Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva

Abstract Fourteen sites were chosen in eight subjects where pre-operatively less than 2 mm of keratinised gingiva was present and associated with pocketing of less than 1.0 mm Three methods were used to provide gingival connective tissue for grafting which facilitated primary closure at the donor site. The pre-operative width of keratinised gingiva was measured by means of a Williams probe from the gingival margin to the mucogingival junction to the nearest 0.5 mm. This was repeated immediately post-operatively, and at 1, 2, 5, 10, and 12 weeks, and at 6 months. The results showed that a statistically significant increase in width of keratinised attached gingiva could be achieved with this method and the resultant tissue was histologically normal.     

Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures?

Abstract The aim of this study was to evaluate whether an increased thickness of the gingiva through the use of a free connective tissue graft, in conjunction with a coronally advanced flap procedure, may positively influence the treatment outcome with respect to (i) root coverage and (ii) long-term stability of the position of the soft tissue margin following treatment of recession type defects. 67 consecutive patients having a total of 103 buccally located recession type defects of at least 3 mm were included in the study. After an initial phase of prophylaxis including instructions in a tooth brushing technique giving minimal apically directed forces to the gingival margin, the recession sites were surgically covered with a coronally advanced flap alone (control sites), or coronally advanced flap combined with a free connective tissue graft taken from the palate (test sites). Clinical examinations, including assessments of oral hygiene, gingival conditions, recession depth, gingival height, probing pocket depth and probing attachment loss, were performed before and 6. 12 and 24 months after surgical treatment. The mean initial recession depth for both treatment groups was about 4.0 mm (SD 1.0) with a gingival height apical to the recession of 1.0 mm (0.5). At the re-examination performed 6 months after surgical treatment, the mean recession depth had decreased to 0.2 mm in both the test and control groups. Complete root coverage was observed at 72% of the test sites and 74% of the control teeth. At teeth treated with the combined surgical procedure, the mean gain in probing attachment amounted to 3.7 mm and the mean gingival height had increased to 3.5 mm (0.6). The corresponding figures for control teeth were 3.6 mm and 1.5 mm (0.5), respectively. At the 24-month follow-up examination, the mean root coverage amounted to 98.9% (test) and 97.1% (control). 88% of the teeth in the test group showed complete root coverage compared to 80% for teeth in the control group. It was concluded that the 2 surgical procedures resulted in similar degree of root coverage and that changes of tooth brushing habits may be of greater importance than increased gingival thickness for long-term maintenance of the surgically established position of the soft tissue margin.     

Healing response of gingival recession defects following guided tissue regeneration procedures in smokers and non-smokers

Abstract This retrospective study evaluated healing response in gingival recession defects following guided tissue regeneration (GTR) in smokers. 22 systemically healthy patients who had been treated for deep (4 mm), buccal. Miller's class I or II gingival recession defects with ePTFE membranes were included. Patients were regarded as smokers if they smoked more than 10 cigarettes/day at the time of surgical procedure. Occasional and former smokers were excluded. 9 patients (6 male, mean age 29 years) were smokers, while 13 patients (4 male, mean age 35 years) were non smokers. Clinical parameters, recorded pre surgery and at 6 months post surgery. included defect-specific plaque (DPI) and bleeding on probing (BoP) scores, recession depth (RD). probing depth (PD). clinical attachment level (CAL). and keratinized tissue width (KG). Extent of membrane exposure (ME) and newly formed tissue (NFT) gain were assessed at membrane removal. Statistical analysis revealed no significant differences between smokers and non-smokers in demographic and pre surgery defect characteristics. DPI and BoP scores were similar pre surgery and remained almost unchanged thorough out the observation interval in both groups. ME was significantly greater in smokers (2.6±1.4 mm) than in non smokers (1.3±0.6 mm). NFT gain was 2.8±1.0 mm in smokers and 3.6±1.4 mm in non-smokers, the difference being not statistically significant. Smokers showed significantly less RD reduction and root coverage (2.5±1.2 mm and 57%, respectively) compared to non-smokers (3.6±1.1 mm and 78%, respectively). In conclusion, the results indicate that treatment outcome following GTR in gingival recession defects is impaired in cigarette smokers.     

Follow-up studies of free gingival grafts

Abstract Vestibuloplasties with free gingival grafts were performed on 42 teeth in 12 patients exhibiting gingival recession. The tendency toward recurrence was studied after postoperative intervals of 1, 6 and 12 months. The extensions (vestibuloplasties), which were always wider than the transplant, recurred up to the transplantation margin. The transplant itself underwent shrinkage averaging 25 per cent. The vestibular depth, which had been increased by the operation, showed a 25 per cent reduction within 1 month, but then had a tendency to deepen again from 1 to 12 months postoperatively. The marginal free gingiva and sulcus depth were not influenced by the operation.     

正畸后龈乳头退缩的研究进展

正畸患者龈乳头退缩所致的前牙"黑三角"是仅次于龋齿和修复体边缘暴露的第三大美学问题,发病率高达38.0％～43.7％.龈乳头退缩的危险因素有正畸移动方式、牙列拥挤程度、牙槽骨高度和局部解剖结构等.目前的治疗方法包括修复、正畸、膜龈手术以及注射透明质酸等.文章就正畸患者龈乳头退缩的危险因素、治疗和预防做一综述,以期制定合...     

Treatment of localized gingival recessions with coronally displaced flaps and citric acid

The present study was designed to examine the effect of citric acid conditioning on the result of healing following treatment of localized gingival recessions with coronally displaced flaps. In 3 beagle dogs, localized gingival recessions were surgically created at the buccal surfaces of canines, premolars and molars. All experimental sites were allowed to accumulate plaque for a period of 6 months. Following preparation of notches in the buccal root surfaces at the level of the gingival margin, buccal and lingual mucoperiosteal flaps were raised. The exposed portion of the root surfaces was scaled and the cementum layer was removed. Another notch was prepared in the root surfaces at the level of the crest of the alveolar bone. Half the number of the roots were treated by topical application of citric acid while the remaining roots were used as non-acid treated controls. The flaps were sutured in a coronally displaced position. After 3 months of healing, the dogs were sacrificed and the jaws removed and placed in fixative. After decalcification, histological sections of the experimental roots and their periodontal tissues were produced. The 2 notches described above were used as reference points in the histological examination. The histological analysis disclosed that new attachment had formed on all test and control roots and extended in some specimens of both groups to a position coronal to the presurgical level of the gingival margin. The amount of new attachment was similar in the 2 categories of roots, demonstrating that citric acid conditioning did not produce additional new attachment.     

Subpedicle connective tissue graft versus free gingival graft in the coverage of exposed root surfaces A 5-year clinical study

Abstract The authors compared the clinical results obtained in gingival recession correction treatment using free gingival and bilaminar connective subpedicle grafts. 35 patients were treated with free gingival grafts (Group A) and 35 with subpedicle grafts (Group B). Class I and II Miller gingival recessions were chosen for treatment by the 2 procedures. The degree of gingival recession (GR), keratinized tissue (KT) and the exposed root surface area (ERSA) were measured preoperatively and again 5 years post-surgery. Bilaminar connective grafting showed better results in reducing the amount of GR while both techniques significantly increased the width of KT (p>0.05). The mean % of root coverage obtained in patients in group A was 53.19%±21.48, whereas for the group B. 85.23%±17.86 of exposed root surface was covered post surgical intervention (p<0.001). In group A. only 3 patients (8.75%) showed a complete resolution of gingival recession after treatment, whereas in group B. 17 subjects (48.57%) presented with complete coverage. On the basis of these results, the authors conclude that the subpedicle graft promises better results in the coverage of exposed root surfaces when compared with the free gingival graft.     

Exfoliative cytological studies in evaluation of free gingival graft healing

Abstract Free palatal grafts were transplanted into the alveolar mucosa area in 12 patients. Smears were taken daily from the graft surface for 9 days and then weekly until the 5th week; smears were taken from the palatal wound only weekly. In addition 5 to 8, 8 to 12 and 12 to 29 months respectively after grafting, cytology was studied at the recipient, palatal donor and control sites, in alveolar mucosa and attached gingiva areas. Degenerative changes in the epithelial cells of the graft were observed during the first few days in the most superficial and the intermediate layers. On the 7th day no degenerated superficial cells were present in the smears. Five weeks postoperatively the superficial cell index had increased to 100 % and the keratinization index to 57 %. It is concluded that the transplanted basal, parabasal and intermediate epithelial cells were active in the healing process which, up to 21/2 half years postoperatively, resulted in cytological smears typical for the palatal but not the alveolar mucosa.     

Exostosis following a subepithelial connective tissue graft

This case report describes the formation of an unusual unaesthetic gingival enlargement during a five year post operative period subsequent to a subepithelial connective tissue graft placed facial to teeth #4 and #6. Histological assessment of the enlarged tissue indicated that it consisted of viable bone and marrow. The exostosis was reduced with rotary instruments and acceptable soft tissue aesthetics were created using a carbon dioxide laser for gingivoplasty. Possible causes for this unusual enlargement are discussed.     

Coronally positioned flap procedures with or without a biodegradable membrane in the treatment of human gingival recession. A 6-year follow-up study

BACKGROUND: Short-term data have indicated that treatment of gingival recession type defects by coronally positioned flap procedures with or without biodegradable membranes may result in similar treatment outcome. The aim of this study was to compare 12-month and 6-year follow-up results for these two treatment approaches. METHODS: Twenty patients with buccal bilateral Miller Class I or Class II gingival recession defects in cuspids or bicuspids were treated randomly by coronally positioned flap alone (20 sites) or in combination with a biodegradable membrane (20 sites). Clinical measurements at baseline, 6, 12 months and 6 years included apical extent of gingival recession, width of the defect at the cemento-enamel junction (CEJ), width of keratinized tissue, as well as attachment level and probing depth. Eleven patients were available for the 6-year evaluation. RESULTS: At 12 months (20 sites), both treatments resulted in significant gain of root coverage (p<0.001), stable probing depth, and increased attachment level (p<0.001). The 6-year evaluation (11 sites) showed a significant gain of root coverage for the non-membrane group only (p<0.05). No significant between-group differences were detected for any other treatment variable regardless of smoking status (p>0.05). Compared with baseline, the 6-year results showed that seven membrane sites gained root coverage, three were unchanged and one lost root coverage. For the 11 non-membrane sites, eight gained root coverage, and three were unchanged. The five membrane and the 10 non-membrane sites exhibiting complete root coverage at 6 months were reduced to two and one, respectively, at the 6-year evaluation. CONCLUSIONS: The coronally positioned flap procedure offers a simple and reliable treatment alternative as a root coverage procedure in Class I and Class II recession type defects. Placement of a biodegradable membrane underneath the flap does not seem to improve neither the short- nor the long-term results. Long-term outcome stability seems to be critically dependent on a continuous follow-up program with re-instruction in non-traumatic brushing habits.     

A two-year prospective study of coronally positioned flap with or without acellular dermal matrix graft

AIM: Evaluation of the treatment of gingival recessions with coronally positioned flap with or without acellular dermal matrix allograft (ADM) after a period of 24 months. METHODS: Thirteen patients with bilateral gingival recessions were included. The defects were randomly assigned to one of the treatments: coronally positioned flap plus ADM or coronally positioned flap alone. The clinical measurements were taken before the surgeries and after 6, 12 and 24 months. RESULTS: At baseline, the mean values for recession height were 3.46 and 3.58 mm for the defects treated with and without the graft, respectively (p>0.05). No significant differences between the groups were observed after 6 and 12 months in this parameter. However, after 24 months, the group treated with coronally positioned flap alone showed a greater recession height when compared with the group treated with ADM (1.62 and 1.15 mm, respectively--p<0.05). A significant increase in the thickness of keratinized tissue was observed in the group treated with ADM as compared with coronally positioned flap alone (p<0.05). CONCLUSIONS: ADM may reduce the residual gingival recession observed after 24 months in defects treated with coronally positioned flap. In addition, a greater gingival thickness may be achieved when the graft is used.