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Treatment of Mandibular Multiple Gingival Recession: Comparison of Two Techniques of Subepithelial Connective Tissue Graft

Year 2022, , 145 - 152, 01.05.2022
https://doi.org/10.53394/akd.1057422

Abstract

ABSTRACT
Objective: The aim of this study was to evaluate effect of connective tissue graft (CTG) either with tunnel technique (TT) or coronally advanced flap (CAF) in the treatment of gingival recession in mandibular canine and premolars, comperatively.
Material and Methods: This randomized, controlled, split-mouth study, consisted 38 regions of 8 patients (5 males, 3 females) with a systemically healthy mean age of 36.5 ± 2.5 years and randomly divided into 2 groups, TT + CTG and CAF+ CTG. Periodontal parameters including plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (CAL), gingival recession depth (GR), and keratinized tissue width (KT) were evaluated at baseline and 6 months.
Results: Percentage of root coverage from baseline to 6 months post-surgery was 58.33 % for TT+CTG group and 75.43 % for CAF+CTG group. Keratinized tissue width was increased in both groups from baseline to 6 months (p<0.001), and this increase was similar in both groups.
Conclusion: Both techniques were effective in root coverage and increased the keratinized tissue. CAF+CTG group demonstrated significantly better clinical outcomes for the treatment of multiple mandibular gingival recessions compared to TT + CTG.
Key Words: Coronally advanced flap, Gingival recession, Subepithelial connective tissue graft, Tunnel technique

References

  • 1. Wennström JL. Mucogingival therapy. Ann Periodontol 1996; 1:671-701.
  • 2. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999 ;4:1-6.
  • 3. Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root‐coverage procedures for the treatment of localized recession‐type defects: A Cochrane systematic review. J Periodontol 2010; 81:452-78.
  • 4. Miller Jr PD. Regenerative and reconstructive periodontal plastic surgery. Mucogingival surgery. Dent Clin North Am 1988; 32:287.
  • 5. Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: A systematic review from the AAP Regeneration Workshop. J Periodontol 2015; 86:8-51.
  • 6. Graziani F, Gennai S, Roldan S, et al. Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions. J Clin Periodontol 2014; 41:63-76.
  • 7. Susin C, Haas AN, Oppermann RV, Haugejorden O, Albandar JM. Gingival recession: epidemiology and risk indicators in a representative urban Brazilian population. J Periodontol 2004; 75:1377-86.
  • 8. Daprile G, Gatto MR, Checchi L. The evolution of buccal gingival recessions in a student population: a 5‐year follow‐up. J Periodontology 2007; 78:611-4.
  • 9. Prato GP, Clauser C, Cortellini P. Periodontal plastic and mucogingival surgery. Periodontol 2000 1995; 9:90-105.
  • 10. Aroca S, Keglevich T, Nikolidakis D, Gera I, Nagy K, Azzi R, Etienne D. Treatment of class III multiple gingival recessions: a randomized‐clinical trial. J Clin Periodontol 2010; 37:88-97.
  • 11. Sculean A, Cosgarea R, Stahli A, Katsaros C, Arweiler NB, Brecx M, Deppe H. The modified coronally advanced tunnel combined with an enamel matrix derivative and subepithelial connective tissue graft for the treatment of isolated mandibular Miller Class I and II gingival recessions: a report of 16 cases. Quintessence Int 2014; 45:829-35.
  • 12. Tonetti MS, Cortellini P, Pellegrini G, Nieri M, Bonaccini D, Allegri M, Bouchard P, Cairo F, Conforti G, Fourmousis I, Graziani F, Guerrero A, Halben J, Malet J, Rasperini G, Topoll H, Wachtel H, Wallkamm B, Zabalegui I, Zuhr O. Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non‐inferiority in root coverage and superiority in oral health‐related quality of life. J Clin Periodontol 2018; 45:78-88.
  • 13. Chambrone L. Clinical insights about the evolution of root coverage procedures: The flap, the graft, and the surgery. J Periodontol 2019; 90:9-15.
  • 14. Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 2014; 41:44-62.
  • 15. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol 1985; 56:715-20.
  • 16. Tavelli L, Barootchi S, Nguyen TV, Tattan M, Ravidà A, Wang HL. Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta‐analysis. J Periodontol 2018; 89:1075-90.
  • 17. Rasperini G, Codari M, Limiroli E, Acunzo R, Tavelli L, Znamenskaite Levickiene A. Graftless Tunnel Technique for the Treatment of Multiple Gingival Recessions in Sites with Thick or Very Thick Biotype: A Prospective Case Series. Int J Periodontics Restorative Dent 2019; 39:203-10.
  • 18. Zabalegui I, Sicilia A, Cambra J, Gil J, Sanz M. Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report. Int J Periodontics Restorative Dent 1999; 19:199-206.
  • 19. Sculean A, Cosgarea R, Stahli A, Katsaros C, Arweiler NB, Miron RJ, Deppe H. Treatment of multiple adjacent maxillary Miller Class I, II, and III gingival recessions with the modified coronally advanced tunnel, enamel matrix derivative, and subepithelial connective tissue graft: a report of 12 cases. Quintessence Int 2016; 47:653-9.
  • 20. Aroca S, Molnár B, Windisch P, Gera I, Salvi GE, Nikolidakis D, Sculean A. Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial. J Clin Periodontol 2013; 40:713-20.
  • 21. Hofmänner P, Alessandri R, Laugisch O, Aroca S, Salvi GE, Stavropoulos A, Aroca S, Salvi GE, Stavropoulos A, Sculean A. Predictability of surgical techniques used for coverage of multiple adjacent gingival recessions—A systematic review. Quintessence Int 2012; 43:545-54.
  • 22. Miller PD Jr. A classification ofmarginal tissue recession. Int J Periodontics Restor Dent 1985; 5:8–13.
  • 23. Loe H. The gingival index, the plaque index and the retention index systems.J Periodontol, 1967; 38:610–16.
  • 24. Loe, H., & Silness, J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963; 21:533–51.
  • 25. Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol 2000; 71:1506-14.
  • 26. Zuhr O, Fickl S, Wachtel H, Bolz W, Hürzeler MB. Covering of gingival recessions with a modified microsurgical tunnel technique: case report. Int J Periodontics Restorative Dent 2007; 27:457-63.
  • 27. Eren G, Atilla G. Platelet-rich fibrin in the treatment of localized gingival recessions: a split-mouth randomized clinical trial. Clin Oral Investig 2014; 18:1941-8.
  • 28. Cugini MA, Haffajee AD, Smith C, Kent RL, Jr., Socransky SS. The effect of scaling and root planing on the clinical and microbiological parameters of periodontal diseases: 12-month results. J Clin Periodontol. 2000; 27:30-6.
  • 29. Sameera S, Nagasri M, Aravind Kumar P, Indeevar P, Raviraj K, Musalaiah S. Comparison of two surgical techniques in the treatment of multiple gingival recessions sandwiched with a combination of A-PRF and L-PRF. Saudi Dent J 2018; 30:183-9.
  • 30. Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 2002; 29:178-94.
  • 31. Silva RC, Joly JC, de Lima AF, Tatakis DN. Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft. Journal of periodontology 2004; 75:413-9.
  • 32. Jepsen K, Jepsen S, Zucchelli G, Stefanini M, Sanctis M, Baldini N, Greven B, Heinz B, Wennström J, Cassel B, Vignoletti F, Sanz M. Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial. J Clin Periodontol 2013; 40:82-9.
  • 33. Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M. Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol 2009; 80:1083-94.
  • 34. Mörmann W, Meier C, Firestone A. Gingival blood circulation after experimental wounds in man. J Clin Periodontol 1979; 6:417-24.
  • 35. Thalmair T, Fickl S, Wachtel H. Coverage of Multiple Mandibular Gingival Recessions Using Tunnel Technique with Connective Tissue Graft: A Prospective Case Series. Int J Periodontics Restorative Dent 2016; 36:859-67.
  • 36. Santamaria MP, Neves F, Silveira CA, Mathias IF, Fernandes-Dias SB, Jardini MAN, Tatakis DN. Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions: a randomized clinical trial. J Clin Periodontol 2017; 44:540-7.
  • 37. Azaripour A, Kissinger M, Farina VS, Noorden CJFV, Gerhold-Ay A, Willershausen B, Cortellini P. Root coverage with connective tissue graft associated with coronally advanced flap or tunnel technique: a randomized, double-blind, mono-centre clinical trial. J Clin Periodontol 2016; 43:1142-50. 38. Tözüm TF, Keçeli HG, Güncü GN, Hatipoğlu H, Sengün D. Treatment of gingival recession: comparison of two techniques of subepithelial connective tissue graft. J Periodontol 2005; 76:1842-8.
  • 39. Salhi L, Lecloux G, Seidel L, Rompen E, Lambert F. Coronally advanced flap versus the pouch technique combined with a connective tissue graft to treat Miller's class I gingival recession: a randomized controlled trial. J Clin Periodontol 2014; 41:387- 95.

Alt Çene Çoklu Dişeti Çekilmesi Tedavisi: İki Subepitelyal Bağ Dokusu Grefti Tekniğinin Karşılaştırılması

Year 2022, , 145 - 152, 01.05.2022
https://doi.org/10.53394/akd.1057422

Abstract

ÖZ
Amaç: Bu çalışmanın amacı, mandibular köpek ve küçük azı dişlerindeki dişeti çekilmesinin tedavisinde, tünel tekniği (TT) veya koronale kaydırılan flep (KKF) ile uygulanan bağ dokusu greftinin (BDG) kök yüzeyi örtmedeki başarısının karşılaştırmalı olarak incelemektir.
Gereç ve Yöntemler: Bu split-mouth çalışmaya, çoklu dişeti çekilmesi defekti bulunan yaş ortalaması 36,5 ± 2,5 yıl olan 8 hasta (5 erkek, 3 kadın) katıldı. Toplamda otuz sekiz defekt randomize olarak TT + BDG veya KKF + BDG grubuna dahil edildi. Plak indeksi (Pİ), gingival indeks (Gİ), sondalama derinliği (SD), klinik ataşman kaybı (KAK), dişeti çekilme derinliği (DÇ) ve keratinize doku genişliği (KD) gibi periodontal parametreler başlangıçta ve 6. ayda değerlendirildi.
Bulgular: Başlangıçtan ameliyattan sonraki 6. aya kadar kök kapsama yüzdesi TT + BDG grubu için % 58,33 ve KKF + BDG grubu için % 75,43'tür. Keratinize doku genişliği her iki grupta da başlangıçtan 6. aya yükseldi (p <0.001) ve bu artış her iki grupta da benzerdi.
Sonuç: Her iki teknik de kök kapanmasında ve keratinize doku artışında etkili olsa da KKF + BDG grubu, çoklu mandibular gingival çekilmelerin tedavisi için TT + BDG 'ye kıyasla önemli ölçüde daha iyi klinik sonuçlar göstermiştir.
Anahtar Sözcükler: Dişeti çekilmesi, Koronale kaydırılan flep, Subepitelyal bağ dokusu grefti, Tünel tekniği

References

  • 1. Wennström JL. Mucogingival therapy. Ann Periodontol 1996; 1:671-701.
  • 2. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999 ;4:1-6.
  • 3. Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root‐coverage procedures for the treatment of localized recession‐type defects: A Cochrane systematic review. J Periodontol 2010; 81:452-78.
  • 4. Miller Jr PD. Regenerative and reconstructive periodontal plastic surgery. Mucogingival surgery. Dent Clin North Am 1988; 32:287.
  • 5. Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: A systematic review from the AAP Regeneration Workshop. J Periodontol 2015; 86:8-51.
  • 6. Graziani F, Gennai S, Roldan S, et al. Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions. J Clin Periodontol 2014; 41:63-76.
  • 7. Susin C, Haas AN, Oppermann RV, Haugejorden O, Albandar JM. Gingival recession: epidemiology and risk indicators in a representative urban Brazilian population. J Periodontol 2004; 75:1377-86.
  • 8. Daprile G, Gatto MR, Checchi L. The evolution of buccal gingival recessions in a student population: a 5‐year follow‐up. J Periodontology 2007; 78:611-4.
  • 9. Prato GP, Clauser C, Cortellini P. Periodontal plastic and mucogingival surgery. Periodontol 2000 1995; 9:90-105.
  • 10. Aroca S, Keglevich T, Nikolidakis D, Gera I, Nagy K, Azzi R, Etienne D. Treatment of class III multiple gingival recessions: a randomized‐clinical trial. J Clin Periodontol 2010; 37:88-97.
  • 11. Sculean A, Cosgarea R, Stahli A, Katsaros C, Arweiler NB, Brecx M, Deppe H. The modified coronally advanced tunnel combined with an enamel matrix derivative and subepithelial connective tissue graft for the treatment of isolated mandibular Miller Class I and II gingival recessions: a report of 16 cases. Quintessence Int 2014; 45:829-35.
  • 12. Tonetti MS, Cortellini P, Pellegrini G, Nieri M, Bonaccini D, Allegri M, Bouchard P, Cairo F, Conforti G, Fourmousis I, Graziani F, Guerrero A, Halben J, Malet J, Rasperini G, Topoll H, Wachtel H, Wallkamm B, Zabalegui I, Zuhr O. Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non‐inferiority in root coverage and superiority in oral health‐related quality of life. J Clin Periodontol 2018; 45:78-88.
  • 13. Chambrone L. Clinical insights about the evolution of root coverage procedures: The flap, the graft, and the surgery. J Periodontol 2019; 90:9-15.
  • 14. Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 2014; 41:44-62.
  • 15. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol 1985; 56:715-20.
  • 16. Tavelli L, Barootchi S, Nguyen TV, Tattan M, Ravidà A, Wang HL. Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta‐analysis. J Periodontol 2018; 89:1075-90.
  • 17. Rasperini G, Codari M, Limiroli E, Acunzo R, Tavelli L, Znamenskaite Levickiene A. Graftless Tunnel Technique for the Treatment of Multiple Gingival Recessions in Sites with Thick or Very Thick Biotype: A Prospective Case Series. Int J Periodontics Restorative Dent 2019; 39:203-10.
  • 18. Zabalegui I, Sicilia A, Cambra J, Gil J, Sanz M. Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report. Int J Periodontics Restorative Dent 1999; 19:199-206.
  • 19. Sculean A, Cosgarea R, Stahli A, Katsaros C, Arweiler NB, Miron RJ, Deppe H. Treatment of multiple adjacent maxillary Miller Class I, II, and III gingival recessions with the modified coronally advanced tunnel, enamel matrix derivative, and subepithelial connective tissue graft: a report of 12 cases. Quintessence Int 2016; 47:653-9.
  • 20. Aroca S, Molnár B, Windisch P, Gera I, Salvi GE, Nikolidakis D, Sculean A. Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial. J Clin Periodontol 2013; 40:713-20.
  • 21. Hofmänner P, Alessandri R, Laugisch O, Aroca S, Salvi GE, Stavropoulos A, Aroca S, Salvi GE, Stavropoulos A, Sculean A. Predictability of surgical techniques used for coverage of multiple adjacent gingival recessions—A systematic review. Quintessence Int 2012; 43:545-54.
  • 22. Miller PD Jr. A classification ofmarginal tissue recession. Int J Periodontics Restor Dent 1985; 5:8–13.
  • 23. Loe H. The gingival index, the plaque index and the retention index systems.J Periodontol, 1967; 38:610–16.
  • 24. Loe, H., & Silness, J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963; 21:533–51.
  • 25. Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol 2000; 71:1506-14.
  • 26. Zuhr O, Fickl S, Wachtel H, Bolz W, Hürzeler MB. Covering of gingival recessions with a modified microsurgical tunnel technique: case report. Int J Periodontics Restorative Dent 2007; 27:457-63.
  • 27. Eren G, Atilla G. Platelet-rich fibrin in the treatment of localized gingival recessions: a split-mouth randomized clinical trial. Clin Oral Investig 2014; 18:1941-8.
  • 28. Cugini MA, Haffajee AD, Smith C, Kent RL, Jr., Socransky SS. The effect of scaling and root planing on the clinical and microbiological parameters of periodontal diseases: 12-month results. J Clin Periodontol. 2000; 27:30-6.
  • 29. Sameera S, Nagasri M, Aravind Kumar P, Indeevar P, Raviraj K, Musalaiah S. Comparison of two surgical techniques in the treatment of multiple gingival recessions sandwiched with a combination of A-PRF and L-PRF. Saudi Dent J 2018; 30:183-9.
  • 30. Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 2002; 29:178-94.
  • 31. Silva RC, Joly JC, de Lima AF, Tatakis DN. Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft. Journal of periodontology 2004; 75:413-9.
  • 32. Jepsen K, Jepsen S, Zucchelli G, Stefanini M, Sanctis M, Baldini N, Greven B, Heinz B, Wennström J, Cassel B, Vignoletti F, Sanz M. Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial. J Clin Periodontol 2013; 40:82-9.
  • 33. Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M. Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol 2009; 80:1083-94.
  • 34. Mörmann W, Meier C, Firestone A. Gingival blood circulation after experimental wounds in man. J Clin Periodontol 1979; 6:417-24.
  • 35. Thalmair T, Fickl S, Wachtel H. Coverage of Multiple Mandibular Gingival Recessions Using Tunnel Technique with Connective Tissue Graft: A Prospective Case Series. Int J Periodontics Restorative Dent 2016; 36:859-67.
  • 36. Santamaria MP, Neves F, Silveira CA, Mathias IF, Fernandes-Dias SB, Jardini MAN, Tatakis DN. Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions: a randomized clinical trial. J Clin Periodontol 2017; 44:540-7.
  • 37. Azaripour A, Kissinger M, Farina VS, Noorden CJFV, Gerhold-Ay A, Willershausen B, Cortellini P. Root coverage with connective tissue graft associated with coronally advanced flap or tunnel technique: a randomized, double-blind, mono-centre clinical trial. J Clin Periodontol 2016; 43:1142-50. 38. Tözüm TF, Keçeli HG, Güncü GN, Hatipoğlu H, Sengün D. Treatment of gingival recession: comparison of two techniques of subepithelial connective tissue graft. J Periodontol 2005; 76:1842-8.
  • 39. Salhi L, Lecloux G, Seidel L, Rompen E, Lambert F. Coronally advanced flap versus the pouch technique combined with a connective tissue graft to treat Miller's class I gingival recession: a randomized controlled trial. J Clin Periodontol 2014; 41:387- 95.
There are 38 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Nezahat Arzu Kayar This is me 0000-0002-2325-2900

Mükerrem Hatipoglu This is me 0000-0003-4698-292X

Publication Date May 1, 2022
Submission Date March 23, 2021
Published in Issue Year 2022

Cite

APA Kayar, N. A., & Hatipoglu, M. (2022). Alt Çene Çoklu Dişeti Çekilmesi Tedavisi: İki Subepitelyal Bağ Dokusu Grefti Tekniğinin Karşılaştırılması. Akdeniz Tıp Dergisi, 8(2), 145-152. https://doi.org/10.53394/akd.1057422