Treatment Of Recession-type Defects Research Articles

Histological evaluation following treatment of recession-type defects with coronally advanced flap and a novel human recombinant amelogenin.

To histologically evaluate the effects of a novel human recombinant amelogenin (rAmelX) on periodontal wound healing / regeneration in recession-type defects. A total of 17 gingival recession-type defects were surgically created in the maxilla of three minipigs. The defects were randomly treated with a coronally advanced flap (CAF) and either rAmelX (test), or a CAF and placebo (control). At three months following reconstructive surgery, the animals were euthanized, and the healing outcomes histologically evaluated. The test group yielded statistically significantly (p = 0.047) greater formation of cementum with inserting collagen fibers compared with the control group (i.e., 4.38mm ± 0.36mm vs. 3.48mm ± 1.13mm). Bone formation measured 2.15mm ± 0.8mm in the test group and 2.24mm ± 1.23mm in the control group, respectively, without a statistically significant difference (p = 0.94). The present data have provided for the first-time evidence for the potential of rAmelX to promote regeneration of periodontal ligament and root cementum in recession-type defects, thus warranting further preclinical and clinical testing. The present results set the basis for the potential clinical application of rAmelX in reconstructive periodontal surgery.

Bilaminar technique for treatment of multiple Miller’s class III recession defects in the mandibular frontal area. A case report

Introduction: Gingival recessions at anterior teeth can be an aesthetic problem for the patients who complain of crown lengthening and can be accompanied by lack of attached gingiva and tooth hypersensitivity. Different surgical techniques (pedicle and free soft-tissue grafting) are proposed for treatment of the exposed root surfaces in the aesthetic zone of dentition. The objective of mucogingival periodontal surgery in the treatment of recession type defects is a complete root coverage and fulfilment of the patient’s aesthetic demands. A bilaminar technique is a suitable technique that can be used for root coverage in the treatment of gingival recessions of a single tooth as well as for root coverage in multiple teeth. The literature survey reports that this technique shows good results in the treatment of Miller’s class I, class II and class III gingival recessions with adequate thickness and height of apical keratinized tissues to the exposed root surface and has high predictability for root coverage. Aim: The aim of this case report is to present the satisfactory aesthetic outcome of bilaminar technique for multiple recession defects of Miller’s class III in the frontal segment of the mandibula. Materials and Methods: Miller’s class III gingival recessions, affecting tooth 41 and tooth 31, were established. A bilaminar technique (connective tissue graft and coronally advanced flap) was used for root coverage of established recessions. Results: The bilaminar technique resulted in complete root coverage and gain of clinical attachment level and keratinized width of gingival tissues. Conclusion: The proposed bilaminar technique presents satisfactory aesthetic outcome in case of thin gingival tissues, interproximal attachment loss, and loss of interdental bone height in the zone between lower central incisors.

Enhancement of healing of donor hard palate site using platelet-rich fibrin

Gingival recession is not only an aesthetic concern but also often is associated with problems such as tooth hypersensitivity. Among various root coverage modalities, free soft-tissue gingival graft shows promising results, but is associated with patient discomfort due to the need for second surgical palatal donor site. The purpose of this case report is to evaluate the effectiveness of platelet-rich fibrin (PRF) at donor palatal site with root coverage procedure in the treatment of recession-type defects. This paper reports a case of a 31-year-old male with a root coverage procedure, and employing PRF at donor site has been discussed below. Hence, the employment of PRF at donor site not only enhances healing but also reduces patient discomfort that occurs due to palatal plate.

Porcine dermal matrix for covering of recession type defects: a case series.

To study the clinical applicability of porcine dermal matrix for treatment of recession type defects. Twenty-eight gingival recessions in six patients were selected for root coverage procedures using a modified tunneling technique and porcine dermal matrix. As primary outcome, depth and width of gingival recession were assessed at baseline and at 6 and 12 months postoperatively. As a secondary outcome, the width of keratinized tissue was studied. At 6 and 12 months postoperatively, mean root coverage was 65.52% and 56.82%, respectively. Complete root coverage was achieved in 42.86% of the treated defects. Porcine dermal matrix may potentially be used as a replacement material for autologous tissue. However, complete root coverage was only achieved in less than half of the studied defects.

Evidence‐based periodontal plastic surgery: an assessment of quality of systematic reviews in the treatment of recession‐type defects

To assess methods, quality and outcomes of systematic reviews (SRs) conducted to evaluate the effectiveness of root coverage (RC) procedures in the treatment of recession-type defects (RTD). MEDLINE and EMBASE were searched up to and including April 2010 to identify SRs investigating the effectiveness/efficacy of surgical interventions for the treatment of patients with RTD. Searching was conducted independently by two reviewers, and data extraction was based on the methodological criteria applied and on the effects of interventions reported by each SR. The checklist proposed by Glenny and colleagues, the Overview Quality Assessment Questionnaire and the "Assessment of Multiple systematic Reviews", instrument were used to assess the quality of SRs. Additionally, the methodological criteria applied by included reviews were compared with those proposed by the Cochrane Collaboration. Search strategy identified 716 potentially eligible articles, of which 12 papers regarding 10 SRs were included in the study. Results from different SRs showed that subepithelial connective tissue grafts associated or not to coronally advanced flaps can be used to reduce recession depth and improve the width of keratinized tissue. All quality assessment tools showed that most of the SRs were of good methodological quality, but they also highlighted key points that could be improved in future reviews. Only two SRs followed in full the guidelines proposed by the Cochrane Collaboration. All SRs agree that RC may be anticipated by different surgical procedures. However, differences in the methodological quality between reviews were quite evident, and thus making a clear indication that there is a need of standardization of the methods that will be applied by future SRs. As a result, a standardized checklist for reporting SRs was proposed by the authors.

Root‐Coverage Procedures for the Treatment of Localized Recession‐Type Defects: A Cochrane Systematic Review

The purpose of this review is to evaluate the effectiveness of different root-coverage procedures in the treatment of recession-type defects. The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for entries up to October 2008. There were no restrictions regarding publication status or the language of publication. Only clinical randomized controlled trials (RCTs) with a duration > or = 6 months that evaluated recession areas (Miller Class I or II > or = 3 mm) that were treated by means of periodontal plastic surgery procedures were included. Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significantly greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTGs) compared to guided tissue regeneration (GTR) with bioabsorbable membranes (GTR bms). A significantly greater gain in keratinized tissue was found for enamel matrix protein compared to a coronally advanced flap (0.40 mm) and for SCTGs compared to GTR bms plus bone substitutes. Limited data exist on the changes of esthetic conditions as related to the opinions and preferences of patients for specific procedures. SCTGs, coronally advanced flaps alone or associated with other biomaterial, and GTR may be used as root-coverage procedures for the treatment of localized recession-type defects. In cases where root coverage and gain in keratinized tissue are expected, the use of SCTGs seems to be more adequate.

The Influence of Tobacco Smoking on the Outcomes Achieved by Root-Coverage Procedures: A Systematic Review

The authors conducted a systematic review to evaluate the effect of smoking on the clinical outcomes achieved by periodontal plastic surgery procedures in the treatment of recession-type defects. The authors performed an electronic search on MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled clinical trials, controlled clinical trials and case series that involved at least six months' follow-up. They looked for studies published through June 2008 that compared the outcome measures achieved by smokers and nonsmokers after they underwent periodontal plastic surgery procedures for treatment of gingival recession. From a total of 632 references, the authors considered seven studies to be relevant. The meta-analysis indicated a statistically significant greater reduction in gingival recession (P < .001) and gain in clinical attachment level (P < .001) for nonsmokers when compared with smokers whose gingival recession was treated with subepithelial connective-tissue grafts. Additionally, nonsmokers exhibited significantly more sites with complete root coverage than did smokers (P = .001). For coronally advanced flaps, differences between the groups were not significant. The results of this review show that smoking may negatively influence gingival recession reduction and clinical attachment level gain. Additionally, smokers may exhibit fewer sites with complete root coverage.