Kuronale Kaydırılan Flep ve Bağ Doku Grefti ile Tedavi Edilen Dişeti Çekilmelerinin Retrospektif Analizi

Yıl 2022, Sayı: 17, 391 - 402, 29.08.2022

Eser Elemek

https://doi.org/10.38079/igusabder.1139065

Öz

Amaç: Bu retrospektif çalışmanın amacı dişeti çekilmelerinin tedavisinde kuronale kaydırılan flep ve bağ doku greftinin (KKF+BDG) etkinliğinin değerlendirilmesidir.

Yöntem: Çalışmada KKF+BDG ile tedavi edilen tekli ve çoklu 32 dişetine çekilmesine sahip 11 hastanın periodontal kayıtları incelendi. Cairo sınıflamasına göre tip 1 dişeti çekilmeleri çalışmaya dahil edildi. Çekilme derinliği (ÇD), cep derinliği (CD) ve klinik ataşman seviyesi (KAS) ölçümleri başlangıç ve takip randevularında yapıldı. Ortalama kök yüzeyi kapanması (OKK) ve tam kök yüzeyi kapanması (TKK) değerlendirildi. Aynı zamanda hastaların destekleyici periodontal tedaviye (DPT) uyumluluğu da belirlendi.

Bulgular: On bir hastanın yaş ortalaması 29.6±4.4 yıl olarak saptandı. Otuz iki dişeti çekilmesinin ortalama gözlem süresi 37.6±24.2 ay olarak belirlendi. Son takip randevularında yapılan ölçümlerde tüm klinik parametrelerde başlangıç değerlere göre olumlu yönde değişiklik gözlendi. Kuronale kaydırılan flep ve bağ doku grefti ile tedavi edilen dişeti çekilmelerinde OKK %92.6±13.1 ve TKK %75 olarak saptandı. Destekleyici periodontal tedaviye uyumluluk oranı %83.3 hesaplandı.

Sonuç: Cairo tip 1 dişeti çekilmelerinin KKF+BDG ile tedavisinde ortalama üç yıldan fazla takibinde tüm klinik parametreler ve TKK açısından pozitif sonuçlar elde edildi. Bu çalışmanın bulguları KKF+BDG’nin dişeti çekilmelerinin tedavisinde altın standart olarak kullanılmasını destekler niteliktedir.

Anahtar Kelimeler

Bağ doku, kök yüzeyi kapama, diş eti çekilmesi

Treatment of Gingival Recessions Using Coronally Advanced Flap and Connective Tissue Graft: A Retrospective Analysis

Öz

Aim: The aim of this retrospective study was to evaluate the effectiveness of coronally advanced flap and connective tissue graft (CAF+CTG) in the treatment of gingival recessions (GR).

Method: Periodontal records of 32 single and multiple GR in 11 patients treated with CAF+CTG were selected for the study. According to Cairo’s classification, recession type 1 defects were included. Recession depth (RD), probing depth (PD) and clinical attachment level (CAL) were assessed at baseline and follow-ups. Mean root coverage (MRC) and complete root coverage (CRC) were evaluated. Compliance with supportive periodontal therapy (SPT) was also determined.

Results: Mean age of 11 patients was 29.6±4.4 years. The mean observation time of 32 recessions was 37.6±24.2 months. All clinical parameters showed an improvement between baseline and the latest follow-up. After treatment with CAF+CTG, MRC was 92.6±13.1% and CRC was achieved in 75% of the recessions. Compliance to SPT was calculated at 83.3%.

Conclusion: The use of CAF+CTG yielded positive outcomes in terms of all clinical parameters and complete root coverage in Cairo recession type 1 defects with a mean observation period of >3 years. The results of the present study confirm the use of CAF+CTG as a gold standard for the treatment of gingival recessions.

Anahtar Kelimeler

Connective tissue, root coverage, gingival recession

Kaynakça

• Jepsen S, Caton JG, Albandar JM, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89(1):237-248. doi:10.1002/JPER.17-0733.
• Seong J, Bartlett D, Newcombe RG, Claydon NCA, Hellin N, West NX. Prevalence of gingival recession and study of associated related factors in young UK adults. J Dent. 2018;76:58-67. doi:10.1016/j.jdent.2018.06.005.
• Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003;134(2):220-225. doi:10.14219/jada.archive.2003.0137.
• Agudio G, Cortellini P, Buti J, Pini Prato G. Periodontal conditions of sites treated with gingival augmentation surgery compared with untreated contralateral homologous sites: An 18- to 35-year long-term study. J Periodontol. 2016;87(12):1371-1378. doi:10.1902/jop.2016.160284.
• 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. doi:10.1902/jop.2016.150625.
• Kim DM, Neiva R. Periodontal soft tissue non–root coverage procedures: A systematic review from the AAP regeneration workshop. J Periodontol. 2015;86(2):56-72. doi:10.1902/jop.2015.130684.
• Sullivan HC, Atkins JH. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics. 1968;6(3):121-129.
• Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000. 2015;68(1):333-368. doi:10.1111/prd.12059.
• 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):644-650. doi:10.1111/j.1600-051X.2010.01559.x.
• Nieri M, Pini Prato GP, Giani M, Magnani N, Pagliaro U, Roberto R. Patient perceptions of buccal gingival recessions and requests for treatment. J Clin Periodontol. 2013;40(7):707-712. doi:10.1111/jcpe.12114.
• Kim SM, Choi YH, Kim YG, Park JW, Lee JM, Suh JY. Analysis of the esthetic outcome after root coverage procedures using a comprehensive approach. J Esthet Restor Dent. 2014;26(2):107-118. doi:10.1111/jerd.12085.
• Zucchelli G, Sharma P, Mounssif I. Esthetics in periodontics and implantology. Periodontol 2000. 2018;77(1):7-18. doi:10.1111/prd.12207.
• Miller PD. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985;5(2):8-13.
• Cairo F, Nieri M, Cincinelli S, 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(7):661-666. doi:10.1111/j.1600-051X.2011.01732.x.
• Zucchelli G, Mele M, Stefanini M, et al. Predetermination of Root Coverage. J Periodontol. 2010;81(7):1019-1026. doi:10.1902/jop.2010.090701.
• Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol. 2000;71(9):1506-1514. doi:10.1902/jop.2000.71.9.1506.
• De Ry SP, Roccuzzo A, Lang NP, Sculean A, Salvi GE. Long-term clinical outcomes of periodontal regeneration with enamel matrix derivative: A retrospective cohort study with a mean follow-up of 10 years. J Periodontol. 2022;93(4):548-559. doi:10.1002/JPER.21-0347.
• Stefanini M, Marzadori M, Aroca S, Felice P, Sangiorgi M, Zucchelli G. Decision making in root-coverage procedures for the esthetic outcome. Periodontol 2000. 2018;77(1):54-64. doi:10.1111/prd.12205.
• Chambrone L, Prato GPP. Clinical insights about the evolution of root coverage procedures: The flap, the graft, and the surgery. J Periodontol. 2019;90(1):9-15. doi:10.1002/JPER.18-0281.
• Jepsen K, Stefanini M, Sanz M, Zucchelli G, Jepsen S. Long-term stability of root coverage by coronally advanced flap procedures. J Periodontol. 2017;88(7):626-633. doi:10.1902/jop.2017.160767.
• Tavelli L, Barootchi S, Cairo F, Rasperini G, Shedden K, Wang HL. The effect of time on root coverage outcomes: A network meta-analysis. J Dent Res. 2019;98(11):1195-1203. doi:10.1177/0022034519867071.
• Korkmaz B, Balli U. Clinical evaluation of the treatment of multiple gingival recessions with connective tissue graft or concentrated growth factor using tunnel technique: A randomized controlled clinical trial. Clin Oral Investig. 2021;25(11):6347-6356. doi:10.1007/s00784-021-03935-3.
• Górski B, Szerszeń M. Effect of root surface biomodification on multiple recession coverage with modified coronally advanced tunnel technique and subepithelial connective tissue graft: A retrospective analysis. Gels. 2022;8(1):31:1-13. doi:10.3390/gels8010031.
• Stefanini M, Zucchelli G, Marzadori M, de Sanctis M. Coronally advanced flap with site-specific application of connective tissue graft for the treatment of multiple adjacent gingival recessions: A 3-year follow-up case series. Int J Periodontics Restorative Dent. 2018;38(1):25-33. doi:10.11607/prd.3438.
• Cairo F, Cortellini P, Pilloni A, et al. Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: A randomized controlled clinical trial. J Clin Periodontol. 2016;43(10):849-856. doi:10.1111/jcpe.12590.
• Rebele SF, Zuhr O, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage Part II. Volumetric. J Clin Periodontol. 2014;41(6):593-603. doi: 10.1111/jcpe.12254.
• Zucchelli G, Felice P, Mazzotti C, et al. 5-year outcomes after coverage of soft tissue dehiscence around single implants: A prospective cohort study. Eur J Oral Implantol. 2018;11(2):215-224.
• Miller PD. Root coverage with the free gingival graft. J Periodontol. 1987;58(10):674-681. doi:10.1902/jop.1987.58.10.674.
• Zucchelli G, Amore C, Sforza NM, Montebugnoli L, De Sanctis M. Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study. J Clin Periodontol. 2003;30(10):862-870. doi:10.1034/j.1600-051X.2003.00397.x.
• Tatakis DN, Trombelli L. Gingival recession treatment: guided tissue regeneration with bioabsorbable membrane versus connective tissue graft. J Periodontol. 2000;71(2):299-307. doi:10.1902/jop.2000.71.2.299.
• Amerio E, Mainas G, Petrova D, Giner Tarrida L, Nart J, Monje A. Compliance with supportive periodontal/peri-implant therapy: A systematic review. J Clin Periodontol. 2020;47(1):81-100. doi:10.1111/jcpe.13204.