different between control and test groups. In addition, the KT had an increase in the follow-up period for both groups. GR associated with NCCLs can be successfully treated with the ECDF and ADMG. Patients frequently search for GR treatment due to cervical wear, root sensitivity, and compromising aesthetics. The NCCL participates with the same issues. The present study contributes to the literature that GR associated with NCCLs can be successfully treated with the ECAF and the ADMG.

Periosteum eversion technique versus subpedicle connective tissue graft technique for root coverage of gingival recessions: A randomized split-mouth study.

Introduction:The connective tissue graft (CTG) with pedicle flap as subpedicle CTG technique (SPCTGT) is considered the gold standard technique in the treatment of gingival recessions. The aim of this study was to compare periosteum eversion technique (PET) with SPCTGT for root coverage of gingival recessions.Materials and Methods:Ten patients having bilateral gingival recessions of Miller class I and II were selected. The left or right side was randomly assigned into PET group and SPCTGT group. Before and after 1 year of surgery, depth of gingival recession (DGR), width of keratinized gingiva (WKG), width of attached gingiva (WAG), and probing depth (PD) were measured and compared. Pre- and post-groups were compared by paired t-test. Two independent groups were compared by independent Student's t-test. A two-tailed (α =2) P < 0.05 was considered statistically significant.Results:Comparing the pre to post mean of PET and SPCTGT showed decrease (net improvement) in DGR (−5.80 ± 0.42 vs. −4.65 ± 0.39, mean difference = −1.15 ± 0.57, t = 2.02, P = 0.058) and in PD (−1.05 ± 0.12 vs. −0.60 ± 0.12, mean difference = −0.45 ± 0.17, t = 2.64, P = 0.017); and increase (net improvement) in WKG (5.80 ± 0.42 vs. 4.80 ± 0.41, mean difference = 1.00 ± 0.58, t = 1.71, P = 0.104) and in WAG (5.60 ± 0.32 vs. 4.90 ± 0.24, mean difference = 0.70 ± 0.41, t = 1.73, P = 0.101). PET showed 19.8% and 42.9% higher decrease in DGR and PD; and 17.2% and 12.5% higher increase in WKG and WAG, respectively, than SPCTGT.Conclusions:The study found that both the modalities were effective in the management of root coverage of gingival recessions. However, PET was found more effective than SPCTGT.

Root surface demineralization by citric acid/tetracycline gel and aPDT associated to subepithelial connective tissue graft improves root coverage outcomes. A 12-month preliminary randomized clinical trial

Root conditioners are used to promote root surface biomodification to increase the success rate of root coverage. Citric acid and tetracycline are commonly used. There is recent indication for using antimicrobial photodynamic therapy (aPDT) with this purpose. The aim of this study is to evaluate the effects of citric acid/tetracycline gel and aPDT in root coverage of gingival recessions using subepithelial connective tissue graft. This parallel, double-blinded clinical trial enrolled 17 patients (60 recession defects; 20/group). Experimental groups were: Control group (SRP) - scaling and root planing only; Citric acid/tetracycline gel (CAT) group - SRP plus citric acid/tetracycline gel; aPDT - SRP, toluidine blue O (100 μl/ml) and red laser. At baseline and after 3, 6 and 12 months, the clinical parameters were evaluated: recession depth (RD), percentage of root coverage (%RC), keratinized tissue width (KTW), soft tissue thickness (STT), probing depth (PD), clinical attachment level (CAL), dentin hypersensitivity (HYPER) and esthetic perception by patient (EST). CAT group presented reduction in PD, CAL, RD, increase in KTW and STT, higher %RC (81.6%) and better esthetic in relation to SRP group (p < .05). aPDT treatment promoted CAL reduction, gain of KTW and STT and higher %RC (82.1%) in relation to SRP (57.7%) (p < .05). There was a reduction in dentin sensitivity in all groups. Complete root coverage was higher for CAT group (65%) and aPDT group (70%) in relation to SRP (30%) (p < .05). Root conditioning, with citric acid/tetracycline gel and aPDT, promotes better long-term clinical outcomes and root coverage after SCTG procedures.

PC142: Root coverage of gingival recessions with connective tissue graft. Comparative study of three different root surface treatment

PC142: Root coverage of gingival recessions with connective tissue graft. Comparative study of three different root surface treatment

Root Coverage of Gingival Recession with Acellular Dermal Matrix. A Case Report

Actually there are other options for the treatment of gingival recessions in addition to the subepithelial connective tissue , one of which is the use of acellular dermal matrix . The present article reports the treatment of gingival recessions using the acellular dermal matrix ( Alloderm® ) and Flap Tunnel Technique.

Root Coverage in Smokers with Acellular Dermal Matrix Graft and Enamel Matrix Derivative: A 12-Month Randomized Clinical Trial.

This study investigated whether enamel matrix derivative (EMD) contributes to root coverage of gingival recessions performed with acellular dermal matrix graft (ADMG) in smokers during a 12-month follow-up. A sample of 19 smokers presenting bilateral Miller Class I or II gingival recessions were included. Selected sites randomly received both ADMG and EMD (test) or ADMG alone (control). Probing depth, clinical attachment level, gingival recession height, keratinized tissue, and root coverage were evaluated. Mean gain in recession height (P < .05), sites with complete root coverage (P < .05), and percentage of root coverage (59.7% and 52.8%, respectively) favored the test group compared with the control group.

Clinical Considerations on the Root Coverage of Gingival Recessions in Thin or Thick Biotype.

Gingival biotype is a clinical term used to describe the thickness of the gingiva. It has been classified as being thick or thin and may be related to the clinical outcome of root coverage procedures. This study evaluated the impact of gingival biotype on the clinical outcome of root coverage procedures following subepithelial connective tissue graft plus coronally positioned flap. A total of 19 patients, 10 with thin and 9 with thick gingival biotype, were treated for localized Miller Class I or II gingival recessions. After 6 months, 14 patients achieved complete root coverage, 7 from each group. The overall mean pooled root coverage rate was 90.93%. The thin biotype cases yielded a reduced mean root coverage of 88.51% compared with 93.63% for patients who had the thick biotype classification. Although the thin gingival biotype may impair the clinical outcome of root coverage procedures, this limitation does not appear to have a strong influence on the success of the root coverage therapy when subepithelial connective tissue graft was associated with the coronal positioning of the flap.

Root surface modifiers and subepithelial connective tissue graft for treatment of gingival recessions: a systematic review.

Many techniques and flap designs have been used to treat gingival recession by root coverage, but subepithelial connective tissue graft (SCTG) seems to be the gold standard procedure. In an attempt to improve the healing process and increase the success rate of root coverage, some authors have used root modifiers, including different root conditioners, lasers, EMD, recombinant human growth factors and platelet-rich plasma (PRP). The aim of this systematic review was to evaluate the effects of root biomodification in clinical outcomes of gingival recessions treated with SCTG. Studies reporting SCTG associated with any form of root surface biomodification for root coverage of gingival recessions (Miller Class I and Class II) were considered as eligible for inclusion. Studies needed to have data of clinical outcomes in a follow up of at least 6months. Screening of the articles, data extraction and quality assessment were conducted independently and in duplicate. None of the products evaluated (citric acid, EDTA, PRP, lasers and EMD) showed evident benefits in clinical outcomes. Test and control groups presented similar outcomes related to root coverage and periodontal parameters, with no statistical differences between them. The exception was root biomodification with the neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, which impaired root coverage and had a detrimental effect on clinical outcomes. Based on the present clinical data, the use of root surface modifiers to improve clinical outcomes in gingival recessions treated with SCTG is not justified. More invivo studies, and randomized clinical trials with larger sample sizes and extended follow up, are necessary.

Acellular dermal matrix graft with or without enamel matrix derivative for root coverage in smokers: a randomized clinical study

The aim of this randomized controlled clinical study was to compare the use of an acellular dermal matrix graft (ADMG) with or without the enamel matrix derivative (EMD) in smokers to evaluate which procedure would provide better root coverage. Nineteen smokers with bilateral Miller Class I or II gingival recessions ≥3mm were selected. The test group was treated with an association of ADMG and EMD, and the control group with ADMG alone. Probing depth, relative clinical attachment level, gingival recession height, gingival recession width, keratinized tissue width and keratinized tissue thickness were evaluated before the surgeries and after 6 months. Wilcoxon test was used for the statistical analysis at significance level of 5%. No significant differences were found between groups in all parameters at baseline. The mean gain recession height between baseline and 6 months and the complete root coverage favored the test group (p=0.042, p=0.019 respectively). Smoking may negatively affect the results achieved through periodontal plastic procedures; however, the association of ADMG and EMD is beneficial in the root coverage of gingival recessions in smokers, 6 months after the surgery.

Subepithelial Connective Tissue Graft for Root Coverage in Smokers and Non‐Smokers: A Clinical and Histologic Controlled Study in Humans

The aim of this study was to evaluate root coverage of gingival recessions and to compare graft vascularization in smokers and non-smokers. Thirty subjects, 15 smokers and 15 non-smokers, were selected. Each subject had one Miller Class I or II recession in a non-molar tooth. Clinical measurements of probing depth (PD), relative clinical attachment level (CAL), gingival recession (GR), and width of keratinized tissue (KT) were determined at baseline and 3 and 6 months after surgery. The recessions were treated surgically with a coronally positioned flap associated with a subepithelial connective tissue graft. A small portion of this graft was prepared for immunohistochemistry. Blood vessels were identified and counted by expression of factor VIII-related antigen-stained endothelial cells. Intragroup analysis showed that after 6 months there a was gain in CAL, a decrease in GR, and an increase in KT for both groups (P <0.05), whereas changes in PD were not statistically significant. Smokers had less root coverage than non-smokers (58.02% +/- 19.75% versus 83.35% +/- 18.53%; P <0.05). Furthermore, the smokers had more GR (1.48 +/- 0.79 mm versus 0.52 +/- 0.60 mm) than the non-smokers (P <0.05). Histomorphometry of the donor tissue revealed a blood vessel density of 49.01 +/- 11.91 vessels/200x field for non-smokers and 36.53 +/- 10.23 vessels/200x field for smokers (P <0.05). Root coverage with subepithelial connective tissue graft was negatively affected by smoking, which limited and jeopardized treatment results.

Double laterally-rotated bilayer flap operation for treatment of gingival recession.

Many root coverage techniques, such as lateral pedicle flap, double papilla flap, free gingival graft, connective tissue graft, and guided tissue regeneration (GTR) procedure have been widely applied in clinical dental practice. Although they all provide various degrees of successful root coverage, some procedures are technique-sensitive and others require a 2-stage operation. In this study, we describe a new technique with a double laterally-rotated bilayer flap for root coverage. Briefly, 2 partial-thickness flaps were prepared, one on each side of the gingival recession, and then laterally repositioned (with mutual overlapping) to cover the root exposure. After thorough planing of the exposed root surfaces, root conditioning with saturated citric acid solution (pH = 1.0) was performed. One partial-thickness flap was de-epithelialized and then rotated to cover the citric acid-conditioned root surface. Another partial-thickness flap was further rotated to cover the de-epithelialized flap. Both flaps were sutured to the recipient periosteal bed. This new root coverage technique was used to treat 2 teeth with gingival recession. The results demonstrated that this new technique provides satisfactory root coverage of gingival recession and improves root dentin hypersensitivity of treated teeth. The main advantages of this technique are simple 1-stage surgery, esthetic color matching of the soft tissue, and a good blood supply of the reflected flap. We conclude that the double laterally-rotated bilayer flap operation may provide a new alternative for the treatment of gingival recession.