Coronally advanced flap and composite restoration of the enamel with or without connective tissue graft for the treatment of single maxillary gingival recession with non-carious cervical lesion. A randomized controlled clinical trial.
aesthetics
connective tissue graft
coronally advanced flap
gingival recession
multiple gingival recessions
root coverage
Journal
Journal of clinical periodontology
ISSN: 1600-051X
Titre abrégé: J Clin Periodontol
Pays: United States
ID NLM: 0425123
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
24
03
2019
revised:
25
11
2019
accepted:
02
12
2019
pubmed:
8
12
2019
medline:
2
10
2020
entrez:
8
12
2019
Statut:
ppublish
Résumé
Aim of this study was to compare coronally advanced flap (CAF) and composite restoration of the cement-enamel junction (CEJ) with or without connective tissue graft (CTG) for treatment of single maxillary gingival recession with non-carious cervical lesion (NCCL). Thirty patients with single gingival recessions and previously restored NCCL were randomly allocated to the two groups. A masked examiner evaluated recession reduction (RecRed), complete root coverage (CRC), keratinized tissue (KT) gain, increase in gingival thickness (GT), patient satisfaction and Root coverage Esthetic Score (RES). No significant difference for RecRed and CRC was detected at 12 months. CAF + CTG resulted in greater increase of KT width and thickness (p < .001). An interaction between baseline GT and type of treatment was reported, suggesting that when baseline GT was ≤0.84 mm adding CTG led to higher RecRed, while for values >0.84 mm the use of CAF was associated with better outcomes. Similarly, CAF alone provided better final RES score for baseline GT > 0.82 mm. Both procedures were effective for root coverage at single RT1 recession with previously restored CEJ. Adding a CTG under CAF should be considered for Rec with thin gingival phenotype.
Sections du résumé
BACKGROUND
Aim of this study was to compare coronally advanced flap (CAF) and composite restoration of the cement-enamel junction (CEJ) with or without connective tissue graft (CTG) for treatment of single maxillary gingival recession with non-carious cervical lesion (NCCL).
MATERIAL AND METHODS
Thirty patients with single gingival recessions and previously restored NCCL were randomly allocated to the two groups. A masked examiner evaluated recession reduction (RecRed), complete root coverage (CRC), keratinized tissue (KT) gain, increase in gingival thickness (GT), patient satisfaction and Root coverage Esthetic Score (RES).
RESULTS
No significant difference for RecRed and CRC was detected at 12 months. CAF + CTG resulted in greater increase of KT width and thickness (p < .001). An interaction between baseline GT and type of treatment was reported, suggesting that when baseline GT was ≤0.84 mm adding CTG led to higher RecRed, while for values >0.84 mm the use of CAF was associated with better outcomes. Similarly, CAF alone provided better final RES score for baseline GT > 0.82 mm.
CONCLUSION
Both procedures were effective for root coverage at single RT1 recession with previously restored CEJ. Adding a CTG under CAF should be considered for Rec with thin gingival phenotype.
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
362-371Informations de copyright
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Baldi, C., Pini-Prato, G., Pagliaro, U., Nieri, M., Saletta, D., Muzzi, L., & Cortellini, P. (1999). Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. Journal of Periodontology, 70, 1077-1084. https://doi.org/10.1902/jop.1999.70.9.1077
Cairo, F.. (2017). Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontology 2000, 75, 296-316.
Cairo, F., Cortellini, P., Pilloni, A., Nieri, M., Cincinelli, S., Amunni, F., … Tonetti, M. S. (2016). 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. Journal of Clinical Periodontology, 43, 849-856. https://doi.org/10.1111/jcpe.12590
Cairo, F., Cortellini, P., Tonetti, M., Nieri, M., Mervelt, J., Cincinelli, S., & Pini-Prato, G. (2012). Coronally advanced flap with and with- out connective tissue graft for the treatment of single maxillary gingival recession with loss of inter-dental attachment. A randomized controlled clinical trial. Journal of Clinical Periodontology, 39, 760-768. https://doi.org/10.1111/j.1600-051X.2012.01903.x
Cairo, F., Cortellini, P., Tonetti, M., Nieri, M., Mervelt, J., Pagavino, G., & Pini-Prato, G. P. (2015). Stability of root coverage outcomes at single maxillary gingival recession with loss of interdental attachment: 3-year extension results from a randomized, controlled, clinical trial. Journal of Clinical Periodontology, 42, 575-581. https://doi.org/10.1111/jcpe.12412
Cairo, F., Nieri, M., Cincinelli, S., Mervelt, J., & Pagliaro, U. (2011). The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: An explorative and reliability study. Journal of Clinical Periodontology, 38, 661-666. https://doi.org/10.1111/j.1600-051X.2011.01732.x
Cairo, F., Nieri, M., & Pagliaro, U. (2014). Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. Journal of Clinical Periodontology 41. (Suppl 15) S44-S62. https://doi.org/10.1111/jcpe.12182
Cairo, F., Pagliaro, U., Buti, J., Baccini, M., Graziani, F., Tonelli, P., … Tonetti, M. S. (2016). Root coverage procedures improve patient aesthetics. A systematic review and Bayesian network meta-analysis. Journal of Clinical Periodontology, 43, 965-975. https://doi.org/10.1111/jcpe.12603
Cairo, F., & Pini-Prato, G. P. (2010). A technique to identify and reconstruct the cement-enamel junction level using combined periodontal and restorative treatment of gingival recession. A prospective clinical study. International Journal Periodontics and Restorative Dentistry, 30, 573-581.
Cairo, F., Pagliaro, U., & Nieri, M. (2008). Treatment of gingival recession with coronally advanced flap procedures: a systematic review. Journal of clinical periodontology, 35, 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. https://doi.org/10.1902/jop.2009.080565
Cortellini, P., & Bissada, N. F. (2018). Muco-gingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. Journal of Periodontology, 89, S204-S213. https://doi.org/10.1002/JPER.16-0671
Cortellini, P., Tonetti, M., Baldi, C., Francetti, L., Rasperini, G., Rotundo, R., … Pini-Prato, G. P. (2009). Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? A multi-centre, randomized, double-blind, clinical trial. Journal of Clinical Periodontology, 36, 68-79. https://doi.org/10.1111/j.1600-051X.2008.01346.x
Holbrook, T., & Ochsenbein, C. (1983). Complete coverage of the denuded root surface with a one-stage gingival graft. International Journal Periodontics and Restorative Dentistry, 3, 8-27.
Hwang, D., & Wang, H. L. (2006). Flap thickness as a predictor of root coverage: A systematic review. Journal of Periodontology, 77, 1625-1634. https://doi.org/10.1902/jop.2006.060107
Jepsen, S., Caton, J. G., Albandar, J. M., Bissada, N. F., Bouchard, P., Cortellini, P., … Yamazaki, K. (2018). 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. Journal of Clinical Periodontology, 45(Suppl 20), S219-S229. https://doi.org/10.1111/jcpe.12951
Pini Prato, G. P., Baldi, C., Nieri, M., Franceschi, D., Cortellini, P., Clauser, C., … Muzzi, L. (2005). Coronally advanced flap: The post-surgical position of the gingival margin is an important factor for achieving complete root coverage. Journal of Periodontology, 76, 713-722. https://doi.org/10.1902/jop.2005.76.5.713
Pini-Prato, G., Cairo, F., Nieri, M., Franceschi, D., Rotundo, R., & Cortellini, P. (2010). Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: A split-mouth study with a 5-year follow-up. Journal of Clinical Periodontology, 37, 644-650. https://doi.org/10.1111/j.1600-051X.2010.01559.x
Pini-Prato, G., Franceschi, D., Cairo, F., Nieri, M., & Rotundo, R. (2010). Classification of dental surface defects in areas of gingival recession. Journal of Periodontology, 81, 885-890. https://doi.org/10.1902/jop.2010.090631
Santamaria, M. P., da Silva Feitosa, D., Nociti, F. H., Casati, M. Z., Sallum, A. W., & Sallum, E. A. (2009). Cervical restoration and the amount of soft tissue coverage achieved by coronally advanced flap: A 2-year follow-up randomized-controlled clinical trial. Journal of Clinical Periodontology, 36, 434-441. https://doi.org/10.1111/j.1600-051X.2009.01389.x
Santamaria, M. P., Silveira, C. A., Mathias, I. F., Neves, F., Dos Santos, L. M., Jardini, M., … Bresciani, E. (2018). Treatment of single maxillary gingival recession associated with non-carious cervical lesion: Randomized clinical trial comparing connective tissue graft alone to graft plus partial restoration. Journal of Clinical Periodontology, 45, 968-976. https://doi.org/10.1111/jcpe.12907
Tonetti, M. S., Cortellini, P., Pellegrini, G., Nieri, M., Bonaccini, D., Allegri, M., … Zuhr, O. (2018). 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. Journal of Clinical Periodontology, 45, 78-88. https://doi.org/10.1111/jcpe.12834
Tonetti, M. S., Jepsen, S., & Working group 2 of the European Workshop on Periodontology (2014). Clinical efficacy of periodontal plastic surgery procedures: Consensus report of Group 2 of the 10th European Workshop on Periodontology. Journal of Clinical Periodontology, 41, S36-S43. https://doi.org/10.1111/jcpe.12219
Zucchelli, G., Gori, G., Mele, M., Stefanini, M., Mazzotti, C., Marzadori, M., … De Sanctis, M. (2011). Non-carious cervical lesions associated with gingival recessions: A decision-making process. Journal of Periodontology, 82, 1713-1724. https://doi.org/10.1902/jop.2011.110080
Zucchelli, G., Testori, T., & De Sanctis, M. (2006). Clinical and anatomical factors limiting treatment outcomes of gingival recession: A new method to predetermine the line of root coverage. Journal of Periodontology, 77, 714-721. https://doi.org/10.1902/jop.2006.050038