scholarly journals Root Coverage for Single Deep Gingival Recessions: Outcomes Based on a Decision-Making Algorithm

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
João B. César Neto ◽  
Marília C. Cavalcanti ◽  
Ricardo T. Sekiguchi ◽  
Claudio M. Pannuti ◽  
Giuseppe A. Romito ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Trials ◽  
Class Ii ◽  
Class Iii ◽  
Root Coverage ◽  
Coronally Advanced Flap ◽  
Connective Tissue Graft ◽  
Keratinized Tissue ◽  
Practical Implications

Aim. The aim of this study is to report root coverage outcomes in single deep gingival recessions (GR) following a proposed decision-making algorithm. Materials and Methods. A retrospective, practice-based study included single deep (≥5 mm) Miller Class II and III defects. The step-by-step decision-making algorithm led to a choice among three different flap designs (coronally advanced flap (CAF), double papilla envelope flap (DPE) or modified lateral sliding flap (LSF)) used with a connective tissue graft. Recession depth (RD) at 6 months follow-up and the corresponding root coverage (RC) were the primary outcomes assessed. Results. Sixteen GR defects were included, with baseline RD of 6.7 ± 1.8 mm. Six months postoperatively, RD was significantly reduced to 1.2 ± 0.8 mm (p<0.05). Mean RC was 81.7 ± 13.0%, without significant differences between Miller Class II (87.1 ± 9.2%; n=9) and Class III (74.6 ± 14.5%; n=7) GRs (p=0.07). Postoperatively, keratinized tissue width increase was greater for LSF (3.5 ± 1.1) and DPE (4.2 ± 1.4 mm) than for CAF (1.9 ± 0.9 mm). Conclusions. Following the proposed decision-making algorithm, root coverage outcomes for GR defects ≥5 mm were comparable to outcomes reported for shallow defects. Prospective clinical trials are needed to validate the proposed approach and techniques. Practical Implications. The proposed algorithm allows the clinician to select the appropriate surgical technique for treatment of single deep gingival recessions with good predictability.

scholarly journals 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

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.

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

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.

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

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.

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 Multidisciplinary Approach to Cover an Apex-Exposed Tooth: A Case Report after 6-Year Follow-Up

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Jamila Kissa ◽  
Wafa El Kholti ◽  
Khadija Sekak ◽  
Sihame Chemlali
Keyword(s):  
Case Report ◽  
Clinical Outcomes ◽  
Multidisciplinary Approach ◽  
Root Apex ◽  
Class Iii ◽  
Root Coverage ◽  
Related Factors ◽  
Clinical Attachment Loss ◽  
Keratinized Tissue

Introduction. The prognosis for a successful treatment of gingival recessions (GRs) is one of the main criteria for deciding whether or not and how to perform root coverage surgery. The defect-related factors are the most important to predict root coverage outcomes. Thus, severe GR could make the root coverage (RC) challenging especially in cases with advanced interdental clinical attachment loss (ICAL). Case Presentation. This case report demonstrates a challenging management of a deep localized Miller Class III GR with root apex exposure associated with ICAL. After initial therapy, the treatment had consisted of a multidisciplinary approach involving endodontic treatment, periodontal plastic surgery including a laterally positioned flap, and orthodontic treatment. The 6-year follow-up showed improvement in clinical outcomes (recession reduction (RR) and keratinized tissue (KT) augmentation) and a higher patient satisfaction. Conclusions. This case report demonstrates the role of the multidisciplinary approach in the management of deep GRs associated with ICAL. A rational choice of the RC technique was critical to achieve good clinical outcomes.

Root Coverage Predictability in the Treatment of Gingival Recessions on Mandibular Anterior Teeth

2021 ◽  
pp. 238008442110094
Author(s):  
M. Agusto ◽  
A. Salman ◽  
D. Parker ◽  
D. Choi ◽  
G.P. Schincaglia
Keyword(s):  
Connective Tissue ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Root Coverage ◽  
Free Gingival Graft ◽  
Coronally Advanced Flap ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Anterior Teeth ◽  
Keratinized Tissue

Introduction: Mandibular anterior teeth are most frequently affected by gingival recession. However, data regarding mucogingival treatment aimed at root coverage in this specific location are limited. Objective: The purpose of this study was to systematically review the scientific literature and to use the meta-analytic approach to address the following focused question: “What is the effectiveness of different surgical approaches on clinical and patient-related outcomes in the treatment of buccal gingival recessions on mandibular anterior teeth?” Methods: Studies were located by searching 3 electronic databases (Medline, Scopus, and Cochrane databases) and cross-referencing. Randomized and nonrandomized studies including at least 1 arm involving the use of pedicle flaps and/or free soft tissue grafts in the treatment of gingival recessions (recession type [RT] 1 and RT2) located on the buccal aspects of mandibular centrals, laterals and canines, were included in the analysis. Primary outcome was mean root coverage (mRC), expressed in percentage, based on a 3- to 12-mo follow-up observation. A Bayesian single-arm network meta-analysis was performed to identify a treatment hierarchy of the different surgical techniques. Results: Sixteen studies, with a total of 23 arms, were included in the quantitative analysis. The greatest mRC is associated with laterally positioned flap (LPF) + connective tissue graft (CTG) (91.2%) and tunnel (TUN) + CTG (89.4%), whereas LPF alone, coronally advanced flap (CAF) + CTG, and free gingival graft (FGG) showed lower mRC (79.1%, 78.9%, and 68.5% respectively). TUN + CTG provides significantly greater mRC compared to CAF+CTG. No difference among the procedures could be observed in terms of keratinized tissue width gain. Conclusions: Treatment hierarchy generated by an arm-based network meta-analysis model suggested that tunnel and laterally positioned flap, both in combination with connective tissue graft, may provide the greatest mean root coverage in the treatment of mandibular anterior recessions. Knowledge Transfer Statement: The results of the present systematic review can be used by clinicians when deciding which approach to adopt when treating buccal gingival recessions on mandibular anterior teeth. In particular, procedures based on a laterally positioned flap or a tunneling technique, both in combination with connective tissue graft, seem to be the most predictable therapeutic decision.

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

2021 ◽  
Vol 10 (2) ◽  
pp. 43-48
Author(s):  
Dhirendra Kumar Giri ◽  
Ajit Kumar Yadav
Keyword(s):  
Gingival Recession ◽  
Application Software ◽  
Average Increase ◽  
Root Coverage ◽  
Score System ◽  
Coronally Advanced Flap ◽  
Keratinized Tissue ◽  
Statistical Application ◽  
Upper Jaw

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.

scholarly journals The treatment of gingival recessions - Our experience

2016 ◽  
Vol 6 (22) ◽  
pp. 85-91
Author(s):  
Ivan Lulchev Chenchev ◽  
Dimitar Todorov Atanasov ◽  
Dilyana Vicheva
Keyword(s):  
Connective Tissue ◽  
Test Group ◽  
Class Ii ◽  
Class I ◽  
Control Group ◽  
Root Coverage ◽  
Gingival Thickness ◽  
Coronally Advanced Flap ◽  
Connective Tissue Graft ◽  
Tissue Graft

Abstract OBJECTIVE. The purpose of this study was to compare the options for treatment of Miller’s Class I and Class II gingival recessions using coronally advanced flap (CAF) and platelet-rich fibrin membrane (PRFm) with CAF and connective tissue graft (CTG). MATERIAL AND METHODS. A surgical treatment was carried out on 30 subjects (23 women and 7 men), with a total of 118 symmetrical recessions of Class I and Class II by Miller on different places of the jaws, using two different methods. On one side of the jaw was held a plastic covering of the recessions with CAF in combination with PRFm (test group), and on the other side – CAF in combination with connective tissue graft (control group). The clinical evaluation includes: gingival recession depth (GRD), probing pocket depth (PPD), clinical attachment level (CAL), keratinized gingival width (KGW), gingival thickness (GTH), mean percent of root coverage (RC %). The results were observed six months postoperatively. RESULTS. The average values for the GRD measured six months postoperatively for the control group were 0.37±0.36 mm and 0.70±0.41 mm for the test group. The results for CAL for the control group were 2.01±0.44 mm and 2.28±0.50 mm for the test group, while the mean percentage of root coverage (RC %) was 90.29±9.05% for the control group and 80.48±10.19% for the test group. The values for GTH were 1.04±0.16mm for the control group and 0.92±0.09 mm for the test group. CONCLUSION. Both compared methods show good results in terms of all evaluated parameters. The group treated with CAF + CTG showed better results with a statistically significant difference for the RC% and the average values for GRD, GTH and CAL. The results of our study demonstrate a good potential for PRFm used in the treatment of Miller’s Class I and Class II gingival recessions.

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