Modified Coronally Positioned Flap for Isolated Gingival Recession, Evaluated with Root  Coverage Esthetic Score System

Background: Various modifications of the coronally displaced flap have been proposed in the literature with the attempt of treating gingival recession. This study is undertaken to evaluate the predictability of the modified coronally positioned flap in isolated gingival recession not only in terms of root coverage but also with the esthetic outcome. Materials and Methods: Fifteen isolated gingival recessions with at least 1mm of keratinized tissue apical to the defect were treated with a modified coronally advanced flap. All recessions fall into Miller class I. The clinical re-evaluation was performed 3 months and 1year after the surgery. Statistical analysis was performed using statistical application software (SPSS16.0). Multivariate ANOVA was used for analysis. Results: At the 1-year examination, the average root coverage was 94.6% of the pre-operative recession depth. There was a mean clinical attachment gain of 3.3±0.1 mm at 1 year follow-up.The average increase of keratinized tissue between the baseline and the 1-year follow-up amounted to 1.53±0.13 mm. Root coverage esthetic score (RES) was recorded at the end of follow-up period. 13/15 cases showed RES score of 9 and 2/15 cases showed RES score of 6. Conclusion: The modified coronally advanced surgical technique is effective in the treatment of isolated gingival recession in the upper jaw.

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Management of Multiple Recession simultaneously with Modified Coronally Advanced Flap

Journal of Nepalese Society of Periodontology and Oral Implantology ◽

10.3126/jnspoi.v1i2.23567 ◽

2017 ◽

Vol 1 (2) ◽

pp. 81-83

Author(s):

Harish Kumar Shah ◽

Shashi Kant Chaudhary ◽

Khushboo Goel ◽

Sajeev Shrestha

Keyword(s):

Prognostic Factors ◽

Gingival Recession ◽

Class I ◽

Root Coverage ◽

Periodontal Health ◽

Aesthetic Result ◽

Coronally Advanced Flap ◽

Flap Procedure ◽

The Aesthetic

Gingival recession is one of the aesthetic concern for a beautiful smile. In an aesthetically driven era, root coverage requires consideration of all prognostic factors for successful results. This paper reports a case of treatment of Miller’s Class I gingival recession involving multiple teeth. A modified coronally advanced flap procedure was performed. At the postoperative follow-up visits, healing was uneventful. After 9 months, excellent aesthetic result was achieved with complete root coverage. Periodontal health was normal and the patient was satisfied with the result.

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Treatment of gingival recession with coronally advanced Flap - A case report

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v1i1.7253 ◽

2012 ◽

Vol 1 (1) ◽

pp. 29-32

Author(s):

R Singh

Keyword(s):

Gingival Recession ◽

Gingival Tissue ◽

Root Caries ◽

Root Coverage ◽

Periodontal Health ◽

Medical College ◽

Coronally Advanced Flap ◽

Normal Colour ◽

Clinical Conditions

Extensive gingival recession associated with cervical abrasions is common. Several different surgical and/or restorative therapies have been proposed to correct these lesions. This paper reports the treatment of multiple gingival recessions associated with shallow root caries. The procedure involved utilization of coronally advanced flap. At the postoperative follow-up visits, the success of the surgical approach was confirmed by the absence of tooth sensitivity and presence of gingival tissue with normal colour, texture and contour. After 12 months of follow-up, the clinical conditions were stable with satisfactory root coverage and periodontal health. An excellent aesthetical outcome was achieved and the patient was satisfied with the outcome. DOI: http://dx.doi.org/10.3126/jkmc.v1i1.7253 Journal of Kathmandu Medical College, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 pp.29-32

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Comparative Evaluation of Coronally Advanced Flap with Platelet-rich Fibrin vs Amniotic Membrane for the Treatment of Gingival Recession

Journal of Health Sciences & Research ◽

10.5005/jp-journals-10042-1045 ◽

2017 ◽

Vol 8 (1) ◽

pp. 31-37 ◽

Cited By ~ 1

Author(s):

Abhishek Gautam

Keyword(s):

Amniotic Membrane ◽

Comparative Evaluation ◽

Gingival Recession ◽

Class I ◽

Root Coverage ◽

Platelet Rich Fibrin ◽

Coronally Advanced Flap ◽

Keratinized Tissue ◽

Probing Depth ◽

To Receive

ABSTRACT Background The purpose of this clinical trial was to compare the outcome of gingival recession technique using the coronally advanced flap (CAF) with platelet-rich fibrin (PRF) and amniotic membrane. Materials and methods About 15 patients with bilateral Miller class I buccal gingival recessions (4–5 mm) in maxillary and mandibular canines were selected. The recessions were randomly assigned to receive either the CAF with PRF or the CAF with amniotic membrane. Recession height (RH), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), probing depth (PD), and clinical attachment level (CAL) were measured at baseline as well as 6 months postsurgery. Patient satisfaction with esthetics, root sensitivity, and postoperative pain was also evaluated. Results The average percentages of root coverage for CAF with PRF and CAF with amniotic membrane were 92.95% and 97.40% (p < 0.05) respectively, and the complete root coverage observed was 56.94% and 76.47% respectively. The CAF with amniotic membrane showed a statistically significant increase in TKT (p < 0.05). There were no significant differences between the two groups with regard to RH, RW, WKT, PD, and CAL. The esthetic condition after both treatments was considered satisfactory by the patients. Conclusion The outcome of this study reflects that CAF with PRF and amniotic membrane can be successfully used to treat class I gingival recession. How to cite this article Gautam A. Comparative Evaluation of Coronally Advanced Flap with Platelet-rich Fibrin vs Amniotic Membrane for the Treatment of Gingival Recession. J Health Sci Res 2017;8(1):31-37.

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A Modified Bilaminar Technique with the Use of a Fibrin-Fibronectin System for a Single Gingival Recession: A Case Report with a Follow-Up of 3 Years

Case Reports in Dentistry ◽

10.1155/2020/3892753 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Michele Perelli ◽

Paolo Giacomo Arduino ◽

Mario Semenza ◽

Roberto Abundo ◽

Hector Sarmiento

Keyword(s):

Case Report ◽

Gingival Recession ◽

Root Coverage ◽

Canine Tooth ◽

Maxillary Canine ◽

Aesthetic Result ◽

Keratinized Tissue ◽

Reduced Dimension ◽

Maximum Root

This case report described a modified bilaminar technique for treating a single gingival recession. Patient presented a gingival recession in a maxillary canine. Tooth was in a buccally prominent position and soft keratinized tissue apical to the recession was reduced but still present. A split-full-split thickness trapezoidal flap was designed. Root’s surface was prepared with curettes. Epithelial-connective tissue graft was harvested from the palate with reduced dimension. After deepithelialization, the graft was placed with a fibrin-fibronectin system at the maximum root coverage level, and the flap coronally advanced and sutured. At 3-year follow-up control, the free gingival margin was still stable at the postsurgery position, with a thicker biotype corresponding to the grafted area, with no probing and a suitable aesthetic result.

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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

Journal of Clinical Medicine ◽

10.3390/jcm9082641 ◽

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.

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Xenogeneic collagen matrix for the treatment of multiple gingival recessions in esthetics areas: a case series with 24-month follow-up

Research Society and Development ◽

10.33448/rsd-v10i10.18776 ◽

2021 ◽

Vol 10 (10) ◽

pp. e349101018776

Author(s):

Raphaella Coelho Michel ◽

Rafael Ferreira ◽

Erika Beatriz Spada de Carvalho ◽

Talyta Sasaki Jurkevicz ◽

Carla Andreotti Damante ◽

...

Keyword(s):

Case Series ◽

Collagen Matrix ◽

Gingival Recession ◽

Health Impact ◽

Anterior Maxilla ◽

Gingival Thickness ◽

Coronally Advanced Flap ◽

Keratinized Tissue ◽

Surgical Pain

Introduction: Multiple gingival recessions (GR) are often associated with high hypersensitivity and esthetics concerns due to exposed roots. The collagen matrix (CM) associated with coronally advanced flap (CAF) may be a suitable treatment for multiple GR in esthetic areas. However, there is a lack of long term follow up investigations. Objective: To evaluate a 24-month follow-up of the CM + CAF treatment for multiple RT1 GRs in esthetics areas. Materials and Methods: Six patients presenting 6 adjacent Cairo’s gingival recessions type 1 (RT1) in the anterior maxilla were treated with CM + CAF, and based on these patients a brief statistical analysis was conduct. The evaluated parameters included gingival recession depth (GRD), gingival recession width (GRW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), gingival thickness (GT), and mean root coverage (MRC). Patient-related outcomes measurements (PROMs) were assessed using an oral health impact profile (OHIP-14) questionnaire and visual analogue scale (VAS). Results: There was significant improvement in GRD, GRW, and CAL measurements at 3 months postoperatively (p<0.05). Besides, CAL also increased from 12 months to 24 months’ follow-up (p=0.0023). The MRC percentage was 82%. PD, GT, and KTW presented no statistical difference. PROMs revealed a high score for esthetics (82.2%) and a significant reduction in hypersensitivity and surgical pain/discomfort. Conclusions: Considering the limitations of a case series, the use of CM + CAF on RT1 multiple gingival recessions in esthetic areas demonstrated positive outcomes after 24 months.

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Clinical Evaluation of Type I Bovine Collagen in the Treatment of Localized Gingival Recession

World Journal of Dentistry ◽

10.5005/jp-journals-10015-1034 ◽

2010 ◽

Vol 1 (3) ◽

pp. 167-173

Author(s):

J Praveen ◽

CD Dwarakanath ◽

GV Prashanth ◽

Sidharth Shankar

Keyword(s):

Gingival Recession ◽

Type I ◽

Significant Gain ◽

Root Coverage ◽

Pocket Depth ◽

Clinical Attachment Level ◽

Coronally Advanced Flap ◽

Bovine Collagen ◽

Keratinized Tissue ◽

Attachment Level

ABSTRACT Background Over the years, coronally advanced flap and the use of guided tissue regeneration have been among the more successful techniques in treating gingival recession. The present study compared the relative efficacies of these two techniques in treating gingival recession. Methods Twelve patients presenting with localized identical anterior recessions were taken up in a split mouth design for the study. One site was randomly assigned to be treated with coronally advanced flap supported by membrane while the other was treated with coronally advanced flap alone. Changes in clinical parameters, such as recession width, recession depth, surface area of the recession defect, width of keratinized tissue, gingival status, probing pocket depth and clinical attachment level were measured at baseline and at 3 and 6 months postoperatively. Results In the 10 patients that were followed up, both treatments resulted in a significant gain in root coverage amounting to a mean gain of 66.49% in the membrane group and 65.56% in the CAF group. The differences in root coverage and the clinical attachment level gains between the groups were not significant. However, significant gain in the width of keratinized tissue was seen in the membrane group after treatment. Conclusion This study suggests that coronally advanced flap procedure provides a predictable, simple and convenient technique in the treatment of localized class I gingival recession. Combining this technique with the placement of a bioabsorbable membrane does not seem to improve the results. The addition of a membrane, however, increases the width of keratinized tissue.

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Coronally Advanced Flap with Connective Tissue Graft for Treating Orthodontic-Associated Miller Class III Gingival Recession of the Lower Incisors: A One-Year Retrospective Study

Journal of Clinical Medicine ◽

10.3390/jcm11010235 ◽

2022 ◽

Vol 11 (1) ◽

pp. 235

Author(s):

Evgeny Weinberg ◽

Roni Kolerman ◽

Lazar Kats ◽

Omer Cohen ◽

Daya Masri ◽

...

Keyword(s):

Connective Tissue ◽

Gingival Recession ◽

Class Iii ◽

Root Coverage ◽

Coronally Advanced Flap ◽

Connective Tissue Graft ◽

Tissue Graft ◽

Keratinized Tissue ◽

Probing Depth ◽

One Year

(1) Background: To assess the clinical outcome of coronally advanced flap combined with connective tissue graft for the treatment of orthodontic-associated Miller Class III gingival recession of the lower incisors. (2) Methods: This study included 15 patients who had undergone orthodontic treatment prior to development of recession. Measurements of recession depth, recession width, probing depth, and width of keratinized tissue were performed clinically immediately before surgery and after one year. In addition, digital measurements of recession depth, recession width, and root coverage esthetic score were performed on intraoral photographs. (3) Results: Significant reduction was observed for probing depth, recession depth, and recession width at one year, with significant increase in width of keratinized tissue. Mean root coverage was 83 ± 24% for recession depth, while complete root coverage was achieved in 10 out of 21 recessions (48%). The average root coverage esthetic score at 12 months was 7.1 ± 2.6. An interaction was found between initial recession depth and mean root coverage. (4) Conclusions: Within the limitations of this study, our results confirm that combination of coronally advanced flap and connective tissue graft is effective in reducing post-orthodontic Miller Class III recessions of the mandibular incisors, even when the correction of the tooth malposition, is unattainable.

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Coronally Advanced Flap With Connective Tissue Graft For Treating Orthodontic-Associated Miller Class III Gingival Recession of The Lower Incisors: A One-Year Retrospective Study

10.21203/rs.3.rs-663623/v1 ◽

2021 ◽

Author(s):

Evgeny Weinberg ◽

Roni Kolerman ◽

Omer Cohen ◽

Alon Sebaoun ◽

Gil Slutzkey

Keyword(s):

Connective Tissue ◽

Gingival Recession ◽

Class Iii ◽

Root Coverage ◽

Coronally Advanced Flap ◽

Connective Tissue Graft ◽

Tissue Graft ◽

Keratinized Tissue ◽

Probing Depth ◽

One Year

Abstract Aims To assess the clinical outcome (after one year) of coronally advanced flap combined with connective tissue graft for the treatment of orthodontic-associated Miller Class III gingival recession of the lower incisors. Materials and methods This study included 15 patients who had undergone orthodontic treatment prior to development of recession. Measurements of recession depth, recession width, probing depth, and width of keratinized tissue were performed clinically immediately before surgery and after one year. In addition, digital measurements of recession depth, recession width, and root coverage esthetic score were performed on intraoral photographs. Results Significant reduction was observed for probing depth, recession depth, and recession width at one year, with significant increase in width of keratinized tissue. Mean root coverage was 83 ± 24% for recession depth, while complete root coverage was achieved in 10 out of 21 recessions (48%). The average root coverage esthetic score at 12 months was 7.1 ± 2.6. An interaction was found between initial recession depth and mean root coverage. Conclusions Within the limitations of this study, our results confirm that combination of coronally advanced flap and connective tissue graft is effective in reducing post-orthodontic Miller Class III recessions of the mandibular incisors with a concomitant increase in width of keratinized tissue. Clinical Relevance These findings suggest that combination of coronally advanced flap with connective tissue graft may significantly improve post-orthodontic Miller Class III recessions of the mandibular incisors, even when the correction of the tooth malposition is unattainable.

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Treatment of Gingival Recessions Class II Miller in Lower Jaw with Coronary Advanced Flap and Connective Tissue Graft-Case Report

Balkan Journal of Dental Medicine ◽

10.2478/bjdm-2020-0029 ◽

2020 ◽

Vol 24 (3) ◽

pp. 60-64

Author(s):

Antoaneta Mlachkova ◽

Zdravka Pashova-Tasseva

Keyword(s):

Case Report ◽

Connective Tissue ◽

Gingival Recession ◽

Class Ii ◽

Root Coverage ◽

Coronally Advanced Flap ◽

Connective Tissue Graft ◽

Tissue Graft ◽

Lower Jaw ◽

Keratinized Tissue

SummaryBackground/Aim: Gingival recession is defined as apical migration if the gingival margin associated with exposure of the cement - enamel junction. The gingival recessions are major esthetic concern in patients at any age. In cases with esthetic and functional considerations mucogingival surgery is indicated. The advantages of CAF with or without CTG are making this procedure highly recommended in the esthetic zone. The results are predictable about root coverage, widening if the gingival tissues and esthetics. The aim of the recent case report is to demonstrate the succesfull combination of coronally advanced flap with connective tissue graft in the treatment of wide and deep gingival recessions.Case Report: Female patient seeking consultation with great concern” not to lose the lower canines”. She noticed elongation of the teeth in the recent years complained with tenderness while brushing them. The initial examination showed presence of multiple gingival recessions in the upper and the lower jaw. Full periodontal status was taken and following diagnosis was established – dental plaque induced gingivitis, class II gingival recession in teeth #33 and #43 (Miller`s classification), RT1 by Cairo. After cause-related therapy two surgical procedures were performed in separate sessions. Both gingival recessions were surgically treated by means of CAF with CTG.Conclusions: Despite the limitating factors such as lack of keratinized tissue in the patient’s mandible that rather difficult the performance of the technique of choise, the coronally advanced flap with connective tissue graft is predictable technique for full root coverage.

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