Miller I. Sınıf Diş Eti Çekilmeleri Olan Hastalarda Kuronale Kaydırılan Flep ile Birlikte Kullanılan Trombositten Zengin Plazma Tedavisinin Klinik Parametrelerle Değerlendirilmesi

Yıl 2024, Cilt: 13 Sayı: 2, 278 - 287, 20.05.2024

Mete Hanzade , Duygu Ilhan

https://doi.org/10.54617/adoklinikbilimler.1299224

Öz

Amaç: Bu çalışmada kuronale kaydırılan flep (KKF) ile birlikte kullanılan trombositten zengin plazma (TZP)’nin klinik parametrelere etkileri incelenmiştir.
Gereç ve Yöntem: Araştırmamız, Miller I. sınıf diş eti çekilmesi tanısı konulan 15 bireyin 70 defekt bölgesinde çalışma (KKF+TZP) ve kontrol (KKF) grupları üzerinde yürütülmüştür. Tedavi öncesi çalışma grubundan alınan kanlardan TZP hazırlanmış, defektlerdeki kök yüzeylerine uygulanmıştır. Tüm gruplarda tedavi öncesi, 10. gün, 6. hafta, 3. ve 6. ayda sondalanabilir cep derinliği, klinik ataşman seviyesi, dikey yönde diş eti çekilmesi, diş eti çekilmesi genişliği, kök yüzeyi örtme yüzdesi, keratinize diş eti dikey boyutu, keratinize diş eti kalınlığı klinik ölçümleri yapılmıştır.
Bulgular: Çalışma ve kontrol grupları arasında sondalanabilir cep derinliği değerlerinde yalnızca çalışma grubunda operasyon öncesi ve 6. ay arasında azalma saptanmıştır (p<0.05). Çalışma ve kontrol grubu operasyon öncesi diş eti çekilmesi genişliği ölçümleri,3.550.88, 3.370.78 mm’dir. Operasyon sonrası 6. ay ise sırasıyla bu değerler 1.131.24 ve 1.391.23 mm’dir. Her iki grupta da 6. ayda diş eti çekilmesi genişliği azalmıştır (p<0.01). Operasyon sonrası 6. ay kök yüzeyi örtme oranları, her iki grupta sırasıyla %85.7517.25 ve %82.4521.88’ di ve fark anlamlı bulunmadı (p>0.05).
Sonuç: Araştırmamızda, gruplar arasında parametrelerde fark saptanmamasına rağmen TZP’deki büyüme faktörlerinin doku rejenerasyonundaki etkileri nedeniyle mukogingival cerrahi ile birlikte kullanılması faydalı olabilir.

Anahtar Kelimeler

Dişeti Çekilmesi, kuronale kaydırılan flep, trombositten zengin plazma, Kök yüzeyi örtme

Destekleyen Kurum

İstanbul Üniversitesi Bilimsel Araştırma Projeleri Birimi

Proje Numarası

Proje No: 479

Evaluation of Platelet-Rich Plasma Treatment with Coronally Advanced Flap in Patients with Miller Class I Recessions in Terms of Clinical Parameters

Öz

Aim: In this study, the effects of platelet-rich plasma (PRP) used together with coronally advanced flap (CAF) with platelet-rich plasma (PRP) on clinical parameters have been examined.
Materials and Method: Our study was carried out on study (CAF + PRP) and control (CAF) groups in 70 defect regions of 15 individuals diagnosed with Miller Class I. gingival recession. PRP was prepared from the blood drawn from the study group before the treatment and applied to root surfaces of the defects. Clinical measurements; probing depth, clinical attachment level, vertical gingival recession, recession width, percentage of root coverage, width of keratinized tissue, keratinized tissue thickness were determined in all groups before treatment, at 10 days, 6 weeks, 3 and 6 months .
Results: A decrease in probing pocket depth values between the study and control groups was detected only in the study group between the preoperative period and the 6th month (p<0.05). Preoperative recession width measurements in the study and control groups were 3.550.88, 3.370.78 mm, respectively. At the 6th month after the surgery, these values were 1.131.24 and 1.391.23 mm, respectively. The recession width was reduced at 6 months in both groups (p<0.01). The 6th month postoperative root coverage rates were determined as 85.7517.25% and 82.4521.88% in the study and control groups, respectively and the difference between the groups was not significant (p>0.05).
Conclusion: Despite no difference was detected in the parameters between the groups in our study, it may be beneficial to use the growth factors in PRP together with mucogingival surgery due to their effects on tissue regeneration.

Anahtar Kelimeler

Coronally advanced flap, gingival recession, platelet rich plasma, root coverage

Proje Numarası

Proje No: 479

Kaynakça

• Cairo F, Nieri M, Cincinelli A, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 2011;38:661-6.
• Lost C. Depth of alveolar bone dehiscences in relation to gingival recessions. J Clin Periodontol 1984;11:583-9.
• Cetiner D, Kalabay PG, Ozdemir B, Cankaya ZT. Efficiency of platelet-rich plasma on acellular dermal matrix application with coronally advanced flap in the treatment of multiple adjacent gingival recessions: A randomized controlled clinical trial. J Dent Sci 2018; 13:198-206
• Eger T, Muller HP, Heinecke A. Ultrasonic determination of gingival thickness. Subject variation and influence of tooth type and clinical features. J Clin Periodontol 1996;23:839-45.
• Valderhaug J. Periodontal conditions and carious lesions following the insertion of fixed prostheses: a 10-year follow-up study. Int Dent J 1980;30:296-304.
• Gorman WJ. Prevalence and etiology of gingival recession. J Periodontol 1967;38:316-22.
• Newman MG, Takei HH, Klokkevold PR, Carranza FA. Newman and Carranza’s Clinical Periodontology,13th ed. Philadelphia, PA: Elsevier; 2019. p. 660-663.
• Stefanini M, Marzadori M, Aroca S, Felice P, Sangiorgini M, Zuchelli G. Decision making in root-coverage procedures for the esthetic outcome. J Periodontol 2000 2018;77:54-64.
• Newman MG, Takei HH, Klokkevold PR, Carranza FA. Newman and Carranza’s Clinical Periodontology,13th ed. Philadelphia, PA: Elsevier; 2019. p.664-675.
• Kobayashi E, Flückiger L, Fujioka M, Sawada K, Sculean A, Schaller B, et al. Comparative release of growth factors from PRP, PRF, and advanced-PRF. Clin Oral Invest 2016;20:2353-60.
• Huang LH, Neiva RE, Soehren SE, Giannobile WV, Wang HL. The effect of platelet-rich plasma on the coronally advanced flap root coverage procedure: a pilot human trial. J Periodontol 2005;76:1768-77.
• Jagtap A, Mangalekar S, Kamble P. Clinical evaluation of coronally advanced flap with or without advanced-platelet rich fibrin membrane in the treatment of Miller’s Class-II localized gingival recession: A Clinical Study. Cureus 2023;15:e34919. doi:10.7759/cureus.34919.
• Petrungaro PS. Using platelet-rich plasma to accelerate soft tissue maturation in esthetic periodontal surgery. Compend Contin Educ Dent 2001;22:729-36.
• Weibrich G, Kleis WK, Kunz-Kostomanolakis M, Loos AH, Wagner W. Correlation of platelet concentration in platelet-rich plasma to the extraction method, age, sex, and platelet count of the donor. Int J Oral Maxillofac Implants 2001;16:693-9.
• Keceli HG, Sengun D, Berberoglu A, Karabulut E. Use of platelet gel with connective tissue grafts for root coverage: a randomized-controlled trial. J Clin Periodontol 2008;35:255-62.
• Baldi C, Pini-Prato G, Pagliaro U, Nieri M, Saletta D, Muzzi L, et al. Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol 1999;70:1077-84.
• Tavelli L, McGuire MK, Zucchelli G, Rasperini G, Feinberg S, Wang HM, et al. Biologics-based regenerative technologies for periodontal soft tissue engineering. J Periodontol 2020;91:147-54.
• Zucchelli G, Testori T, De SM. Clinical and anatomical factors limiting treatment outcomes of gingival recession: a new method to predetermine the line of root coverage. J Periodontol 2006;77:714-21.
• Zucchelli G, Mele M, Stefanini M, Mazzotti C, Mounssif I, Marzadori M, et al. Predetermination of root coverage. J Periodontol 2010;81:1019-26.
• Muller HP, Schaller N, Eger T. Ultrasonic determination of thickness of masticatory mucosa: a methodologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:248-53.
• Gurgan CA, Oruc AM, Akkaya M. Alterations in location of the mucogingival junction 5 years after coronally repositioned flap surgery. J Periodontol 2004;75:893-901.
• da Silva RC, Joly JC, de Lima AF, Tatakis DN. Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft. J Periodontol 2004;75:413-9.
• Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 2002;29 Suppl 3:S178-94.
• Cheung WS, Griffin TJ. A comparative study of root coverage with connective tissue and platelet concentrate grafts: 8-month results. J Periodontol 2004;75:1678-87.
• Fowler C, Garrett S, Crigger M, Egelberg J. Histologic probe position in treated and untreated human periodontal tissues. J Clin Periodontol 1982;9:373-85.
• De SM, Zucchelli G. Coronally advanced flap: a modified surgical approach for isolated recession-type defects: three-year results. J Clin Periodontol 2007;34:262-8.
• Griffin TJ, Cheung WS. Treatment of gingival recession with a platelet concentrate graft: a report of two cases. Int J Periodontics Restorative Dent 2004;24:589-95.
• Pini PG, Pagliaro U, Baldi C, Nieri M, Saletta D, Cairo F et al. Coronally advanced flap procedure for root coverage. Flap with tension versus flap without tension: a randomized controlled clinical study. J Periodontol 2000; 71:188-201.
• Pini Prato GP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C et al. Coronally advanced flap: the post-surgical position of the gingival margin is an important factor for achieving complete root coverage. J Periodontol 2005;76:713-22.