Subepithelial Connective Tissue Graft Technique Research Articles

Volumetric Soft Tissue Changes After Using Injectable Platelet-Rich Fibrin (I-PRF) Versus Subepithelial Connective Tissue Graft in Interdental Papillae Defects: A Randomized Controlled Clinical Study

Background: Lost interdental papillae in the esthetic region are of great concern from the esthetic and functional point of view. We elicit a clinical study of papillary reconstruction in this article using injectable platelet-rich fibrin (I-PRF) as a nonsurgical procedure and compare its results to those of the subepithelial connective tissue graft (SECTG), being considered the gold standard method used to reconstruct interdental papillae. Methods: Twenty-four patients seeking treatment for black triangles were randomized into two groups: group A patients were treated with the SECTG technique, and group B patients were treated with I-PRF. Four injections were given at each papilla site at baseline, two-, four-, and six-week intervals to ensure optimal esthetics. Pain, clinical, and volumetric assessments were done. Volumetric assessment was completed through intraoral scanning of the papilla site at baseline and after six months, after which the results were obtained by superimposition of both scans. Results: Group A (5.08 ±2.15) had a significantly higher mean pain score value than group B (1.17 ±0.94) (p < 0.001). Group B (0.31 ±0.21) had a higher mean value of volumetric changes at the interdental papillae than group A (0.25 ±0.17), yet the difference was not significant (p = 0.517). Conclusion: Injectable platelet-rich fibrin gave comparable results to SECTG in Nordland Class I defects only, provided that the injection protocol was once every 15 days for a two-month period. Patients treated with I-PRF were more satisfied with the procedure and the results than patients who were treated with SECTG.

Double Lateral Sliding Bridge Flap versus Laterally Closed Tunnel for the Treatment of Single Recessions in the Mandibular Anterior Teeth: A Pseudorandomized Clinical Trial.

(1) Background: This study compared the clinical and esthetic results of the double lateral sliding bridge flap (DLSBF) and the laterally closed tunnel (LCT) techniques, with a subepithelial connective tissue graft (SCTG), for the treatment of single Miller class II-III recessions in the mandibular anterior teeth. (2) Methods: This pseudorandomized clinical trial evaluated 14 patients, 7 of whom were part of the DLSBF + SCTG group, with an average follow-up of 58.7 ± 24.0 months, and 7 of whom were in the LCT + SCTG group, with an average follow-up of 16.7 ± 3.3 months. Clinical and esthetic evaluations of the following parameters were performed and the results for the two groups were compared: gingival recession depth, probing depth, keratinized tissue width, gingival thickness, percentage of root coverage and root coverage esthetic score. (3) Results: After the follow-up period, each technique provided evidence of a reduction in recession depth and clinical attachment level, as well as increased keratinized tissue width and gingival thickness, with statistically significant differences (p < 0.05). The analysis showed that gingival recession depth decreased less in the DLSBF group (4.3 ± 1.2 mm to 0.6 ± 1.1 mm) than it did in the LCT group (4.9 ± 1.1 mm to 0.1 ± 0.4 mm), but no significant difference was found between the two groups. Similarly, a greater reduction in the clinical attachment level parameter was observed in the LCT group, while a greater increase in gingival thickness was observed in the DLSBF group. The presence of scars was the only parameter for which statistically significant differences (p < 0.05) between the two study groups were found. (4) Conclusions: Within the limitations of the study, it indicates that the LCT + SCTG technique may be considered an optimal technique in terms of reducing gingival recession depth, complete root coverage and esthetic results for the treatment of single gingival recessions in the mandibular anterior teeth.

Er-Yag Laser Root Preparation During Subepithelial Connective Tissue Graft Procedures.

Areas of gingival recession cause either an esthetic problem and or root sensitivity. Obtaining predictable root coverage has become an important part of periodontal therapy. A deep, long – standing recession promoted by ANUG was treated using subepithelial connective tissue graft technique combined with decontamination of root surface by using Er:YAG laser. Our clinical findigs suggest that this technique is a predictable procedure to treat gingival recession and promote root decontamination.

The Use of Subepithelial Connective Tissue Graft Technique to the Treatment of Class I Miller Recession in Lower Tooth with Abrasion: Case Report

Gingival recession can cause aesthetic problems, discomfort for cervical dentin hypersensitivity and can be treated by connective tissue grafts. This case report used subepithelial connective tissue graft to treatment class I Miller recession in premolar lower with abrasion. The premolar were treated by scaling and root planing chemical modification with 24% ethylenediaminetetraacetic acid (EDTA), bur shaped reconteur of abrasion lesion and subepithelial connective tissue graft combined with coronal flap. The results provide excellent root coverage, improve the root hypersensitivity and abrasion lesion. Although the longevity of this successful treatment depends on the diagnosis and removal of the causative agent, as well as the patient's cooperation in maintained of oral hygiene.

Microsurgical Approach To Subepithelial Connective Tissue Graft For Treatment of Gingival Recession

Abstract Gingival recession is one of the most common mucogingival deformity and treatment should be rendered in a manner such that the best esthetic results are achieved. Periodontal plastic surgery is a rapidly emerging field, which helps us to meet this criterion. Various techniques have been employed in the past years using conventional surgical procedures to achieve coverage of denuded roots. Increased patient awareness has generated the demand for an ideal therapy encompassing the elimination of disease and the restoration of esthetics and function that is administered with minimal trauma and discomfort.. This case report throws light on the use of a surgical operating microscope to cover Miller's class I gingival recession in a maxillary left canine using the subepithelial connective tissue graft technique and its advantages over the conventional technique under normal or macro vision. Satisfactory root coverage was obtained with excellent esthetics and patient comfort.

Influence of crown shape on root coverage therapy

Objectives:The aim of this study was to evaluate the influence of the crown shape on the outcomes of root coverage procedures.Material and methods:Eighty patients with Miller class I gingival recessions in maxillary canines or premolars were selected. The recession areas were treated using the subepithelial connective tissue grafting. The following clinical parameters were analyzed: crown length (CL) and width (CW), recession height and width, probing depth, clinical attachment level, width and thickness of the keratinized tissue and percentage of root coverage achieved. These measurements were recorded at baseline and 6 months after the surgical procedure. The CW/CL ratio was calculated for each tooth and the median obtained (0.83). Patients were then ranked into two groups, according to the shape of the tooth with gingival recession: Group A – square crown shape (CW/CL values above 0.83) and Group B – long and narrow crown shape (CW/CL values below 0.83).Results:No statistically significant differences (p>0.05) were found between groups in any of the clinical parameters at baseline. After 6 months, both groups presented improved clinical outcomes for all parameters analyzed compared to baseline (p>0.05). The mean percentages and standard deviations of root coverage achieved in Group A and Group B was 91.37 (16.75) and 85.49 (23.55), respectively (p>0.05).Conclusions:Crown shape did not influence the root coverage obtained with the subepithelial connective tissue graft technique.

Root coverage assessment: validity and reproducibility of an image analysis system

The aim of this methodological study was to validate a new method for root coverage evaluation following periodontal plastic surgery. Thirty recessions were treated in 21 consecutive patients, using a subepithelial connective tissue graft technique. Clinical measurements and photographs were taken at baseline and 12+/-6 months after treatment. The mean percentage of root coverage for linear and surface area measurements was calculated using conventional clinical evaluation, and compared with ImageJ, a public domain Java image processing program. Bland-Altman plots were used for assessing repeatability and agreement between clinical and ImageJ measurements. The strength of the relationship was calculated using the Pearson product moment correlation coefficient. The repeatability of ImageJ was excellent for both linear and surface area measurements. The agreement between clinical and ImageJ measurements was good for the linear evaluation, showing lower and upper limits of -13.14% and 17.42%, respectively. Significant correlations (p<0.001) were found between clinical and ImageJ measurements, ranging from 0.93 to 0.94 for linear evaluation, and from 0.89 to 0.90 for surface evaluation. The outcomes of this study show that the ImageJ analysis is a reliable, reproducible method to evaluate the percentage of root coverage after periodontal plastic surgery, when a midfacial linear measurement is used.

Periodontal wound healing of the experimental subepithelial connective tissue graft in dogs

【Several methods have been used for regeneration of tissue lost by periodontal disease. Subepithelial connective tissue graft technique, one of the technniques of mucogingival surgery, is used for the regeneration in esthetic problems such as recession, and denuded root coverage. This study is performed to evaluate the healing process and the regeneration and reattachment of periodontal tissue, including the reconstruction of junctional epithelium, and connective tissue. Alveolar defects in five adult dogs were treated with periodontal surgery and were attained by removing the marginal alveolar bone by $4{\time}3mm$ from CEJ in the labial side of incisors, and root surfaces were planed. The experimental sites were divided into two groups as follows. 1. root planing alone(control group) 2. with connective tissue graft (Experimental Group) In the two groups flaps were positioned and sutured tightly, the healing processes were observed and were histologically compared with each other after 2days, 4days, 1week, 2weeks, 4weeks. The results were obtained as follows : 1. In the two groups blood clots were observed as early as 2 and 4 days, and were resorbed at 1 week. 2. In the two groups moderate inflammation was observed as early as 2 and 4 days, decreased at 1 and 2 weeks, and disappeared at 4 weeks. 3. Junctional Epithelium migration was more significant in the control group, and was restrained by graft materials in the experimental group. 4. Features of connective tissue fiber attachment partially showed the parallel pattern in the two groups from 2 weeks, and entirely from 4weeks. 5. Anastomosis, between graft and connective tissue, appeared from 4 days in the experimental group and the border between them was not discriminated at 4weeks.】

Subepithelial connective tissue graft technique for root coverage.

This article describes the use of the subepithelial connective tissue graft as a donor source for root coverage. The success of these grafts has been attributed to the double-blood supply at the recipient site from the underlying connective tissue base and the overlying recipient flap. Four cases have been illustrated to demonstrate the versatility of this procedure for areas of single or multiple root coverage especially in the maxillary arch, coverage of existing crown margins and areas requiring a combination of ridge augmentation and root coverage. An increase of 2 to 6 mm of root coverage has been achieved in 56 cases over 4 years with minimal sulcus depth and no recurrence of recession. The donor site is a closed wound which produces less postoperative discomfort.