scholarly journals Effect of 24% EDTA root conditioning on the outcome of modified coronally advanced tunnel technique with subepithelial connective tissue graft for the treatment of multiple gingival recessions: a randomized clinical trial

2021 ◽  
Author(s):  
Bartłomiej Górski ◽  
Marcin Szerszeń ◽  
Tomasz Kaczyński
Keyword(s):  
Connective Tissue ◽  
Ethylenediaminetetraacetic Acid ◽  
Treatment Modalities ◽  
Root Coverage ◽  
Gingival Thickness ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Keratinized Tissue ◽  
Patient Reported ◽  
Subepithelial Connective Tissue Graft

Abstract Objectives To investigate effects of root conditioning with 24% ethylenediaminetetraacetic acid (EDTA) on the 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG). Materials and methods Twenty patients with 142 GR were treated (72 test sites: SCTG + EDTA and 70 control sites: SCTG). Average and complete root coverage (ARC, CRC), gain in keratinized tissue width (KTW), gain in gingival thickness (GT), root esthetic coverage score (RES), and patient-reported outcome measures (PROMs) were evaluated at 12 months post-operatively. Results Differences between pre- and post-operative values were statistically significant only within but not between treatment modalities. At 12 months, ARC was 86.0% for SCTG + EDTA-treated and 84.6 for SCTG-treated defects (p = 0.6636). CRC was observed in 90.2% (tests) and 91.4% (controls) of all cases (p = 0.9903). Professional assessment of esthetic outcomes using RES showed highly positive results reaching the value of 8.9 in case of test sites and 8.7 for control sites (p = 0.3358). Severity of pain and swelling did not differ between sites, regardless of whether EDTA was used. Conclusions Test and control sites presented similarly positive outcomes related to root coverage, periodontal and esthetic parameters, and patient satisfaction and self-reported morbidity with no statistical differences between them 12 months after surgery. No significant differences in evaluated variables were observed between sites treated with and without 24% EDTA. Clinical relevance Considering the limitations of the present study, the use of 24% EDTA for root conditioning did not improve 12-month outcomes after treatment of multiple RT1 and RT2 gingival recessions with MCAT and SCTG. Trial registration ClinicalTrials.gov identifier: NCT03354104

scholarly journals Effect of Root Surface Biomodification on Multiple Recession Coverage with Modified Coronally Advanced Tunnel Technique and Subepithelial Connective Tissue Graft: A Retrospective Analysis

Gels ◽  
2022 ◽  
Vol 8 (1) ◽  
pp. 31
Author(s):  
Bartłomiej Górski ◽  
Marcin Szerszeń
Keyword(s):  
Connective Tissue ◽  
Root Surface ◽  
Enamel Matrix Derivative ◽  
Root Coverage ◽  
Clinical Attachment Level ◽  
Gingival Thickness ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Subepithelial Connective Tissue Graft ◽  
Attachment Level

To improve treatment efficacy of gingival recessions (GR), chemical preparation of the exposed root surface was advocated. The aim of this study was to compare the additional influence of root biomodifications with 24% ethylenediaminetetraacetic acid (EDTA) alone or with enamel matrix derivative (EMD) on the 12 month outcomes of modified coronally advanced tunnel (MCAT) with subepithelial connective tissue graft in the treatment of multiple GR. Average root coverage (ARC), complete root coverage (CRC), reduction in GR, reduction in recession width (RW), gain in clinical attachment level (CAL), increase in gingival thickness (GT), increase in keratinized tissue width (KTW) and changes in root coverage esthetic score (RES) were evaluated. A total of 60 patients with 215 GR were enrolled. In 70, GR root surfaces were treated with EDTA + EMD, in other 72, with EDTA, while in the remaining 73 saline solution was applied. ARC was 94%, 89%, and 91% in the EDTA + EMD, the EDTA and the saline groups, respectively (p = 0.8871). Gains in clinical attachment level (CAL; 2.1 ± 1.1 mm) and RES values (9.6 ± 0.9) were significantly higher in the EDTA + EMD group, when compared with two other groups. The differences between other preoperative and postoperative parameters showed statistical significance only within but not between groups. MCAT outcomes may benefit from adjunctive use of EDTA + EMD regarding 12 month CAL gain and professionally assessed esthetics using RES following treatment of GR.

scholarly journals Tunnel/Pouch versus Coronally Advanced Flap Combined with a Connective Tissue Graft for the Treatment of Maxillary Gingival Recessions: Four-Year Follow-Up of a Randomized Controlled Trial

2020 ◽  
Vol 9 (8) ◽  
pp. 2641
Author(s):  
Souheil Salem ◽  
Leila Salhi ◽  
Laurence Seidel ◽  
Geoffrey Lecloux ◽  
Eric Rompen ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Test Group ◽  
Gingival Recession ◽  
Root Coverage ◽  
Gingival Thickness ◽  
Coronally Advanced Flap ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Keratinized Tissue

Background: The long-term stability after soft tissue graft for covering gingival recession remains a pivotal goal for both patient and periodontist. Therefore, the aim of this study was to compare the four-year outcomes of the coronally advanced flap (CAF) versus the pouch/tunnel (POT) technique, both combined with connective tissue graft (CTG), for gingival recession treatment. Methods: Forty patients were initially randomly assigned to the control group (CAF + CTG; N = 20) and the test group (POT + CTG; N = 20). Clinical outcomes included mean root coverage (MRC) and complete root coverage (CRC), gingival thickness (GT), and keratinized tissue (KT) gain. Esthetic outcomes were also analyzed using the pink esthetic score (PES) and patient-reported outcome measures (PROMs). All outcomes initially assessed at six months were extended to four years post-surgery. Results: No significant differences were observed between the two patient groups in terms of MRC and CRC. At four years, significantly greater GT and KT gain were noted in the POT + CTG group, and tissue texture enhancement was also more prominent in the test group. Conclusions: The POT + CTG technique allows for long-term clinical coverage of gingival recessions comparable to that of the CAF + CTG technique, but it potentially improves gingival thickness, keratinized tissue and esthetic results.

scholarly journals Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes

2021 ◽  
Author(s):  
Bartłomiej Górski ◽  
Renata Górska ◽  
Marcin Szerszeń ◽  
Tomasz Kaczyński
Keyword(s):  
Logistic Regression ◽  
Connective Tissue ◽  
Enamel Matrix Derivative ◽  
Enamel Matrix ◽  
Root Coverage ◽  
Gingival Thickness ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Subepithelial Connective Tissue Graft ◽  
Matrix Derivative

Abstract Objectives To investigate factors that influence 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG) with enamel matrix derivative (EMD) (tests) or without (controls). Materials and methods Twenty patients with 150 GR were treated. Logistic regression models were used to identify baseline parameters that could predict 12-month average root coverage (ARC), complete root coverage (CRC), root esthetic coverage score (RES), gain in keratinized tissue width (KTW), and gain in gingival thickness (GT). Results The likelihood of ARC > 85% increased sevenfold (odds ratio [OR] = 7.33; 95% confidence interval [CI] = 2.43–12.12), of achieving CRC: 21-fold (OR = 21.23; 95% CI = 10.21–45.32), and of gaining RES = 10: tenfold (OR = 10.23; 95% CI = 5.78–32.23) in favor of EMD-treated sites. With each 1-mm2 increase in baseline avascular exposed root surface area (AERSA), the odds of failure (ARC ≤ 85%, not achieving CRC and postoperative GT ≤ 2 mm) increased almost fourfold (OR = 3.56; 95% CI = 1.98–10.19), fourfold (OR = 4.23; 95% CI = 1.11–9.02), and nearly sixfold (OR = 5.76; 95% CI = 2.43–12.87), respectively. The greater the baseline GT, the more likely the chance of achieving CRC (OR = 10.23; 95% CI = 8.37–16.23) and RES = 10 (OR = 5.50; 95% CI = 3.34–16.43). All models exhibited fair to excellent discrimination and satisfactory calibration. Conclusions Based on logistic regression, EMD application improved postoperative ARC, CRC and RES; baseline AERSA predicted 12-month ARC, CRC, and GT gain, whereas baseline GT was a predictor of achieving CRC and perfect RES. Clinical relevance Additional use of EMD, lower baseline AERSA, and greater baseline GT significantly increase the odds of obtaining better outcomes 12 months after MCAT + SCTG technique.

scholarly journals EFFECT OF SMOKING ON THE PERIODONTAL MICROSURGERY TECHNIQUE ON THE TREATMENT OF GINGIVAL RECESSION

2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Renata De Araújo Barbosa ◽  
Mônica Dourado ◽  
Maria Cecília Azoubel ◽  
Roberta Santos Tunes ◽  
Érica Del Peloso Ribeiro ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Gingival Recession ◽  
Root Coverage ◽  
Average Percentage ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Keratinized Tissue ◽  
Probing Depth ◽  
Subepithelial Connective Tissue Graft ◽  
Attachment Level

This paper aims to evaluate the effects of smoking on periodontal microsurgery technique using the subepithelial connective tissue graft (SCTG) for treatment of gingival recession on smokers. 14 patients nonsmokers and 12 smokers were selected, presenting Miller’s Class I and II gingival recession ≥ 2.0 mm. For both groups, the subepithelial connective tissue graft was used with the aid of a surgical microscope. The clinical parameters of width and height of the gingival recession, height and thickness of keratinized tissue, probing depth and clinical attachment level were evaluated before and six months after surgery. At the end of the study, there were obtained an average percentage of 96.66% of root coverage on nonsmokers and 82.49% on smokers (p=0.03). Complete root coverage was observed in 78,57% and 50% of patients, respectively. Therapy can benefit both groups, but smokers have less favorable outcomes to root coverage with periodontal microsurgery using the SCTG.

scholarly journals Multiple Marginal Tissue Recession Treated with a Simplified Lateral Sliding Flap Technique

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Fernando Salimon Ribeiro ◽  
Juliana Aparecida Najarro Dearo de Morais-Camillo ◽  
José Marcos Alves Fernandes ◽  
Juliana Rico Pires ◽  
Elizangela Partata Zuza ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Simple Procedure ◽  
Root Coverage ◽  
Gingival Thickness ◽  
Connective Tissue Graft ◽  
Flap Technique ◽  
Tissue Graft ◽  
Dentin Sensitivity ◽  
Keratinized Tissue

Marginal tissue recession is a common esthetic problem that is usually accompanied by dentin sensitivity, and patients frequently report a fear of dental loss. Lateral sliding flaps have been used for localized recession, but they are rarely used for multiple recessions. The aim of this paper was to report a case of coverage of multiple marginal tissue recessions by means of a lateral sliding flap associated with a connective tissue graft. This was a modification of Nelson’s technique, which was originally described as the combination of the double papilla technique, lateral sliding flap, and connective tissue graft. In the present case, double papilla was not performed, rendering the maneuver less complicated. After surgery on teeth #23 to #25, total root coverage, decreased dentin sensitivity, and increased keratinized tissue band and gingival thickness were achieved. In the present case, modified Nelson technique proved to be a more simple procedure for the treatment of multiple recessions in one session, resulting in adequate healing, predictable root coverage, and, more importantly, esthetic and functional success.

scholarly journals Laterally Positioned Flap with Subepithelial Connective Tissue Graft Modified One-Stage Procedure for the Treatment of Deep Isolated Gingival Recessions in Mandibular Incisors

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Alvaro Francisco Bosco ◽  
Juliano Milanezi de Almeida ◽  
Belén Retamal-Valdes ◽  
Renata Tavares ◽  
Jessica M. Latimer ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Donor Site ◽  
Root Coverage ◽  
Connective Tissue Graft ◽  
One Stage ◽  
Tissue Graft ◽  
Adjacent Tooth ◽  
Keratinized Tissue ◽  
Subepithelial Connective Tissue Graft ◽  
Mandibular Incisors

The laterally positioned flap (LPF) has been proposed as a promising treatment for isolated gingival recessions (GRs) in mandibular incisors. Several modifications have been proposed to reduce the risk of gingival recession (GR) at the donor tooth site. Therefore, the aim of this was to describe a modified one-stage procedure of performing the LPF associated with the subepithelial connective tissue graft (LPF + SCTG) with the modifications for the treatment of deep isolated GR in mandibular incisors. The modified one-stage technique (LPF + SCTG) is unique because it was presented being bilaminar with tunneled connective tissue graft (CTG) in the adjacent tooth and extended to the flap donor site, without a submarginal incision in the adjacent tooth, taking the entire band of the keratinized tissue (KT) into the flap. In addition, 3 clinical cases were described using this surgical technique. Three healthy patients with Cairo RT1 or RT2 GRs on teeth 31 or 41 were treated with the LPF + SCTG technique. Probing depth (PD), clinical attachment level (CAL), complete root coverage (CRC), mean root coverage (MRC), recession depth (RD), and keratinized tissue width (KTW) were assessed at baseline and in the follow-up periods of 18, 24, and 48 months, in the cases 1, 2, and 3, respectively. The LPF + SCTG with the modifications presented is a predictable approach for the treatment of deep isolated RT1 and RT2 GRs in mandibular incisors that are well positioned in the bone envelope with the presence of KTW adjacent to GR and adequate vestibule depth in the donor area of the flap.

Subepithelial Connective Tissue Graft for Gingival Recession Coverage: A Case Report

2020 ◽  
Author(s):  
Anita Mehta
Keyword(s):  
Case Report ◽  
Connective Tissue ◽  
Gingival Recession ◽  
Tooth Brushing ◽  
Vulnerable Area ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Keratinized Tissue ◽  
Subepithelial Connective Tissue Graft ◽  
Dentinal Hypersensitivity

The Gingival recession is considered a multi-factorial. The etiology may be an anatomically vulnerable area, faulty tooth brushing, high frenum attachment. In cases where there is progressive recession, aesthetics concern or increasing dentinal hypersensitivity, we can do recession coverage. Depending upon the presence or absence of adequate keratinized tissue we can choose the technique. In case of adequate width of keratinized tissue, usually we can do displaced flap and in case where there is inadequate width, we can do gingival grafting.

scholarly journals Dynamics of Matrix Metalloproteinase-1 and -8 Secretion in Gingival Crevicular Fluid after Gingival Recession Therapy via MCAT with Either Subepithelial Connective Tissue Graft or Collagen Matrix

Biomolecules ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 731
Author(s):  
Anna Skurska ◽  
Violetta Dymicka-Piekarska ◽  
Robert Milewski ◽  
Małgorzata Pietruska
Keyword(s):  
Connective Tissue ◽  
Gingival Crevicular Fluid ◽  
Collagen Matrix ◽  
Gingival Recession ◽  
Gingival Thickness ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Keratinized Tissue ◽  
Matrix Metalloproteinase 1 ◽  
Crevicular Fluid

Objectives: The objective of this study was to determine and estimate the changing levels of matrix metalloproteinases 1 and 8 (MMP-1 and MMP-8) in GCF at consecutive stages of healing after root coverage procedure via modified coronally advanced tunnel (MCAT) combined with either sub-epithelial connective tissue graft (SCTG) or collagen matrix (CM) and also to relate those changes to clinical outcomes of both therapeutic approaches. Materials and methods: The study involved 20 patients with a total of 91 recessions. Those on one side of the mandible received MCAT plus CM while the contralateral ones MCAT plus SCTG. The evaluation of MMP-1 and MMP-8 concentrations in Gingival Crevicular Fluid (GCF) took place at baseline, then at 1, 2, and 4 weeks, and finally at 3 months after surgery. Elisa protocol was applied to determine the levels of MMP-1 and MMP-8 in GCF. Results: Three-month observation revealed statistically significant changes in MMP-1, MMP-8 and Sulcus Fluid Flow Rate (SFFR) values after implementation of both techniques. A correlation was found between a difference in MMP-1 concentrations and gain in Keratinized Tissue (KT) after SCTG and CM. MMP-8 levels and a Gingival Thickness (GT) gain observed after CM was also correlated. Conclusions: A type of augmentative material does appear to determine the dynamics of MMP-1 secretion.

scholarly journals ROOT COVERAGE USING THE SUBEPITHELIAL CONNECTIVE TISSUE GRAFT OR THE ACELLULAR DERMAL MATRIX FOR THE TREATMENT OF GINGIVAL RECESSION: A CLINICAL STUDY

2018 ◽  
Vol 9 ◽  
pp. 20
Author(s):  
Shula Zuleika Sumana ◽  
Sri Lelyati C Masulili ◽  
Robert Lessang
Keyword(s):  
Connective Tissue ◽  
Acellular Dermal Matrix ◽  
Gingival Recession ◽  
Root Coverage ◽  
Dermal Matrix ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Operative Data ◽  
Subepithelial Connective Tissue Graft ◽  
Acellular Dermal

Objective: This study aims to evaluate periodontal clinical conditions after treatment for gingival recession (GR) using subepithelial connective tissue graft (SCTG) and acellular dermal matrix (ADM).Methods: Ten patients with Miller’s Class I and II recessions that had been treated with SCTG or ADM at the Periodontics Outpatient Department at Universitas Indonesia were selected for this study. The pre-operative data for GR, clinical attachment levels (CAL), and attached gingiva (AG) were retrieved from the patients’ medical records. The patients were recalled and the post-operative data were recorded.Results: The application of SCTG and ADM yields significant changes to GR, CAL, and AG levels. A comparison of two groups at the post-operative assessment stage showed no statistically significant differences, in terms of GR, CAL, and AG.Conclusion: SCTG and ADM yield similar outcomes in the treatment of GR. As such, ADM may be suggested as an alternative to SCTG for root coverage.

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