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

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.

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

(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.

The effect of different soft-tissue management techniques for alveolar ridge preservation: a randomized controlled clinical trial

Purpose For alveolar ridge preservation, various treatment protocols have been described. While most studies focus on the effect of the bone graft material, the aim of this study was to analyze the influence of different soft-tissue management techniques on the soft and hard tissue. Methods A total of 20 maxillary extraction sockets were grafted with an anorganic xenogenic bone graft and then randomly treated with either a combined epithelialized-subepithelial connective tissue graft (CECG) or a porcine collagen matrix (CM) placed in labial and palatal tunnels. Measurements of soft-tissue thickness were performed at tooth extraction (T0), implant insertion (T1) and second stage surgery (T2). Results In the CECG group, gingival thickness was 1.18 ± 0.56 mm (T0), 1.29 ± 0.26 mm (T1) and 1.2 ± 0.32 mm (T3). In the CM group, the measurements were 1.24 ± 0.50 mm (T0), 1.6 ± 0.6 mm (T1) and 1.7 ± 1.06 mm. Thus, there was an overall increase in gingival thickness from T0 to T2 of 0.02 ± 0.66 mm (CECG) compared to 0.46 ± 0.89 mm (CM). The thickness of keratinized soft-tissue was 3.91 ± 1.11 mm (CECG) and 4.76 ± 1.48 mm (CM) before extraction and 3.93 ± 1.17 mm (CECG) and 4.22 mm ± 1.26 mm (CM) at implant follow-up. Mean peri-implant probing depths were 3.15 ± 1.39 mm (CECG) and 3.41 ± 0.99 mm (CM). Conclusions After ridge preservation, comparable soft-tissue parameters were observed in both groups, whether treated with a collagen matrix or a combined autologous connective tissue graft.

Surgical management of RT2 gingival recession using sub epithelial connective tissue graft and coronally advanced flap: A case report

Apical migration of the gingival fiber attachment and marginal gingiva leads to gingival recession and can be caused due to many factors such as faulty tooth brushing, masochistic habits, periodontal disease etc. This causes dentinal hypersensitivity, aesthetic problems, root caries, cervical abrasion, and difficulty in maintaining oral hygiene and often possess a challenging situation for the clinician to deliver best care to the patients. This case reports about the use of SCTG along with coronally advanced flap. To report a case of RT2 recession, older term – Millers Class II recession which showed promising result when root coverage procedure was done using sub-epithelial connective tissue and coronally advancing the flap. A 62-year-old male patient was referred to the Department of Periodontology, with a chief complaint of hypersensitivity and downward shifting of gum in upper front left teeth region which was progressive in nature with no obvious medical history.After achieving profound anaesthesia over the concerned region the recipient site was prepared. After which the donor tissue was retrieved from the palatal area using trap door method and placed over the recipient site. No root biomodification agents were used. The graft was stabilised using interrupted suture and then criss-cross suturing was done, and non-eugenol periodontal dressing was given. The follow up results showed good outcome with predictable root coverage achieved using Sub-epithelial Connective Tissue Graft (SCTG) and coronally advanced flap in the canine region which is often the most difficult one to achieve complete root coverage because of canine prominence. SCTG can be used successfully along with coronally advanced flap and clinicians must opt for such treatment modalities for patients benefit.