LÖKOSİT VE TROMBOSİTTEN ZENGİN FİBRİN ÇOKLU KOMŞU DİŞETİ ÇEKİLMELERİNİN TEDAVİSİNDE BİR ALTERNATİF Mİ: BİR OLGU SERİSİ VE LİTERATÜR DERLEMESİ

Yıl 2013, Cilt: 2 Sayı: 1, 43 - 53, 30.04.2013

Gizem Torumtay Yener Özat , Burak Doğan

Öz

Çoklu dişeti çekilmeleri, ilişkili kozmetik veya patolojik sorunların yanı sıra tedavi sonuçlarının öngörülebilirliği açısından da klinisyenler için zorlu durumlardır. Bu anlamda pek çok cerrahi teknik ve materyal önerilmiş olsa da, hangi yaklaşımın ne oranda öngörülebilir başarı sağladığı tam olarak açıklığa kavuşturulmamıştır. Önerilen teknikler arasında tek başına veya koronale pozisyone flep ile kombine subepitelyal bağ doku grefti tam kök yüzey örtülemesi açısından daha başarılı bulunsa da, donör dokunun sınırlı olması, ikinci cerrahi saha gerekliliği ve ilgili postoperatif rahatsızlıktan ötürü daha az invaziv ve kolay tekniklere yönelik araştırmalar devam etmiştir. Bu çalışmalarda yer alan trombosit konsantratlarının kullanımı, yakın dönem klinik ve histolojik veriler ile desteklenmiş, yumuşak doku iyileşmesini geliştirmeye yönelik bir yaklaşımdır. Lökosit ve trombositten zengin fibrin (L-PRF), hazırlama basitliği, uygulama kolaylığı ve tamamen otojenik yapısı ile oral ve periodontal cerrahide kullanılan trombosit konsantratları içinde öne çıkmaktadır. Bu çalışmanın amacı, çoklu dişeti çekilmelerinin tedavisi ile ilgili literatürü gözden geçirmek ve Miller sınıf 1&2 bilateral çoklu dişeti çekilmelerinin tedavisinde koronale pozisyone flep ile kombine uygulanan subepitelyal bağ doku grefti ve L-PRF yaklaşımlarının erken dönem klinik başarı açısından karşılaştırıldığı bir olgu serisini sunmaktı.

Anahtar Kelimeler

Çoklu dişeti çekilmesi, bağ doku grefti

IS LEUKOCYTE- AND PLATELET-RICH FIBRIN MEMBRANE AN ALTERNATIVE FOR THE TREATMENT OF MULTIPLE ADJACENT GINGIVAL RECESSIONS: A CASE SERIES AND REVIEW OF THE LITERATURE

Öz

Multiple adjacent gingival recessions (MAGR) are challenging for clinicians in respect to cosmetic and pathologic problems and predictability of treatment results as well. Although several surgical techniques and materials have been proposed, the question of ‘which approach promises predictable clinical success’ has not been clarified. Among proposed techniques, subepithelial connective tissue graft (SECTG) alone or in combination with coronally advanced flap (CAF) has demonstrated better results for complete root coverage but due to donor tissue limitation, requirement of a second surgical site and related postoperative discomfort, research for less invasive and easy techniques has proceeded. As a topic of these studies, use of platelet concentrations targets enhanced wound healing in soft tissues as supported by recent clinical and histological data. Leukocyte- and platelet-rich fibrin (L-PRF) steps ahead among platelet concentrations used in oral and periodontal surgeries due to the features of easy preparation, simple application and utterly autogenic structure. The aim of this paper was to revise the literature regarding the treatment of MAGR and to present a case series consisting an early-term clinical comparison of SECTG versus L-PRF, both combined with CAF, performed for the treatment of bilateral Miller Class 1&2 MAGR.

Anahtar Kelimeler

Multiple gingival recession, connective tissue graft

Kaynakça

• 1. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4(1):1-6.
• 2. Loe H, Anerud A, Boysen H. The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession. J Periodontol. 1992;63(6):489-95.
• 3. Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003;134(2):220-5.
• 4. Leichter JW, Monteith BD. Prevalence and risk of traumatic gingival recession following elective lip piercing. Dent Traumatol. 2006;22(1):7-13.
• 5. Serino G, Wennstrom JL, Lindhe J, Eneroth L. The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene. J Clin Periodontol. 1994;21(1):57-63.
• 6. Hofmanner P, Alessandri R, Laugisch O et al:. Predictability of surgical techniques used for coverage of multiple adjacent gingival recessions--A systematic review. Quintessence Int. 2012;43(7):545-54.
• 7. Oates TW, Robinson M, Gunsolley JC. Surgical therapies for the treatment of gingival recession. A systematic review. Ann Periodontol. 2003;8(1):303-20.
• 8. Chambrone L, Lima LA, Pustiglioni FE, Chambrone LA. Systematic review of periodontal plastic surgery in the treatment of multiple recession-type defects. J Can Dent Assoc. 2009;75(3):203a-f.
• 9. Aroca S, Keglevich T, Barbieri B, Gera I, Etienne D. Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: a 6-month study. J Periodontol. 2009;80(2):244-52.
• 10. Bielecki T, Dohan Ehrenfest DM, Everts PA, Wiczkowski A. The Role of Leukocytes from L-PRP/L-PRF in Wound Healing and Immune Defense: New Perspectives. Curr Pharm Biotechnol. 2012;13(7):1153-62.
• 11. Del Corso M, Vervelle A, Simonpieri A et al:. Current Knowledge and Perspectives for the Use of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) in Oral and Maxillofacial Surgery Part 1: Periodontal and Dentoalveolar Surgery. Curr Pharm Biotechnol. 2012;13(7):1207-30.
• 12. Simonpieri A, Del Corso M, Vervelle A et al:. Current Knowledge and Perspectives for the Use of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) in Oral and Maxillofacial Surgery Part 2: Bone Graft, Implant and Reconstructive Surgery. Curr Pharm Biotechnol. 2012;13(7):1231-56.
• 13. Carvalho PF, da Silva RC, Cury PR, Joly JC. Modified coronally advanced flap associated with a subepithelial connective tissue graft for the treatment of adjacent multiple gingival recessions. J Periodontol. 2006;77(11):1901-6.
• 14. Chambrone LA, Chambrone L. Subepithelial connective tissue grafts in the treatment of multiple recession-type defects. J Periodontol. 2006;77(5):909-16.
• 15. Ozcelik O, Haytac MC, Seydaoglu G. Treatment of multiple gingival recessions using a coronally advanced flap procedure combined with button application. J Clin Periodontol. 2011;38(6):572-80.
• 16. Rasperini G, Roccuzzo M, Francetti L, Acunzo R, Consonni D, Silvestri M. Subepithelial connective tissue graft for treatment of gingival recessions with and without enamel matrix derivative: a multicenter, randomized controlled clinical trial. Int J Periodontics Restorative Dent. 2011;31(2):133-9.
• 17. Zaher CA, Hachem J, Puhan MA, Mombelli A. Interest in periodontology and preferences for treatment of localized gingival recessions. J Clin Periodontol. 2005;32(4):375-82.
• 18. Amberkar SC, Deshmukh V, Acharya A, Jhaveri HM. Management of multiple and isolated gingival recession sites with periodontal plastic surgical procedures--a case report. Quintessence Int. 2010;41(9):739-48.
• 19. 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(3):413-9.
• 20. Cairo F, Nieri M, Cattabriga M et al:. Root coverage esthetic score after treatment of gingival recession: an interrater agreement multicenter study. J Periodontol. 2010;81(12):1752-8.
• 21. Cairo F, Rotundo R, Miller PD, Pini Prato GP. Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol. 2009;80(4):705-10.
• 22. Kerner S, Sarfati A, Katsahian S et al:. Qualitative cosmetic evaluation after root-coverage procedures. J Periodontol. 2009;80(1):41-7.
• 23. Aroca S, Keglevich T, Nikolidakis D et al:. Treatment of class III multiple gingival recessions: a randomized-clinical trial. J Clin Periodontol. 2010;37(1):88-97.
• 24. Cetiner D, Bodur A, Uraz A. Expanded mesh connective tissue graft for the treatment of multiple gingival recessions. J Periodontol. 2004;75(8):1167-72.
• 25. Danesh-Meyer MJ, Wikesjo UM. Gingival recession defects and guided tissue regeneration: a review. J Periodontal Res. 2001;36(6):341-54.
• 26. Dembowska E, Drozdzik A. Subepithelial connective tissue graft in the treatment of multiple gingival recession. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104(3):e1-7.
• 27. Rosetti EP, Marcantonio E, Jr., Zuza EP, Marcantonio RA. Root coverage stability of the subepithelial connective tissue graft and guided tissue regeneration: A 30-month follow-up clinical trial. J Dent. 2012;
• 28. Tozum TF, Dini FM. Treatment of adjacent gingival recessions with subepithelial connective tissue grafts and the modified tunnel technique. Quintessence Int. 2003;34(1):7-13.
• 29. de Sanctis M, Baldini N, Goracci C, Zucchelli G. Coronally advanced flap associated with a connective tissue graft for the treatment of multiple recession defects in mandibular posterior teeth. Int J Periodontics Restorative Dent. 2011;31(6):623-30.
• 30. Deliberador TM, Martins TM, Furlaneto FA, Klingenfuss M, Bosco AF. Use of the connective tissue graft for the coverage of composite resin-restored root surfaces in maxillary central incisors. Quintessence Int. 2012;43(7):597-602.
• 31. Park JB. Treatment of multiple gingival recessions using subepithelial connective tissue grafting with a single-incision technique. J Oral Sci. 2009;51(2):317-21.
• 32. Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P. Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. J Clin Periodontol. 2010;37(7):644-50.
• 33. Chambrone L, Pannuti CM, Tu YK, Chambrone LA. Evidence-based periodontal plastic surgery. II. An individual data meta-analysis for evaluating factors in achieving complete root coverage. J Periodontol. 2012;83(4):477-90.
• 34. Hwang D, Wang HL. Flap thickness as a predictor of root coverage: a systematic review. J Periodontol. 2006;77(10):1625-34.
• 35. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol. 1985;56(12):715-20.
• 36. McGuire MK, Nunn M. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 1: Comparison of clinical parameters. J Periodontol. 2003;74(8):1110-25.
• 37. Bashutski JD, Wang HL. Role of platelet-rich plasma in soft tissue root-coverage procedures: a review. Quintessence Int. 2008;39(6):473-83.
• 38. Pini-Prato G, Cairo F, Nieri M, Rotundo R, Franceschi D. Esthetic evaluation of root coverage outcomes: a case series study. Int J Periodontics Restorative Dent. 2011;31(6):603-10.
• 39. Zucchelli G, De Sanctis M. The coronally advanced flap for the treatment of multiple recession defects: a modified surgical approach for the upper anterior teeth. J Int Acad Periodontol. 2007;9(3):96-103.
• 40. Woodyard JG, Greenwell H, Hill M, Drisko C, Iasella JM, Scheetz J. The clinical effect of acellular dermal matrix on gingival thickness and root coverage compared to coronally positioned flap alone. J Periodontol. 2004;75(1):44-56.
• 41. Mahn DH. Use of the tunnel technique and an acellular dermal matrix in the treatment of multiple adjacent teeth with gingival recession in the esthetic zone. Int J Periodontics Restorative Dent. 2010;30(6):593-9.
• 42. Schlee M, Esposito M. Human dermis graft versus autogenous connective tissue grafts for thickening soft tissue and covering multiple gingival recessions: 6-month results from a preference clinical trial. Eur J Oral Implantol. 2011;4(2):119-25.
• 43. Pini Prato G, Tinti C, Vincenzi G, Magnani C, Cortellini P, Clauser C. Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession. J Periodontol. 1992;63(11):919-28.
• 44. Cortellini P, Clauser C, Prato GP. Histologic assessment of new attachment following the treatment of a human buccal recession by means of a guided tissue regeneration procedure. J Periodontol. 1993;64(5):387-91.
• 45. Harris RJ. A comparison of 2 root coverage techniques: guided tissue regeneration with a bioabsorbable matrix style membrane versus a connective tissue graft combined with a coronally positioned pedicle graft without vertical incisions. results of a series of consecutive cases. J Periodontol. 1998;69(12):1426-34.
• 46. Wang HL, Bunyaratavej P, Labadie M, Shyr Y, MacNeil RL. Comparison of 2 clinical techniques for treatment of gingival recession. J Periodontol. 2001;72(10):1301-11.
• 47. Kimble KM, Eber RM, Soehren S, Shyr Y, Wang HL. Treatment of gingival recession using a collagen membrane with or without the use of demineralized freeze-dried bone allograft for space maintenance. J Periodontol. 2004;75(2):210-20.
• 48. Wang HL, Al-Shammari KF. Guided tissue regeneration-based root coverage utilizing collagen membranes: technique and case reports. Quintessence Int. 2002;33(10):715-21.
• 49. Boltchi FE, Allen EP, Hallmon WW. The use of a bioabsorbable barrier for regenerative management of marginal tissue recession. I. Report of 100 consecutively treated teeth. J Periodontol. 2000;71(10):1641-53.
• 50. Al-Hamdan K, Eber R, Sarment D, Kowalski C, Wang HL. Guided tissue regeneration-based root coverage: meta-analysis. J Periodontol. 2003;74(10):1520-33.
• 51. Wang HL, Modarressi M, Fu JH. Utilizing collagen membranes for guided tissue regeneration-based root coverage. Periodontol 2000. 2012;59(1):140-57.
• 52. McGuire MK, Cochran DL. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 2: Histological evaluation. J Periodontol. 2003;74(8):1126-35.
• 53. Trombelli L. Periodontal regeneration in gingival recession defects. Periodontol 2000. 1999;19:138-50.
• 54. Koop R, Merheb J, Quirynen M. Periodontal regeneration with enamel matrix derivative in reconstructive periodontal therapy: a systematic review. J Periodontol. 2012;83(6):707-20.
• 55. Cordaro L, di Torresanto VM, Torsello F. Split-mouth comparison of a coronally advanced flap with or without enamel matrix derivative for coverage of multiple gingival recession defects: 6- and 24-month follow-up. Int J Periodontics Restorative Dent. 2012;32(1):e10-20.
• 56. Cheung WS, Griffin TJ. A comparative study of root coverage with connective tissue and platelet concentrate grafts: 8-month results. J Periodontol. 2004;75(12):1678-87.
• 57. Griffin TJ, Cheung WS. Guided tissue regeneration-based root coverage with a platelet concentrate graft: a 3-year follow-up case series. J Periodontol. 2009;80(7):1192-9.
• 58. 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(10):1768-77.
• 59. 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(3):255-62.
• 60. Kontovazainitis G, Griffin TJ, Cheung WS. Treatment of gingival recession using platelet concentrate with a bioabsorbable membrane and coronally advanced flap: a report of two cases. Int J Periodontics Restorative Dent. 2008;28(3):301-7.
• 61. Suaid FF, Carvalho MD, Santamaria MP et al:. Platelet-rich plasma and connective tissue grafts in the treatment of gingival recessions: a histometric study in dogs. J Periodontol. 2008;79(5):888-95.
• 62. Lafzi A, Chitsazi MT, Farahani RM, Faramarzi M. Comparative clinical study of coronally advanced flap with and without use of plasma rich in growth factors in the treatment of gingival recession. Am J Dent. 2011;24(3):143-7.
• 63. Anilkumar K, Geetha A, Umasudhakar, Ramakrishnan T, Vijayalakshmi R, Pameela E. Platelet-rich-fibrin: A novel root coverage approach. J Indian Soc Periodontol. 2009;13(1):50-4.
• 64. Jankovic S, Aleksic Z, Milinkovic I, Dimitrijevic B. The coronally advanced flap in combination with platelet-rich fibrin (PRF) and enamel matrix derivative in the treatment of gingival recession: a comparative study. Eur J Esthet Dent. 2010;5(3):260-73.
• 65. Aleksic Z, Jankovic S, Dimitrijevic B, Divnic-Resnik T, Milinkovic I, Lekovic V. [The use of platelet-rich fibrin membrane in gingival recession treatment]. Srp Arh Celok Lek. 2010;138(1-2):11-8.
• 66. Dohan Ehrenfest DM, Bielecki T, Mishra A et al:. In search of a consensus terminology in the field of platelet concentrates for surgical use: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), fibrin gel polymerization and leukocytes. Curr Pharm Biotechnol. 2012;13(7):1131-7.
• 67. Dohan Ehrenfest DM. How to optimize the preparation of leukocyte- and platelet-rich fibrin (L-PRF, Choukroun's technique) clots and membranes: introducing the PRF Box. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(3):275-8; author reply 8-80.
• 68. Dohan Ehrenfest DM, de Peppo GM, Doglioli P, Sammartino G. Slow release of growth factors and thrombospondin-1 in Choukroun's platelet-rich fibrin (PRF): a gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors. 2009;27(1):63-9.
• 69. 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(2):199-206.
• 70. 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(7):1083-94.
• 71. Bittencourt S, Del Peloso Ribeiro E, Sallum EA, Nociti FH, Jr., Casati MZ. Surgical microscope may enhance root coverage with subepithelial connective tissue graft: a randomized-controlled clinical trial. J Periodontol. 2012;83(6):721-30.