Connective Tissue Graft Research Articles

Comparative Evaluation of Coronally Advanced Flap with and without Amniotic Membrane in the treatment of Localised Miller’s Class I and Class II Gingival Recession Defects: A Randomised Controlled Trial

Introduction: Gingival recession is the exposure of the root surface of the tooth, characterised by the displacement of the gingival margin apically from the Cementoenamel Junction (CEJ). Various techniques have been suggested for treating recession, such as Free Gingival Graft (FGG), Connective tissue grafts, laterally or Coronally Advanced Flaps (CAF), and Guided Tissue Regeneration (GTR)-based procedures. Different membranes have been used for GTR, one of which is the amnion membrane. Aim: To evaluate root coverage using Coronally Advanced Flap (CAF) with and without amniotic membrane in the treatment of localised gingival recession. Materials and Methods: A randomised controlled trial was conducted at Pandit Deendayal Upadhyay Dental College and Hospital, Solapur, Maharashtra, India from March 2017 to February 2018. In this study, 30 teeth were treated, with 15 teeth undergoing CAF with amniotic membrane (Group IITest Group) and 15 teeth treated with CAF without amniotic membrane (Group I-Control Group). Probing Depth (PD), Clinical Attachment Level (CAL), Relative Attachment Level (RAL), Recession Width (RW), Recession Depth (RD), Width of Keratinised Gingiva (WKG), Width of Attached Gingiva (WAG), and gingival biotype were assessed between baseline and after three months. Statistical analysis was performed using paired t-test, independent t-test, and Mann-Whitney U-Test. Statistical Package for Social Sciences (SPSS) software version 20.0 was used for analysis. The α error of 5% (p-value=0.05) and β error of 20% were taken into consideration. Results: The mean age of the study population was 30.36±4.55 years, with 18 males and 12 females. There was a decrease in RD, RW, PD, and a gain in CAL and RAL in both groups after three months compared to the baseline values. Additionally, there was an increase in WKG, WAG, and a significant change in the thickness of the gingival biotype from thin to thick in both groups at the end of three months. On inter group comparison, the changes in PD (p-value=1.00), RD (p-value=1.00), RW (0.176), CAL (0.664), RAL (1.00), WKG (p-value=0.313) were not statistically significant at the end of three months. WAG was higher in Group II compared to Group I (p-value=0.014*), and the mean root coverage was greater in Group II (15.62%) than in the control group (11.642%) (p-value=0.005) at the end of three months. There was a statistically significant difference (p-value=0.005*) in Group II (15.62%) compared to the control group (11.642%). Conclusion: Amniotic membrane in combination with CAF proves to be a successful option for root coverage in localised recession defects. However, histological evidence and a greater number of future longitudinal studies are necessary to study the efficacy of this approach.

Comparison Between the Use of Advanced Platelet-Rich Fibrin (A-PRF) and Connective Tissue Graft in the Treatment of Cairo Type 1 Gingival Recession Associated with the Coronally Advanced Flap

Comparison Between the Use of Advanced Platelet-Rich Fibrin (A-PRF) and Connective Tissue Graft in the Treatment of Cairo Type 1 Gingival Recession Associated with the Coronally Advanced Flap

Connective Tissue Graft with Coronally Advanced Flap for Complete Root Coverage in the Aesthetic Area: A Case Report

Connective Tissue Graft with Coronally Advanced Flap for Complete Root Coverage in the Aesthetic Area: A Case Report

Efficacy of xenogeneic collagen matrix in the treatment of gingival recessions: a controlled clinical trial.

This study aimed to evaluate the efficacy of a xenogeneic collagen matrix (XCM) in treating gingival recessions (GR) in a thin gingival phenotype. This double-blind, planned, controlled, split-mouth clinical trial included 30 patients with bilateral recessions, randomly assigned to a test group (extended flap + XCM) and a control group (extended flap + connective tissue graft; CTG). Root coverage at 18 months was 1.75 ± 0.8 mm (72.9%) and 2.4 ± 0.51 mm (88.9%) in the test and the control groups, respectively. The upper limit of the confidence interval was not greater than the non-inferiority margin of 0.69 mm. The increase in gingival thickness was greater for autogenous graft (p = 0.003). Both treatments improved quality of life at 18 months. The keratinized tissue width (KTW) increased significantly in the grafted teeth, in both the test (p < 0.001) and the control groups (p < 0.001). Total root coverage was similar in both groups, reaching 70% and 66.7% in the control and test groups, respectively, with no significant differences observed for partial or complete root coverage (CRC). An association was observed in the quality of the gingival phenotype at 18 months according to the treatment group, i.e., a higher percentage of cases with a thicker phenotype was observed in the control group (86.7%), compared with the test group (53.3%) (p = 0.005). XCM was effective in treating GR, but CTG had better results because of significantly increased gingival thickness and phenotypic conversion.

Pontic Site Development using Soft-tissue Augmentation with Connective Tissue Graft in Maxillary Anterior Region: A Case Report

Pontic Site Development using Soft-tissue Augmentation with Connective Tissue Graft in Maxillary Anterior Region: A Case Report

Use of Platelet-rich Fibrin in Immediate Implantation of Posterior Teeth and its effect on Soft Tissue Changes

Background: Immediate implant placement is favored as it reduces number of surgical appointments and overall reduces treatment duration.However, at times disadvantage of this proceduce is the inadequate dimension of soft tissue surrounding the implant, which presents a challenge forimmediate implantation in posterior teeth. . Due to which, patients frequently necessitate soft tissue augmentation to avoid potential complications.This study is minimally invasive technique which utilizing platelet-rich fibrin (PRF) which was employed to enhance soft tissuethicknessand keratinized tissue widthduring immediate implantation in the posterior region of the jaw. MethodsandMaterials: total 20 bone-level implants were utilized in 20different patients for the immediate implant procedure. As soft tissue augment , 10patients were treated with platelet-rich fibrin (PRF) on immediate implants in the test group, and the rest 10 patients received connectivetissue graft (CTG) on immediate implants in the control group. All implants were uncovered through surgery after 3 months andhealing abutments were placed on fixtures. The width of the Keratinized tissue was measured using a periodontal probe at baseline, and after 1 month, and 3 monthspost implant placement, where as softtissue thickness wasmeasured at baseline and 3 months post implantplacement.

Restorative surgery using modified Kazanjian vestibuloplasty and subepithelial connective tissue graft for severe trismus and mandibular denudation after facial contouring surgery: A case report

Oral vestibule is important in oral health. Various vestibuloplasty techniques are used in cases involving vestibule loss. This case report describes the treatment outcomes from performing modified Kazanjian vestibuloplasty with artificial der-mis graft and connective tissue graft for severe trismus and mandibular denudation caused by shallow vestibule and postoperative scarring after facial contouring surgery. Based on an accurate understanding of the anatomical structures within the oral cavity, problems caused by multiple surgery due to inflammatory complications after a facial contouring surgery, including scarring, discomfort during mouth and cheek movements due to loss of oral vestibule, trismus, alveolar bone exposure, and gingival recession, were resolved with a single surgery. When performing intraoral surgery, it is necessary to understand the meaning and importance of vestibule and perform incision and suturing to minimize the shallowing of vestibule. In cases involving vestibule loss, appropriate techniques should be selected to ensure restoration of vestibule.

Optimization of the tunneling technique in the treatment of gingival recessions

Introduction: Gingival recession has presented significant aesthetic and functional challenges for patients, making it imperative to search for effective surgical techniques that improve periodontal results. Therefore, the present study has focused on optimizing the tunneling technique with a subepithelial connective tissue graft, through the implementation and evaluation of different clinical strategies that improve the results of surgery and patient safety.Method: The VIKOR method was used for multi-criteria decision making, which allowed the analysis of several strategies based on specific criteria related to the results of surgery and patient safety. Eight evaluation criteria were established and six strategies were rated in two aspects, one focused on satisfaction with the results and the other on patient safety and health.Results: The advanced training and clinical practice strategies and comprehensive periodontal health program were identified as the most effective, showing high scores in technical competence, patient satisfaction, adherence to the protocol, and reduction of complications.Conclusions: The tunneling technique with a graft of subepithelial connective tissue is effective for the treatment of gingival recessions. The success of this technique has critically depended on surgeon training, adherence to standardized protocols, and an integrated approach that has included patient education and rigorous follow-up. The objective and systematic evaluation of the proposed strategies allowed us to highlight the importance of a well-informed and managed clinical practice.

Optimization of the tunneling technique in the treatment of gingival recessions

Introduction: gingival recession has presented significant aesthetic and functional challenges for patients, making it imperative to search for effective surgical techniques that improve periodontal results. Therefore, the present study has focused on optimizing the tunneling technique with a subepithelial connective tissue graft, through the implementation and evaluation of different clinical strategies that improve the results of surgery and patient safety.Method: the VIKOR method was used for multi-criteria decision making, which allowed the analysis of several strategies based on specific criteria related to the results of surgery and patient safety. Eight evaluation criteria were established and six strategies were rated in two aspects, one focused on satisfaction with the results and the other on patient safety and health.Results: the advanced training and clinical practice strategies and comprehensive periodontal health program were identified as the most effective, showing high scores in technical competence, patient satisfaction, adherence to the protocol, and reduction of complications.Conclusions: the tunneling technique with a graft of subepithelial connective tissue is effective for the treatment of gingival recessions. The success of this technique has critically depended on surgeon training, adherence to standardized protocols, and an integrated approach that has included patient education and rigorous follow-up. The objective and systematic evaluation of the proposed strategies allowed us to highlight the importance of a well-informed and managed clinical practice

Modified Coronally Advanced Tunnel (MCAT) Technique with Subepithelial Connective Tissue Graft (SCTG): A Case Report

Modified Coronally Advanced Tunnel (MCAT) Technique with Subepithelial Connective Tissue Graft (SCTG): A Case Report

Evaluation of Soft Tissue Changes Following Platelet-rich Fibrin in Immediate Implantation of Posterior Teeth: A Randomized Clinical Trial

Background: Currently, immediate implant placement is favored due to its reduced number of surgical appointments and shorter overall treatment duration. However, a notable disadvantage of this protocol is the inadequate dimension of soft tissue surrounding the implant, which presents a challenge for immediate implantation in posterior teeth. As a result, patients frequently necessitate soft tissue augmentation to alleviate potential complications. In this randomized clinical trial study, a minimally invasive technique utilizing platelet-rich fibrin (PRF) was employed to enhance soft tissue thickness and keratinized tissue width during immediate implantation in the posterior region of the jaw. Methods and Materials: A total of 20 bone-level implants were utilized in 20 patients through the immediate implantation protocol. In order to augment soft tissue, 10 patients were subjected to treatment with platelet-rich fibrin (PRF) on immediate implants in the test group, while 10 patients received connective tissue graft (CTG) on immediate implants in the control group. After a period of 3 months, all implants were uncovered through surgery, and healing abutments were placed on fixtures. Keratinized tissue width was measured using a periodontal probe at baseline, 1 month, and 3 months after implant placement, while soft tissue thickness was measured at baseline and 3 months after implant placement. Results: Treatment was successful for all the patients. The average keratinized tissue width in the test and control group was 3.45 and 2.65 at baseline, 4.00 and 3.40 one month after surgery, and 4.20 and 3.85 three months after implant placement, respectively. Average keratinized tissue thickness in the test and control group was 2.45 and 2.05 at baseline and 3.20 and 3.25 at reentry (three months after implant placement), respectively. The average increase in keratinized tissue thickness from baseline to 3rd month was 0.75 in the test and 1.20 in the control group. The average increase in keratinized tissue width from baseline to 1st month was 0.55 in the test and 0.75 in the control group, and from baseline to 3rd month, it was 0.75 in the test and 1.20 in the control group, respectively. Data for both parameters in each group from baseline to 3rd month were statistically significant. Data for keratinized tissue thickness (p=0.077) and keratinized tissue width (p=0.089) between both the groups were not statistically significant. Conclusion: Platelet-rich fibrin (PRF) has the potential to serve as a minimally invasive approach for augmenting soft tissue in the posterior region of the jaw during immediate implant placement. Clinical Trial Registration Number: The clinical trial registration number for this study is IRCT20190723044313N1.

Differential molecular profiles and associated functionalities characterize connective tissue grafts obtained at different locations and depths in the human palate

The present study aimed to assess the molecular profiles of subepithelial connective tissue grafts (CTGs) obtained at different locations and depths in the human palate. Sixty-four CTGs belonging to anterior deep (AD), anterior superficial (AS), posterior deep (PD), and posterior superficial (PS) groups were subjected to RNA-Sequencing and their transcriptomes were analyzed computationally. Functional correlations characterizing the CTG groups were validated by cell biological experiments using primary human palatal fibroblasts (HPFs) extracted from the CTGs. A clearly more pronounced location-dependent than depth-dependent difference between the grafts, with a minimal number of genes (4) showing no dependence on the location, was revealed. Epithelial, endothelial, and monocytic cell migration was strongly (P < 0.001) potentiated by AD- and PS-HPFs. Moreover, significantly increased expression of genes encoding C-C and C-X-C motif chemokine ligands as well as significantly (P < 0.01) activated p38 signaling suggested immunomodulatory phenotype for AD- and PS-HPFs. Increased growth factor gene expression and significantly activated (P < 0.001) Erk and Akt signaling in HPFs originating from A-CTGs implied their involvement in cell survival, proliferation, and motility. Prominent collagen-rich expression profile contributing to high mechanical stability, increased osteogenesis-related gene expression, and strongly activated (P < 0.001) Smad1/5/8 signaling characterized HPFs originating from P-CTGs. The present data indicate that in humans, differences between palatal CTGs harvested from different locations and depths appear to be location- rather than depth-dependent. Our findings provide the basis for future personalization of the therapeutic strategy by selecting an optimal graft type depending on the clinical indications.

Harvest graft substitute for soft tissue volume augmentation around existing implants: A randomized, controlled and blinded multicenter trial.

Using a single-blind, randomized, controlled, multicenter, practice-based clinical trial, a volume-stable collagen matrix (VCMX) was compared with connective tissue graft (CTG) for soft tissue augmentation around existing dental implants. Sixty patients (31 VCMX and 31 CTG) were included. The primary outcome was a soft tissue thickness change 3mm below the gingival margin (GM). Secondary outcomes included clinical measures, such as keratinized tissue widths (KTw), probing pocket depths, and pink esthetic scores, and patient-reported outcomes (PRO). There were no significant differences between test and control patient demographics or clinical measures throughout the 1-year study. VCMX "grafts" were by design larger than CTG, and surgery time was less (27% less, p=0.0005). Three millimeters below the GM (primary endpoint), tissue thickness increase was noninferior for VCMX compared with CTG (0.93±0.80mm vs. 1.10±0.51mm, respectively), inferior (by 0.25mm) at 1mm, and noninferior at 5mm. Postoperative pain was significantly less for VCMX patients (p<0.0001), but all other PRO measures, including esthetics and satisfaction, improved similarly for both therapies. Given the inclusion criteria for this study, namely soft tissue augmentation around existing implants with some evidence of KTw and minimal recession, VCMX provided soft tissue thickness and volume increases similar (noninferior) to CTG. Clinical measures and PRO were similar between therapies-site sensitivity and esthetics improved similarly for both therapies-but surgery time and pain following surgery were significantly less for VCMX.

Marine Collagen Matrix Carrier with Injectable Platelet-Rich Fibrin in Management of Gingival Recession Defects

Background. The gold standard in the management of gingival recession (GR) defects has been connective tissue graft (CTG) with coronally advanced flap (CAF). But patient morbidity associated with graft harvesting is a major drawback and has led to the development of various substitute biomaterials which have been tried and tested. Aim. Our study is aimed at checking the efficacy of marine collagen matrix (MCM) impregnated with injectable platelet-rich fibrin (I-PRF) with modified CAF in the treatment of Miller’s class I and II recession defects. Case Description. Six patients with ten GR defects in maxilla were treated with CAF + MCM + I-PRF. Clinical parameters like recession height (RH), recession width (RW), root coverage (RC%), width of attached gingiva (WAG), keratinized tissue height (KTH), probing pocket depth (PPD), clinical attachment level (CAL), gingival biotype (GB), plaque index (PI), and visual analogue score (VAS-E) esthetic scores were evaluated up to six months. There was significant root coverage observed at three- and six-month follow-ups. Conclusion. The proposed treatment was effective in the management of GR defects and improvement in soft tissue biotype without the morbidity associated with soft tissue harvest.

Profilometric analysis of cross-linked collagen matrix for soft tissue thickness augmentation in dental implants: A randomized controlled clinical trial

BACKGROUND: Dental implantation is an effective method for rehabilitating patients without teeth. The long-term survival of implants is influenced by various factors, one of which is the condition of the soft tissue surrounding the implant.&#x0D; AIM: To evaluate the effectiveness of cross-linked collagen matrix for soft tissue augmentation in the implant area.&#x0D; MATERIALS AND METHODS: Thirty-two patients with soft tissue thickness deficiency were examined. The patients were divided into two groups depending on the method of surgery. Group 1 received a cross-linked collagen matrix, whereas group 2 underwent the transplantation of a free connective tissue graft. The increase in soft tissue thickness was assessed 3 and 6 months after surgery.&#x0D; RESULTS: Soft tissue thickness 3 months after surgery increased by 1.77±0.61 and 1.26±0.41 mm in groups 1 and 2, respectively (p 0.001). Moreover, 6 months after surgery, soft tissue thickness increased by 1.11±0.44 and 1.43±0.81 mm compared with the initial value (p=0.012).&#x0D; CONCLUSION: The use of the collagen matrix increases the soft tissue thickness in the implant area; however, the effect size is lower than that obtained by autograft transplantation.

Effectiveness of soft tissue augmentation using subepithelial connective tissue graft in comparison with free gingival graft and no graft for increasing the width of keratinized mucosa around dental implants: a meta-analysis

The soft tissues around dental implants are important to prevent inflammatory peri-implant diseases and ensure the long-term survival of a dental implant. Periodontal plastic surgery has evolved from traditional mucogingival surgery, according to Zuhr et al as a result of the development of subepithelial connective tissue grafts/free gingival grafts. So, the aim of this review was to compare the effectiveness of soft tissue augmentation using subepithelial connective tissue graft in comparison with free gingival graft and no graft for increasing the width of keratinized mucosa around dental implants. The review was according to PRISMA protocol. A comprehensive search of the specialized databases was performed to include the studies. Quality assessment and meta-analysis were carried out. 10 articles included. Two articles evaluated KTW with FGG and SCTG; FGG and no graft (3); SCTG and no graft (5). All the included studies assessed either primary or secondary outcome measures. In the end, it was concluded that for soft tissue volume augmentation, SCTG is a treatment choice for an increase in KTW at implant sites.

Root coverage achieved with a connective tissue graft overlaid onto allogeneic demineralized dentin matrix incorporated with rhBMP-2

Autogenous demineralized dentin matrix (DDM) has been widely used in implant dentistry and highlighted as a potential carrier of recombinant human bone morphogenetic protein-2 (rhBMP-2). Allogeneic DDM (Allo-DDM) is comparable to autogenous DDM in safety and effectiveness. The various endogenous growth factors in dentin, including BMP, transform-ing growth factor, fibroblast growth factor, and insulin growth factor suggest that DDM incorporated with rhBMP-2 (DDM/ rhBMP-2) may exert a synergistic effect that promotes soft tissue healing through angiogenic activity, in addition to its osteoinductivity. This case report describes a successful outcome of root coverage where connective tissue graft (CTG) was overlaid onto Allo-DDM incorporated with rhBMP-2 (Allo-DDM/rhBMP-2).

Clinical efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) for treatment of multiple gingival recession defects: a systematic review, meta-analysis and meta-regression.

This study investigated the efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) compared to other methods for treating multiple adjacent gingival recessions (MAGRs) through a systematic review and meta-analysis. A systematic literature search was performed through June 2023, to identify clinical trials investigating VISTA for root coverage on MAGRs. A meta-analysis with meta-regression model was employed on the primary outcomes of mean and complete root coverages (MRC, CRC), comparing VISTA with other techniques. Clinical efficacy of various graft materials was assessed. Fourteen studies were included, 8 of which met the criteria for quantitative assessment. The cumulative MRC (88.15% ± 20.79%) and CRC (67.85% ± 21.72%) of VISTA were significantly higher compared to the tunneling technique (SMD = 0.83 (95% CI [0.36, 1.30], p < 0.01). The baseline recession depth showed a negative correlation with CRC, whereas baseline keratinized gingiva width exhibited a positive correlation with this outcome. The VISTA technique, particularly with acellular dermal matrix (ADM) or connective tissue graft (CTG) materials, offers superior outcomes compared to the tunneling technique. The capacity of platelet-rich fibrin (PRF) to substitute for connective tissue graft (CTG) in VISTA-root coverage was noteworthy, provided there is adequate keratinized tissue width. VISTA in concert with acellular dermal matrix or CTG resulted in improved root coverage, surpassing the outcomes achieved through tunneling. PRF emerged as a viable alternative to CTG, when used in conjunction with VISTA, demonstrating comparable mean root coverage. This is particularly evident in situations where sufficient keratinized gingiva is available and when patient comfort is taken into consideration.

Free Gingival and Connective Tissue Graft: Split Mouth Case of Root Coverage

Free Gingival and Connective Tissue Graft: Split Mouth Case of Root Coverage

Leukocytic platelet rich fibrin (L-PRF) versus subepithelial connective tissue graft (SCTG) using tunneling technique in treatment of gingival recession: Randomize controlled clinical study

Introduction: Gingival recession is a problem encountered daily in clinical practice, its etiology is often a multifactorial one. Surgical treatment is the only method to reverse this condition. Objective: to evaluate the effectiveness of leukocytic platelet rich fibrins (L-PRF) versus subepithelial connective tissue graft (SCTG) in the management of recession defects Miller’s class I or II (RT1) using the tunnel technique (TUN). Methods: 20 systemically healthy patients were allocated randomly to TUN with L-PRF (group A), and TUN with SCTG (group B). Probing depth, clinical attachment level, recession depth, width of keratinized tissue, gingival thickness, and recession esthetic score and wound healing index are clinical variables measured at baseline,14 days, 3 months, and 6 months postoperatively. Results: Significant improvement in mean CAL, and RD for both groups, and significant difference in GT and WKT for group B as well as higher RES. A significant difference was also recorded in group A for WHI Conclusions: Both grafting modalities in combination with tunnel technique improved gingival phenotype switching. Although SCTG gives higher esthetic and functional results including better color matching, tissue contour and increased width of keratinized tissue, L-PRF has superior healing properties and can be used as an alternative to treat multiple gingival recession defects where the need of second surgical site is eliminated.