Clinical Evaluation of Coronally Positioned Flap in the Treatment of Single Gingival Recession Defects of Patients with Thick Gingival Biotype: Case Series

Abstract

Background: The purpose of this study was to evaluate the root coverage of coronally positioned flap (CPF) in the treatment of Miller class I and II single gingival recession defects of patients with thick gingival biotype.
Materials and Methods: The present study was conducted on 14 patients with Miller class I and II single recession defects. The recession defects were treated by CPF. The clinical parameters plaque index (PI), gingival index (GI), gingival thickness (GT), probing depth (PD), gingival recession depth (GRD), gingival recession width (GRW), keratinized tissue (KT) and attached gingiva (AG) were recorded at baseline. All parametes except for GT were remeasured at 6 months.
Results: CPF procedure resulted in statistically significant decreases in PD, GRD, GRW, and increases in KT and AG at 6 months (p<0.05). The mean percentage of root coverage at the final evaluation was 82±23%.
Conclusion: Within the limits of this study it can be concluded that CPF may be a successful surgical procedure in the treatment of Miller class I and II single gingival recession defects of patients with thick gingival biotype.

Kalın Dişeti Biyotipine Sahip Hastalardaki Tekli Dişeti Çekilmelerinin Kuronale Pozisyone Flep Tekniği ile Tedavisinin Klinik Değerlendirilmesi: Vaka Serisi

Abstract

Amaç: Bu çalışmanın amacı, kalın dişeti biyotipine ve yeterli keratinize dişetine sahip hastaların Miller sınıf I ve sınıf II tekli dişeti çekilme defektlerinin tedavisinde kuronale pozisyone flep tekniğinin (KPF) kök kapaması üzerine olan etkisini değerlendirmektir.
Materyal ve metod: Çalışma Miller sınıf I ve II tekli dişeti çekilmesi defekti olan 14 hasta üzerinde yürütülmüştür. Dişeti çekilme defektleri KPF tekniği ile tedavi edilmiştir. Başlangıç klinik ölçümleri; plak indeks (PI), gingival indeks (GI), dişeti kalınlığı (DK), cep derinliği (CD), dişeti çekilme derinliği (DÇD), dişeti çekilme genişliği (DÇG), keratinize doku yüksekliği (KDY) ve yapışık dişeti (YD) miktarıdır. DK dışındaki tüm ölçümler operasyon sonrası 6. ayda tekrarlanmıştır.
Bulgular: KPF tekniği ile kök yüzey kapanmasını değerlendirdiğimiz bu çalışma neticesinde başlangıca göre 6.ayda CD, DÇD, DÇG parametrelerinde istatistiksel olarak anlamlı derecede azalma gözlenirken, KDY ve YD miktarında istatistiksel olarak anlamlı bir artış meydana gelmiştir. Ortalama kök kapanma yüzdesinin ise %82±23 olduğu saptanmıştır.
Sonuç: Çalışmamızın süresi ve sınırları dahilinde kalın dişeti biyotipine ve yeterli keratinize dişeti miktarına sahip Miller sınıf I ve II tekli dişeti çekilmeleri olan hastaların tedavisinde KPF operasyonunun başarılı bir cerrahi işlem olabileceği söylenebilir.

Keywords

• dişeti çekilmesi
• kalın dişeti biyotipi
• kuronale pozisyone flep

References

1. Wennstrom JL, Zucchelli G. Increased gingival dimensions. a significant factor for successful outcome of root coverage procedures? a 2 year prospective clinical study. J Clin Periodontol 1996; 23:770-777.
2. 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(15):44-62.
3. Allen, EP, Miller PD. Jr. Coronal positioning of existing gingiva: Short term results in the treatment of shallow marginal tissue recession. J Periodontol 1989; 60: 316-319.
4. De Sanctis M, Zucchelli G. Coronally advanced flap: a modified Surcigal approach for isolated recession-type defects:Three year result Journal of Clinical Periodontol 2007; 34 (3):262-268.
5. Clementini M, Discepoli N, Danesi C, de Sanctis MJ. Biologically guided flap stability: the role of flap thickness including periosteum retention on the performance of the coronally advanced flap-A double-blind randomized clinical trial. J Clin Periodontol. 2018; 45(10):1238-1246.
6. La Rocca AP, Alemany AS, Levi P Jr, Juan MV, Molina JN, Weisgold AS. Anterior maxil- lary and mandibular biotype: relationship be- tween gingival thickness and width with respect to underlying bone thickness. Implant Dent 2012; 21(6):507-515.
7. Renkema AM, Fudalej PS, Renkema A, Kiekens R, Katsaros C. Development of labial gingival recessions in orthodontically treated patients. Am J Orthod Dentofacial Orthop 2013; 143(2):206-212.
8. Sin YW, Chang HY, Yun WH, Jeong SN, Pi SH, You HK. Association of gingival biotype with the results of scaling and root planing. J Periodontal İmplant Sci 2013; 43(6):283-290.

9. Cook DR, Mealey BL, Verrett RG, Mills MP, Noujeim ME, Lasho DJ, et al. Relationship between clinical periodontal biotype and labial plate thickness: an in vivo study. Int J of Periodontics Restorative Dent 2011; 31(4):345-354.
10. Bains VK, Gupta V, Srivastava R, Agarwal SK. Accretion of gingival height by gingival thickness augmentation: a clinical report. Asian J Oral Health Allied Sci 2013; 3(1):25-31.
11. Silness J, Löe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22:121-135.
12. Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol 1967; 38:610-616.
13. Chambrone L, Tatakis DN Long-Term Outcomes of Untreated Buccal Gingival Recessions: A Systematic Review and Meta-Analysis. J Periodontol. 2016; 87(7):796-808.
14. Hall, WB. The current status of mucogingival prosblems and their therapy. J. Periodontol 1981; 52:569-575.
15. Matter J. Free gingival grafts for the treatment of gingival recession. A review some techniques. J Clin Periodontol 1982 (2):103-114.
16. Harrıs RJ. The connective tissue with partial thickness double pedicle graft. the results of 100 consecutively treated defects. J Periodontol1994; 65:448-461.
17. Rasperini G, Acunzo R, Pellegrini G, Pagni G, Tonetti M, Pini Prato GP, Cortellini P. Predictor factors for long-term outcomes stability of coronally advanced flap with or without connective tissue graft in the treatment of single maxillary gingival recessions: 9 years results of a randomized controlled clinical trial. J Clin Periodontol. 2018; 45(9):1107-1117.
18. Pini Prato GP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C, Rotundo R, Muzzi L. Coronally advanced flap: the post-surgical position of the gingival margin is an important factor for achieving complete root coverage. J Periodontol. 2005; 76(5):713-722.
19. Huang LH, Neiva RE, Wang HL. Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 2005; 76:1729- 1734.
20. Claffey N, Shanley D. Relation ship of gingival thickness and bleeding to loss of probing attachment in shallow sites folllowing nonsurgical periodontal theraphy. J Clin Periodontol 1986; 13:654- 657.
21. Thomas LS, Sadasivan A, Koshi E (2015). Gingival biotype. SIS Index ID 833, 258.
22. Santamaría MP, Ambrosano GM, Casati MZ, Nociti FH Jr, Sallum AW, Sallum EA. Connective tissue graft and resin glass ionomer for the treatment of gingival recession associated with noncarious cervical lesions: a case series. Int J Periodontics Restorative Dent. 2011;31(5):57-63.
23. Greenwell, H, Bissada, NF., Henderson, RD, Dodge JR. The deceptive nature of root coverage results. J Periodontol 2000; 71:1327-1337.
24. Wennström, JL. Mucogingival theraphy. Ann Periodontol 1996; 1:671-701.
25. Huang, LH, Neiva, REF, Wang HL. Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 2005; 76:1729-1734.