Coronally positioned flap for root coverage: poorer outcomes in smokers

BACKGROUND: Gingival recession is significantly more common among smokers, while the relative outcome of various root coverage procedures in smokers, compared to non-smokers, is debatable. The objective of this study was to evaluate the influence of cigarette smoking on the outcome of coronally positioned flap (CPF) in the treatment of Miller Class I gingival recession defects. METHODS: Ten current smokers (> or = 10 cigarettes daily for at least 5 years) and 10 non-smokers (never smokers), each with one 2- to 3-mm Miller Class I recession defect in an upper canine or bicuspid, were treated with CPF. At baseline and 6 months, clinical parameters, probing depth (PD), clinical attachment level (CAL), recession depth (RD), and apico-coronal width of keratinized tissue (KT) were determined. RESULTS: Intragroup analysis showed that CPF was able to reduce RD and improve CAL in both groups (P <0.05). Intergroup analysis demonstrated that smokers presented greater residual RD at 6 months and lower percentage of root coverage (69.3% versus 91.3%; P <0.05). No smokers obtained complete root coverage compared to 50% of non-smokers (P <0.05). CONCLUSIONS: Within the limits of the present study, it can be concluded that CPF provides benefits for both smokers and non-smokers in terms of root coverage of shallow Miller Class I recession defects. However, cigarette smoking negatively impacts the clinical outcomes, specifically residual recession, percent root coverage, and frequency of complete root coverage.     

Root coverage outcome may be affected by heavy smoking: a 2-year follow-up study

BACKGROUND: Although subepithelial connective tissue graft (CTG) has been reported to be a predictable procedure for root coverage, the impact of smoking on the long-term outcome of periodontal plastic surgery is unclear. Hence, the aim of this study was to evaluate the effect of smoking, on a long-term basis, on the stability of gingival tissue following CTG treatment of gingival recession. METHODS: Twenty-two defects were treated by CTG in canine and premolar Miller Class I and II gingival recessions (11 smokers and 11 non-smokers). The following clinical measurements were obtained at baseline and at 1, 2, 3, 4, 6, 12, 18, and 24 months after surgery: plaque and gingival indexes, extension of gingival recession (GR), probing depth (PD), clinical attachment level (CAL), and gingival thickness. Individuals smoking > or =20 cigarettes/day for > or =5 years were considered smokers. RESULTS: Data analysis demonstrated that both groups presented similar plaque and gingival indexes (P >0.05), and an intragroup analysis showed that CTG was able to promote root coverage and increase gingival thickness in both groups over time (P <0.05). However, at 24 months postoperatively, statistical analysis showed that smokers presented poorer outcomes with regard to PD, GR, and CAL (P <0.05); in addition, a more satisfactory stabilization of the gingival tissue was found in the non-smoker group. CONCLUSION: Smoking may represent a challenge to root coverage outcome for CTG because smoking significantly affected the stability of gingival tissue over time.     

Smoking may affect root coverage outcome: a prospective clinical study in humans

BACKGROUND: Cigarette smoking has been shown to negatively influence healing following periodontal therapeutic procedures. Therefore, the aim of this study was to evaluate the impact of smoking on clinical outcome of root coverage following subepithelial connective tissue graft (CTG) surgery. METHODS: Eighteen defects were treated in 15 patients (seven smokers and eight non-smokers) who presented canine and pre-molar Miller Class I and II recessions. CTG was performed and clinical measurements were obtained at baseline, and 30, 60, 90, and 120 days after surgery. Clinical measurements included plaque and gingival indexes, gingival recession, probing depth, clinical attachment level, gingival thickness, and keratinized tissue width. RESULTS: Intragroup analysis showed that CTG was able to promote root coverage, increase gingival thickness, and improve clinical attachment level in both groups (P < 0.05). On the other hand, intergroup analysis demonstrated that smokers presented with a lower percentage of root coverage (58.84% +/- 13.68% versus 74.73% +/- 14.72%), less clinical attachment level gain (2.54 +/- 0.79 mm versus 2.00 +/- 1.04 mm), and deeper probing depths (1.56 +/- 0.53 mm versus 2.35 +/- 0.67 mm) than non-smokers (P < 0.05). Moreover, 4 months after CTG, smokers presented more keratinized tissue compared to non-smokers (3.30 +/- 0.86 mm versus 4.50 +/- 1.16 mm) (P < 0.05). CONCLUSION: Within the limits of the present study, it can be concluded that cigarette consumption may present a negative impact on root coverage outcome by CTG and, therefore, may represent one more challenge for periodontal plastic therapy.     

Coronally positioned flap for root coverage in smokers and non-smokers: stability of outcomes between 6 months and 2 years

BACKGROUND: Smoking adversely affects the short-term outcomes of coronally positioned flap (CPF) root coverage procedures, but the long-term stability of this procedure in smokers has not been studied. The objective of this study was to evaluate the effect of smoking on the long-term outcomes of CPF in recession treatment. METHODS: CPF was used to treat a Miller Class I defect in a maxillary canine or premolar in 10 current smokers (> or =10 cigarettes daily for > or =5 years) and 10 non-smokers (never smokers). At baseline and 6, 12, and 24 months, clinical parameters, including probing depth (PD), clinical attachment level (CAL), recession depth (RD), and width of keratinized tissue (KT), were determined. RESULTS: Intragroup analysis showed that CPF failed to maintain the gingival margin at the initially achieved position. RD significantly increased in smokers (from 0.84 +/- 0.49 to 1.28 +/- 0.58 mm) and in non-smokers (from 0.22 +/- 0.29 to 0.50 +/- 0.41 mm) between 6 and 24 months. Further analysis showed that 50% of smokers and 10% of non-smokers lost between 0.5 and 1.0 mm of root coverage in the same period. Intergroup analysis showed that smokers had significantly greater residual recession (P = 0.001) at 24 months. Both smokers and non-smokers lost CAL and experienced decreases in KT. CONCLUSIONS: The long-term stability of CPF outcomes is less than desirable, particularly in smokers. Two years after a CPF procedure, smokers have significantly greater residual recession compared to non-smokers both statistically and clinically.     

Evaluation of root coverage with two connective tissue grafts obtained from the same location

The purpose of this study was to compare the clinical root coverage achieved with two connective tissue grafts that were removed from the same donor area at different times and used in subepithelial grafts for root coverage. Sixty patients, each of whom had two connective tissue grafts removed from the same donor area at different times, were included in this study. The connective tissue grafts were used in two different subepithelial grafts for root coverage. The subepithelial grafts with both the first and second connective tissue grafts produced statistically significant changes in recession, probing depth, width of keratinized tissue, and attachment level. The changes obtained in the clinical measurements were not statistically significantly different between the first and second connective tissue grafts. The mean percentages of root coverage with the first and second connective tissue grafts were 95.4% and 98.2%, respectively, a statistically significant difference. None of the factors evaluated (sex, age, smoking history, and time between the two surgeries) could be related to statistically significant differences in the mean root coverage obtained. In this study, the second connective tissue graft produced greater mean root coverage than the first connective tissue graft.     

Gingival dimensions after root coverage with free connective tissue grafts

Abstract. Traumatic injury in the presence of a thin and narrow zone of gingival tissue may lead to gingival recession. Especially in class I and II recessions, root coverage may be accomplished with connective tissue grafts. In order to prevent recurrent recession, altering gingival dimensions width and thickness might be of advantage. In the present study, dimensions of gingiva were followed for 1 year after root coverage with connective tissue grafts. The study population consisted of 18 patients with a total of 28 class I or II recessions. Gingival width and depth of the recession were measured with a caliper, and thickness of the marginal tissue with an ultrasonic device. Periodontal probing depth was determined with a pressure-controlled electronic probe. Mean (±sd) recession depth at baseline was 3.l±l.4 mm. After 12 months, coverage amouted to 74±30%. Width of gingiva rose from 2.1±1.0 mm to 3.2±1.4 mm. whereas thickness was increased from 0.8±0.3 mm to 1.5±0.7 mm, on average. No significant alteration of periodontal probing depth was observed but a mean gain of clinical attachment of 1.7± 1.1 mm was ascertained. In a multiple regression analysis, recession depth and presence of the recession in the maxilla, but not tooth type significantly influenced relative root coverage (R²-=0.34, p <0.01). Attachment gain after surgery depended on baseline attachment loss and was negatively influenced by smoking. The present results point to the possibility of doubling gingival thickness after root coverage with connective tissue crafts.     

Root coverage with connective tissue grafts: an evaluation of short- and long-term results

BACKGROUND: Subepithelial connective tissue grafts have been shown to be effective in obtaining root coverage. However, little is known about the long-term results. The goal of this study was to evaluate and compare the short-term (13.0 weeks) and long-term (27.5 months) root coverage results obtained with subepithelial connective tissue grafts. METHODS: One-hundred patients with 146 Miller Class I or Class II recession defects were treated with subepithelial connective tissue grafts to obtain root coverage. The changes in the clinical measurements were compared between the preoperative and short-term results, between preoperative and long-term results, and between short-term and long-term results. RESULTS: The mean root coverage at 13.0 weeks was 97.1% and 98.4% at 27.5 months. This difference was statistically significant. There was a statistically significant decrease in recession and probing depth, reduction in attachment loss, and increase in quantity of keratinized tissue between the preoperative and short-term results and between the preoperative and long-term results. There was a statistically significant decrease in recession, increase in the quantity of keratinized tissue, increase in probing depth, and increase in attachment loss between short-term and long-term results. CONCLUSIONS: The results of this study demonstrate that the subepithelial connective tissue graft is an effective method to cover exposed roots. The mean root coverage tended to improve with time.     

Subperiosteal connective tissue grafts for pocket reduction and preservation of gingival esthetics: a case report

BACKGROUND: Clinical studies and recent histological evidence following mucogingival surgery for the treatment of gingival recession have documented that when closely adapted to a previously exposed root surface, connective tissue is capable of forming a new attachment. Despite these findings, no clinical tests have been conducted to examine the ability of connective tissue to reduce probing depth (PD) and increase clinical attachment levels (CAL) when it is implanted into periodontal osseous defects. The purpose of this paper is to report the clinical results on a patient following 2 subperiosteal connective tissue grafts. METHODS: Subperiosteal connective tissue grafts were placed in 2 sites of periodontal bone loss and deep pocketing in one patient. Following flap reflection and root preparation, a connective tissue graft 1.5 to 2.0 mm in thickness was draped and sutured over each osseous defect and then completely covered by the external flap. RESULTS: Ten months following subperiosteal connective tissue grafting, tooth #7 had 4 mm of CAL gain. Tooth #10 had 3 mm of CAL gain 8 months postoperatively. Both teeth had 1 mm gain in gingival recession. Both teeth probed 3 mm postoperatively. CONCLUSIONS: When connective tissue was grafted into 2 periodontal osseous defects, there were significant reductions in probing depth and gains in CAL. There was minimal postoperative gingival recession. The new clinical attachment gain remained stable for 8 to 10 months following subperiosteal connective tissue grafting.     

Subepithelial connective tissue graft for root coverage in smokers and non-smokers: a clinical and histologic controlled study in humans

BACKGROUND: The aim of this study was to evaluate root coverage of gingival recessions and to compare graft vascularization in smokers and non-smokers. METHODS: Thirty subjects, 15 smokers and 15 non-smokers, were selected. Each subject had one Miller Class I or II recession in a non-molar tooth. Clinical measurements of probing depth (PD), relative clinical attachment level (CAL), gingival recession (GR), and width of keratinized tissue (KT) were determined at baseline and 3 and 6 months after surgery. The recessions were treated surgically with a coronally positioned flap associated with a subepithelial connective tissue graft. A small portion of this graft was prepared for immunohistochemistry. Blood vessels were identified and counted by expression of factor VIII-related antigen-stained endothelial cells. RESULTS: Intragroup analysis showed that after 6 months there a was gain in CAL, a decrease in GR, and an increase in KT for both groups (P <0.05), whereas changes in PD were not statistically significant. Smokers had less root coverage than non-smokers (58.02% +/- 19.75% versus 83.35% +/- 18.53%; P <0.05). Furthermore, the smokers had more GR (1.48 +/- 0.79 mm versus 0.52 +/- 0.60 mm) than the non-smokers (P <0.05). Histomorphometry of the donor tissue revealed a blood vessel density of 49.01 +/- 11.91 vessels/200x field for non-smokers and 36.53 +/- 10.23 vessels/200x field for smokers (P <0.05). CONCLUSION: Root coverage with subepithelial connective tissue graft was negatively affected by smoking, which limited and jeopardized treatment results.     

Subepithelial connective tissue grafts for the coverage of denuded root surfaces: a clinical report.

AIMS AND OBJECTIVES: The aim of this study is to determine the effectiveness of subepithelial connective tissue grafts (SCTG) in the coverage of denuded roots. MATERIALS AND METHODS: A total of 16 sites with > or =2 mm of recession height were included in the study for treatment with SCTG. The clinical parameters, such as recession height, recession width, width of keratinized gingiva, probing pocket depth, and clinical attachment level were measured at the baseline, third month, and at the end of the study [sixth month]. The defects were treated with a coronally positioned pedicle graft combined with connective tissue graft. RESULTS: Out of 16 sites treated with SCTG, 11 sites showed complete (100%) root coverage; the mean root coverage obtained was 87.5%. There was a statistically significant reduction in recession height, recession width, and probing pocket depth. There was also a statistically significant increase in the width of keratinized gingiva and also a gain in clinical attachment level. The postoperative results were both clinically and statistically significant ( P 0.05). CONCLUSION: From this study, it may be concluded that SCTG is a safe and effective method for the coverage of denuded roots.     

运用脱细胞真皮基质或结缔组织移植物治疗多发性相邻牙龈退缩的Meta分析

目的 应用Meta分析方法评估运用脱细胞真皮基质或自体结缔组织移植物治疗多发性相邻牙龈退缩的差异性。 方法 根据纳入和排除标准在4个英文电子数据库中筛选随机对照试验,检索日期截止至2022年4月20日,主要结局指标为角化牙龈组织宽度、退缩深度、探诊深度、临床附着水平、完全根面覆盖和根面覆盖美学评分。 结果 共纳入7项随机对照试验,术后12个月后,对照组结缔组织移植物较试验组脱细胞真皮基质能增加角化牙龈组织宽度［MD=-0.28（-0.47,-0.08）,P=0.006］、降低牙龈退缩深度［MD=0.23（0.12,0.35）,P<0.000 1］和提高完全根面覆盖［RR=0.80,95%CI（0.69,0.93）,P=0.003］;探诊深度、临床附着水平和根面覆盖美学评分差异无统计学意义。 结论 多发性相邻牙龈退缩治疗后,结缔组织移植物在增加角化牙龈组织宽度、降低牙龈退缩深度和提高完全根面覆盖方面具有优势,但脱细胞真皮基质由于手术简便并有相似的效果亦有临床应用价值。     

Root coverage in molar recession: report of 50 consecutive cases treated with subepithelial connective tissue grafts

BACKGROUND: The purpose of this study was to evaluate root coverage of molar recession defects. METHODS: Fifty patients with a molar recession defect on one molar were treated with a subepithelial connective tissue graft. The procedure was performed as previously reported. RESULTS: Complete root coverage was obtained in 29 of the 50 defects (58%). A mean root coverage of 91.1% was obtained. There was a statistically significant decrease in recession depth (4.4 mm to 0.5 mm), increase in quantity of keratinized tissue (0.9 mm to 3.1 mm), decrease in probing depth (3.0 mm to 2.3 mm), and decrease in attachment level loss (7.4 mm to 2.8 mm). CONCLUSION: The subepithelial connective tissue graft is an effective method to obtain root coverage of recession defects on molars.     

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.     

Cigar, pipe, and cigarette smoking as risk factors for periodontal disease and tooth loss

BACKGROUND: Our purpose was to test the hypotheses that cigar and pipe smoking have significant associations with periodontal disease and cigar, pipe, and cigarette smoking is associated with tooth loss. We also investigated whether a history of smoking habits cessation may affect the risk of periodontal disease and tooth loss. METHODS: A group of 705 individuals (21 to 92 years-old) who were among volunteer participants in the ongoing Baltimore Longitudinal Study of Aging were examined clinically to assess their periodontal status and tooth loss. A structured interview was used to assess the participants' smoking behaviors with regard to cigarettes, cigar, and pipe smoking status. For a given tobacco product, current smokers were defined as individuals who at the time of examination continued to smoke daily. Former heavy smokers were defined as individuals who have smoked daily for 10 or more years and who had quit smoking. Non-smokers included individuals with a previous history of smoking for less than 10 years or no history of smoking. RESULTS: Cigarette and cigar/pipe smokers had a higher prevalence of moderate and severe periodontitis and higher prevalence and extent of attachment loss and gingival recession than non-smokers, suggesting poorer periodontal health in smokers. In addition, smokers had less gingival bleeding and higher number of missing teeth than non-smokers. Current cigarette smokers had the highest prevalence of moderate and severe periodontitis (25.7%) compared to former cigarette smokers (20.2%), and non-smokers (13.1%). The estimated prevalence of moderate and severe periodontitis in current or former cigar/pipe smokers was 17.6%. A similar pattern was seen for other periodontal measurements including the percentages of teeth with > or = 5 mm attachment loss and probing depth, > or = 3 mm gingival recession, and dental calculus. Current, former, and non- cigarette smokers had 5.1, 3.9, and 2.8 missing teeth, respectively. Cigar/pipe smokers had on average 4 missing teeth. Multiple regression analysis also showed that current tobacco smokers may have increased risks of having moderate and severe periodontitis than former smokers. However, smoking behaviors explained only small percentages (<5%) of the variances in the multivariate models. CONCLUSION: The results suggest that cigar and pipe smoking may have similar adverse effects on periodontal health and tooth loss as cigarette smoking. Smoking cessation efforts should be considered as a means of improving periodontal health and reducing tooth loss in heavy smokers of cigarettes, cigars, and pipes with periodontal disease.     

Tobacco smoking and periodontal health in a Saudi Arabian population

BACKGROUND: The objective of this study was to examine the association between tobacco smoking, in particular water pipe smoking, and periodontal health. METHODS: A total of 262 citizens of Jeddah, Saudi Arabia in the age range from 17 to 60 years volunteered to participate in the study. The clinical examinations were carried out at King Faisal Specialty Hospital and Research Center in Jeddah and included assessments of oral hygiene, gingival inflammation, and probing depth. Smoking behavior was registered through a questionnaire and confirmed by an interview. Participants were stratified into water pipe smokers (31%), cigarette smokers (19%), mixed smokers (20%), and non-smokers (30%). RESULTS: The mean probing depth per person was 3.1 mm for water pipe smokers, 3.0 mm for cigarette smokers, 2.8 mm for mixed smokers, and 2.3 mm for non-smokers. The association between smoking and probing depth was statistically significant controlling for age (P <0.001). The association between lifetime smoking exposure and mean probing depth was statistically significant in water pipe as well as cigarette smokers controlling for age (P <0.001). Using multivariate analysis, besides smoking, the gingival and plaque indexes were associated with increased probing depth. The prevalence of periodontal disease defined as a minimum of 10 sites with a probing depth > or =5 mm was 19.5% in the total population, 30% in water pipe smokers, 24% in cigarette smokers, and 8% in non-smokers. The prevalence was significantly greater in water pipe and cigarette smokers compared to non-smokers (P <0.001). The relative risk for periodontal disease increased by 5.1- and 3.8-fold in water pipe and cigarette smokers, respectively, compared to non-smokers (P <0.001 and P <0.05, respectively). CONCLUSIONS: An association was observed between water pipe smoking and periodontal disease manifestations in terms of probing depth measurements. The impact of water pipe smoking was of largely the same magnitude as that of cigarette smoking.     

Root coverage of advanced gingival recession: a comparative study between acellular dermal matrix allograft and subepithelial connective tissue grafts

BACKGROUND: Acellular dermal matrix allograft (ADMA) has successfully been applied as a substitute for free connective tissue grafts (CTG) in various periodontal procedures, including root coverage. The purpose of this study was to clinically compare the efficiency of ADMA and CTG in the treatment of gingival recessions > or = 4 mm. METHODS: Seven patients with bilateral recession lesions participated. Fourteen teeth presenting gingival recessions > or = 4 mm were randomly treated with ADMA or CTG covered by coronally advanced flaps. Recession, probing depth, and width of keratinized tissue were measured preoperatively and 12 months postoperatively. Changes in these clinical parameters were calculated within and compared between groups and analyzed statistically. RESULTS: Baseline recession, probing depth, and keratinized tissue width were similar for both groups. At 12 months, root coverage gain was 4.57 mm (89.1%) versus 4.29 mm (88.7%) (P = NS), and keratinized tissue gain was 0.86 mm (36%) versus 2.14 mm (107%) (P < 0.05) for ADMA and CTG, respectively. Probing depth remained unchanged (0.22 mm/0 mm), with no difference between the groups. CONCLUSIONS: Recession defects may be covered using ADMA or CTG, with no practical difference. However, CTG results in significantly greater gain of keratinized gingiva.     

Harvesting technique using a mucotome and modified surgical procedure for root coverage with enamel matrix derivatives with and without a connective tissue graft

The aim of this clinical study was to evaluate the coverage of gingival recession defects with enamel matrix derivatives (EMD) with or without a connective tissue graft (CTG). Twenty-five patients (16 female, 9 male) from 16 to 58 years of age (mean: 32.2; SD: 11.2) with 92 gingival recessions (Miller Class I and II) and with at least 4.0 mm of clinical attachment loss were treated with a modified surgical technique for root coverage by CTG with EMD (45 recession defects) or EMD only (47 recession defects). Vertical recession depth, probing depth, clinical attachment level, dehiscence depth, width of keratinized gingiva (vertical), and recession coverage were recorded before surgery (baseline) and at 12 and 24 months. The average presurgical recession depth was 4.4 mm (SD: 1.3) with EMD and CTG versus 3.2 mm (SD: 1.1) with EMD only. Both treatment modalities led to a significant decrease in recession and a gain in attachment. Mean root coverage 12 months postoperatively was 92.7% (SD: 13.5) (EMD and CTG) versus 96.3% (SD: 11.5) (EMD only). Compared to the mean root coverage of recession after 24 months, the change was not significant. The results confirmed that the applied modified surgical techniques are safe and predictable, with better clinical outcomes at the donor and recipient sites.     

Expanded mesh connective tissue graft for the treatment of multiple gingival recessions

BACKGROUND: The connective tissue graft procedure is an effective method to achieve root coverage. Although multiple sites often need grafting, the palatal mucosa supplies only a limited area of grafting material. The expanded mesh graft provides a method whereby a graft can be stretched to cover a larger area. The aim of this study was to determine the effectiveness and the predictability of expanded mesh connective tissue graft (e-MCTG) in the treatment of multiple gingival recessions. METHODS: Fifty-two buccal gingival recessions were treated in 10 systemically healthy patients. Fifteen recession treated operation sites with at least three adjacent Miller Class I and/or II recessions were performed. The connective tissue graft obtained from the palatal mucosa was expanded to cover the recipient bed, which was 1.5 times larger than the graft. Clinical measurements recorded at baseline and 12 months postoperatively included gingival recession depth (RD), gingival recession width (RW), percentage root coverage (RC), probing depth (PD), width of keratinized tissue (KT), and clinical attachment level (CAL). RESULTS: Twelve months after surgery, a statistically significant gain in CAL (3.2 +/- 0.8 mm, P < 0.001) and increase in KT (1.2 +/- 0.4, P < 0.001) were assessed. In 80% of the treated sites, 100% RC was achieved (mean 96%). CONCLUSIONS: The results of this study demonstrated that the use of e-MCTG technique allowed the treatment of multiple adjacent recessions with adequate wound healing and highly predictable root coverage. This procedure can be applied favorably in treating multiple gingival recessions in one surgery.     

Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft

BACKGROUND: Various surgical techniques have been proposed for treating gingival recession. This randomized clinical trial compared the coronally positioned flap (CPF) alone or in conjunction with a subepithelial connective tissue graft (SCTG) in the treatment of gingival recession. METHODS: Eleven non-smoking subjects with bilateral and comparable Miller Class I recession defects were selected. The defects, at least 3.0 mm deep, were randomly assigned to the test (CPF + SCTG) or control group (CPF alone). Recession depth (RD), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (KT), and gingival/mucosal thickness (GT) were assessed at baseline and 6 months postoperatively. RESULTS: Recession depth was significantly reduced 6 months postoperatively (P<0.05) for both groups. Mean root coverage was 75% and 69% in the test and control groups, respectively. There were no significant differences between the two groups in RD, PD, or CAL, either at baseline or at 6 months postoperatively. However, at 6 months postoperatively, the test group showed a statistically significant increase in KT and GT compared to the control group (P<0.05). CONCLUSIONS: The results indicate that both surgical approaches are effective in addressing root coverage. However, when an increase in gingival dimensions (keratinized tissue width, gingival/mucosal thickness) is a desired outcome, then the combined technique (CPF + SCTG) should be used.     

Treatment of gingival recessions in heavy smokers using two surgical techniques: a controlled clinical trial

Smokers have small root coverage which is associated with bad vascularity of periodontal tissues. This study evaluated a technique that can increase the blood supply to the periodontal tissues compared with a traditional technique. Twenty heavy smokers (10 males and 10 females) with two bilateral Miller class I gingival recessions received coronally positioned flaps in one side (Control group)and extended flap technique in the other side (Test group). Clinical measurements (probing pocket depth, clinical attachment level, bleeding on probing, gingival recession height, gingival recession width, amount of keratinized tissue, and width and height of the papillae adjacent to the recession) were determined at baseline, 3 and 6 months postoperatively. Salivary cotinina samples were taken as an indicator of the nicotine exposure level. No statistically significant differences (p>0.05) were detected for the clinical measurements or smoke exposure. Both techniques promoted low root coverage (Control group: 43.18% and Test group: 44.52%). In conclusion, no difference was found in root coverage between the techniques. Root coverage is possible and uneventful even, if rather low, in heavy smoker patients with low plaque and bleeding indices.