Coronally advanced flap versus the pouch technique combined with a connective tissuegraft to treat Miller's class I gingival recession: a randomized controlled trial
[en] AIM:
The objective of this study was to compare two different periodontal plastic surgery procedures to treat Miller's class I recession: a coronally advanced flap (control group) versus the pouch technique (test group), both of which were associated with connective tissue graft.
METHODS:
Forty consecutive patients were included, with 20 patients being allocated for each group. The level of recession coverage, the keratinized tissue (KT) quantity, gingival aesthetics (PES) and post-operative outcomes were assessed for a follow-up period of 6 months.
RESULTS:
After 6 months, both techniques allowed for the excellent mean root coverage of 96.3 ± 12.1% in the control group and of 91.3 ± 17.6% in the test group. Complete root coverage was achieved in 89.5% (17/19) and 79% (15/19) of the recession cases in the control and the test groups respectively. A significant increase in KT height (p = 0.0011) was observed in the test group. A significant improvement in the pink aesthetic score was found in the two groups, but gingival texture displayed significantly better results in the test group (p < 0.0001). No significant difference between the two groups was found in terms of the morbidity outcomes. Pain killer consumption was similar in the two groups and significantly decreased over time.
CONCLUSIONS:
Both surgical techniques are relevant in treating Miller's class I recession. The pouch technique seems to increase the height of KT better and provides good gingival-related aesthetic outcomes.
Research center :
d‐BRU - Dental Biomaterials Research Unit - ULiège
Disciplines :
Dentistry & oral medicine
Author, co-author :
SALHI, Leila ; Centre Hospitalier Universitaire de Liège - CHU > Médecine dentaire
LECLOUX, Geoffrey ; Centre Hospitalier Universitaire de Liège - CHU > Médecine dentaire
Seidel, Laurence ; Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique
ROMPEN, Eric ; Centre Hospitalier Universitaire de Liège - CHU > Médecine dentaire
LAMBERT, France ; Centre Hospitalier Universitaire de Liège - CHU > Médecine dentaire
Language :
English
Title :
Coronally advanced flap versus the pouch technique combined with a connective tissuegraft to treat Miller's class I gingival recession: a randomized controlled trial
Abolfazli, N., Saleh-Saber, F., Eskandari, A., &, Lafzi, A,. (2009) A comparative study of the long term results of root coverage with connective tissue graft or enamel matrix protein: 24-month results. Med Oral Patol Oral Cir Bucal 14, E304-E309.
Ainamo, A., Bergenholtz, A., Hugoson, A., &, Ainamo, J,. (1992) Location of the mucogingival junction 18 years after apically repositioned flap surgery. Journal of Clinical Periodontology 19, 49-52.
Albandar, J. M., &, Kingman, A., (1999) Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. Journal of Periodontology 70, 30-43.
Allen, A. L., (1994) Use of the supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique. Int J Periodontics Restorative Dent 14, 216-227.
Allen, E. P., (1988) Use of mucogingival surgical procedures to enhance esthetics. Dental Clinics of North America 32, 307-330.
Al-Wahadni, A., &, Linden, G. J., (2002) Dentine hypersensitivity in Jordanian dental attenders. A case control study. Journal of Clinical Periodontology 29, 688-693.
Andrade, P. F., Grisi, M. F., Marcaccini, A. M., Fernandes, P. G., Reino, D. M., Souza, S. L., Taba, M., Palioto, D. B., &, Novaes, A. B,. (2010) Comparison between micro- and macrosurgical techniques for the treatment of localized gingival recessions using coronally positioned flaps and enamel matrix derivative. Journal of Periodontology 81, 1572-1579.
Bittencourt, S., Del Peloso Ribeiro, E., Sallum, E. A., Sallum, A. W., &, Nociti, F. H., Jr,. &, Casati, M. Z,. (2006) Comparative 6-month clinical study of a semilunar coronally positioned flap and subepithelial connective tissue graft for the treatment of gingival recession. Journal of Periodontology 77, 174-181.
Bittencourt, S., Del Peloso Ribeiro, E., Sallum, E. A., Sallum, A. W., &, Nociti, F. H Jr,. &, Casati, M. Z,. (2009) Semilunar coronally positioned flap or subepithelial connective tissue graft for the treatment of gingival recession: a 30-month follow-up study. Journal of Periodontology 80, 1076-1082.
Bouchard, P., Etienne, D., Ouhayoun, J. P., &, Nilveus, R,. (1994) Subepithelial connective tissue grafts in the treatment of gingival recessions. A comparative study of 2 procedures. Journal of Periodontology 65, 929-936.
Bruno, J. F., (1994) Connective tissue graft technique assuring wide root coverage. Int J Periodontics Restorative Dent 14, 126-137.
Byun, H. Y., Oh, T. J., Abuhussein, H. M., Yamashita, J., Soehren, S. E., &, Wang, H. L,. (2009) Significance of the epithelial collar on the subepithelial connective tissue graft. Journal of Periodontology 80, 924-932.
Cairo, F., Pagliaro, U., &, Nieri, M,. (2008) Treatment of gingival recession with coronally advanced flap procedures: a systematic review. Journal of Clinical Periodontology 35 (8 Suppl), 136-162.
Cairo, F., Rotundo, R., Miller, P. D., &, Pini Prato, G. P,. (2009) Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. Journal of Periodontology 80, 705-710.
Carvalho, P. F., da Silva, R. C., Cury, P. R., &, Joly, J. C,. (2006) Modified coronally advanced flap associated with a subepithelial connective tissue graft for the treatment of adjacent multiple gingival recessions. Journal of Periodontology 77, 1901-1906.
Cetiner, D., Bodur, A., &, Uraz, A,. (2004) Expanded mesh connective tissue graft for the treatment of multiple gingival recessions. Journal of Periodontology 75, 1167-1172.
Chambrone, L. A., &, Chambrone, L., (2006) Subepithelial connective tissue grafts in the treatment of multiple recession-type defects. Journal of Periodontology 77, 909-916.
Chambrone, L., Sukekava, F., Araujo, M. G., Pustiglioni, F. E., Chambrone, L. A., &, Lima, L. A,. (2010) Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review. Journal of Periodontology 81, 452-478.
Cheng, Y. F., Chen, J. W., Lin, S. J., &, Lu, H. K,. (2007) Is coronally positioned flap procedure adjunct with enamel matrix derivative or root conditioning a relevant predictor for achieving root coverage? A systemic review. Journal of Periodontal Research 42, 474-485.
Cordioli, G., Mortarino, C., Chierico, A., Grusovin, M. G., &, Majzoub, Z,. (2001) Comparison of 2 techniques of subepithelial connective tissue graft in the treatment of gingival recessions. Journal of Periodontology 72, 1470-1476.
Del Pizzo, M., Zucchelli, G., Modica, F., Villa, R., &, Debernardi, C,. (2005) Coronally advanced flap with or without enamel matrix derivative for root coverage: a 2-year study. Journal of Clinical Periodontology 32, 1181-1187.
Furhauser, R., Florescu, D., Benesch, T., Haas, R., Mailath, G., &, Watzek, G,. (2005) Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implants Res 16, 639-644.
Grupe HE, W. R,. (1956). Repair of gingival defects by a sliding flap operation. Journal of Periodontology 27, 92-95.
Han, J. S., John, V., Blanchard, S. B., Kowolik, M. J., &, Eckert, G. J,. (2008) Changes in gingival dimensions following connective tissue grafts for root coverage: comparison of two procedures. Journal of Periodontology 79, 1346-1354.
Huang, L. H., Neiva, R. E., Soehren, S. E., Giannobile, W. V., &, Wang, H. L,. (2005) The effect of platelet-rich plasma on the coronally advanced flap root coverage procedure: a pilot human trial. Journal of Periodontology 76, 1768-1777.
Jahnke, P. V., Sandifer, J. B., Gher, M. E., Gray, J. L., &, Richardson, A. C,. (1993) Thick free gingival and connective tissue autografts for root coverage. Journal of Periodontology 64, 315-322.
Joly, J. C., Carvalho, A. M., da Silva, R. C., Ciotti, D. L., &, Cury, P. R,. (2007) Root coverage in isolated gingival recessions using autograft versus allograft: a pilot study. Journal of Periodontology 78, 1017-1022.
Kassab, M. M., &, Cohen, R. E,. (2002). Treatment of gingival recession. Journal of the American Dental Association 133, 1499-1506; quiz 1540.
Keceli, H. G., Sengun, D., Berberoglu, A., &, Karabulut, E,. (2008) Use of platelet gel with connective tissue grafts for root coverage: a randomized-controlled trial. Journal of Clinical Periodontology 35, 255-262.
Langer, B., &, Langer, L., (1985) Subepithelial connective tissue graft technique for root coverage. Journal of Periodontology 56, 715-720.
McGuire, M. K., &, Cochran, D. L., (2003) Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 2: Histological evaluation. Journal of Periodontology 74, 1126-1135.
McGuire, M. K., &, Nunn, M., (2003) Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 1: Comparison of clinical parameters. Journal of Periodontology 74, 1110-1125.
Miller, P. D. Jr, (1985) A classification of marginal tissue recession. The International Journal of Periodontics & Restorative Dentistry 5, 8-13.
Miller, P. D. Jr, (1988) Regenerative and reconstructive periodontal plastic surgery. Mucogingival surgery. Dental Clinics of North America 32, 287-306.
Modica, F., Del Pizzo, M., Roccuzzo, M., &, Romagnoli, R,. (2000) Coronally advanced flap for the treatment of buccal gingival recessions with and without enamel matrix derivative. A split-mouth study. Journal of Periodontology 71, 1693-1698.
Muller, H. P., Stahl, M., &, Eger, T,. (1999) Root coverage employing an envelope technique or guided tissue regeneration with a bioabsorbable membrane. Journal of Periodontology 70, 743-751.
Paolantonio, M., di Murro, C., Cattabriga, A., &, Cattabriga, M,. (1997) Subpedicle connective tissue graft versus free gingival graft in the coverage of exposed root surfaces. A 5-year clinical study. Journal of Clinical Periodontology 24, 51-56.
Paolantonio, M., Dolci, M., Esposito, P., D'Archivio, D., Lisanti, L., Di Luccio, A., &, Perinetti, G,. (2002) Subpedicle acellular dermal matrix graft and autogenous connective tissue graft in the treatment of gingival recessions: a comparative 1-year clinical study. Journal of Periodontology 73, 1299-1307.
Pini Prato, G., Tinti, C., Vincenzi, G., Magnani, C., Cortellini, P., &, Clauser, C,. (1992) Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession. Journal of Periodontology 63, 919-928.
de Queiroz Cortes, A., Sallum, A. W., Casati, M. Z., &, Nociti, F. H. Jr,. &, Sallum, E. A,. (2006) A two-year prospective study of coronally positioned flap with or without acellular dermal matrix graft. Journal of Clinical Periodontology 33, 683-689.
Raetzke, P. B., (1985) Covering localized areas of root exposure employing the "envelope" technique. Journal of Periodontology 56, 397-402.
Roccuzzo, M., &, Buser, D., (1996) Treatment of buccal gingival recessions with e-PTFE membranes and miniscrews: surgical procedure and results of 12 cases. Int J Periodontics Restorative Dent 16, 356-365.
Roccuzzo, M., Bunino, M., Needleman, I., &, Sanz, M,. (2002). Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. Journal of Clinical Periodontology 29 (Suppl. 3), 178-194; discussion 195-176.
Rompen, E. H., Kohl, J., Nusgens, B., &, Lapiere, C. M,. (1993) Kinetic aspects of gingival and periodontal ligament fibroblast attachment to surface-conditioned dentin. Journal of Dental Research 72, 607-612.
Rotundo, R., Nieri, M., Mori, M., Clauser, C., &, Prato, G. P,. (2008) Aesthetic perception after root coverage procedure. Journal of Clinical Periodontology 35, 705-712.
Shavers, V. L., Bakos, A., &, Sheppard, V. B,. (2010) Race, ethnicity, and pain among the U.S. adult population. Journal of Health Care for the Poor and Underserved 21, 177-220.
Spahr, A., Haegewald, S., Tsoulfidou, F., Rompola, E., Heijl, L., Bernimoulin, J. P., Ring, C., Sander, S., &, Haller, B,. (2005) Coverage of Miller class I and II recession defects using enamel matrix proteins versus coronally advanced flap technique: a 2-year report. Journal of Periodontology 76, 1871-1880.
Staffileno, H,. (1964) Management of gingival recession and root exposure problems associated with periodontal disease. Dental Clinics of North America 3, 1111-1120.
Sullivan, H. C., &, Atkins, J. H., (1968) Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics 6, 121-129.
Tarnow, D. P., (1986) Semilunar coronally repositioned flap. Journal of Clinical Periodontology 13, 182-185.
Tozum, T. F., (2006) Root coverage with subepithelial connective tissue grafts and modified tunnel technique. An evaluation of long-term results. N Y State Dent J 72, 38-41.
Tozum, T. F., &, Dini, F. M., (2003) Treatment of adjacent gingival recessions with subepithelial connective tissue grafts and the modified tunnel technique. Quintessence International 34, 7-13.
Trombelli, L., &, Scabbia, A., (1997) Healing response of gingival recession defects following guided tissue regeneration procedures in smokers and non-smokers. Journal of Clinical Periodontology 24, 529-533.
Vanheusden, A., Nusgens, B., Goffinet, G., Zahedi, S., Lapière, C. M., &, Rompen, E., (1998) In vitro modulation of human gingival epithelial cell attachment and migration by minocycline-HCL. Journal of Periodontal Research 33, 377-385.
Vanheusden, A. J., Goffinet, G., Zahedi, S., Nusgens, B., Lapière, C. M., &, Rompen, E.H., (1999) In vitro stimulation of human gingival epithelial cell attachment to dentin by surface conditioning. Journal of Periodontal 70, 594-603.
Wilson, T. G. Jr, McGuire, M. K., &, Nunn, M. E,. (2005) Evaluation of the safety and efficacy of periodontal applications of a living tissue-engineered human fibroblast-derived dermal substitute. II. Comparison to the subepithelial connective tissue graft: a randomized controlled feasibility study. Journal of Periodontology 76, 881-889.
Woodyard, J. G., Greenwell, H., Hill, M., Drisko, C., Iasella, J. M., &, Scheetz, J,. (2004) The clinical effect of acellular dermal matrix on gingival thickness and root coverage compared to coronally positioned flap alone. Journal of Periodontology 75, 44-56.
Young, E. E., Lariviere, W. R., &, Belfer, I,. (2012) Genetic basis of pain variability: recent advances. Journal of Medical Genetics 49, 1-9.
Zabalegui, I., Sicilia, A., Cambra, J., Gil, J., &, Sanz, M,. (1999) Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report. Int J Periodontics Restorative Dent 19, 199-206.
Zucchelli, G., &, De Sanctis, M., (2000) Treatment of multiple recession-type defects in patients with esthetic demands. Journal of Periodontology 71, 1506-1514.
Zucchelli, G., &, De Sanctis, M., (2005) Long-term outcome following treatment of multiple Miller class I and II recession defects in esthetic areas of the mouth. Journal of Periodontology 76, 2286-2292.
Zucchelli, G., Clauser, C., De Sanctis, M., &, Calandriello, M,. (1998) Mucogingival versus guided tissue regeneration procedures in the treatment of deep recession type defects. Journal of Periodontology 69, 138-145.