Digital workflow to assess gingival recession coverage independently of the cemento-enamel Junction: a prospective clinical study using the modified coronally advanced tunnel technique with porcine dermal matrix.
Coronally advanced tunnel technique
Digital measurement
Gingival recession
Recession type
Root coverage
Journal
Clinical oral investigations
ISSN: 1436-3771
Titre abrégé: Clin Oral Investig
Pays: Germany
ID NLM: 9707115
Informations de publication
Date de publication:
27 Oct 2024
27 Oct 2024
Historique:
received:
24
03
2024
accepted:
14
09
2024
medline:
28
10
2024
pubmed:
28
10
2024
entrez:
28
10
2024
Statut:
epublish
Résumé
The limited number of studies using digital workflows to measure soft tissue changes depend on the cemento-enamel junction (CEJ), which has been reported to be unreliable. Our primary objective was to apply an advanced digital assessment method, measuring independent from the CEJ to evaluate the modified coronally advanced tunnel technique (MCAT) with a porcine dermal matrix (PDM) for gingival recession coverage. Patients with type RT1 and RT2 gingival recessions were treated with the MCAT and a PDM. Plaster casts (preoperative and 6 months postoperative) were digitalized. Subsequent stereolithography (STL)-files were imported and superimposed in the open-source software GOM Inspect for computer-based analysis. Recession depth, mean root and complete root coverage (mRC and cRC), mean recession reduction (mRR) and gingival thickness were evaluated. Statistical analysis was performed using mixed linear models. A total of 82 teeth (19 patients) were included in the study. Healing was uneventful in all patients. The mean preoperative recession depth was 1.34 ± 0.92 mm. mRC was 65.06 ± 48.26%, cRC was 25.61%, mRR was 0.87 ± 0.83 mm, and gingival thickness gain was 0.33 ± 0.30 mm, with comparable results for RT1 and RT2. Neither tooth type nor type of jaw had any effect on the amount of root coverage. The digital evaluation workflow employed offers an approach to evaluate gingival recession coverage outcomes independent of the CEJ. The PDM used in combination with the MCAT shows promising results for root coverage.
Identifiants
pubmed: 39463191
doi: 10.1007/s00784-024-05936-4
pii: 10.1007/s00784-024-05936-4
doi:
Types de publication
Journal Article
Clinical Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
613Informations de copyright
© 2024. The Author(s).
Références
Kassab MM, Cohen RE (2003) The etiology and prevalence of gingival recession. J Am Dent Assoc 134:220–225. https://doi.org/10.14219/jada.archive.2003.0137
doi: 10.14219/jada.archive.2003.0137
pubmed: 12636127
Löe H, Anerud A, Boysen H (1992) The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession. 0022-3492 63:489–495. https://doi.org/10.1902/jop.1992.63.6.489
doi: 10.1902/jop.1992.63.6.489
pubmed: 1625148
Eger T, Müller HP, Heinecke A (1996) Ultrasonic determination of gingival thickness. Subject variation and influence of tooth type and clinical features. J Clin Periodontol 23:839–845. https://doi.org/10.1111/j.1600-051x.1996.tb00621.x
doi: 10.1111/j.1600-051x.1996.tb00621.x
pubmed: 8891935
Zucchelli G, Mounssif I (2015) Periodontal plastic surgery. Periodontol 2000 68:333–368. https://doi.org/10.1111/prd.12059
doi: 10.1111/prd.12059
pubmed: 25867992
Yoneyama T, Okamoto H, Lindhe J et al (1988) Probing depth, attachment loss and gingival recession. Findings from a clinical examination in Ushiku, Japan. J Clin Periodontol 15:581–591. https://doi.org/10.1111/j.1600-051X.1988.tb02133.x
doi: 10.1111/j.1600-051X.1988.tb02133.x
pubmed: 3264295
Albandar JM, Kingman A (1999) Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988–1994. 0022–3492 70:30–43. https://doi.org/10.1902/jop.1999.70.1.30
Cairo F, Nieri M, Cincinelli S et al (2011) The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 38:661–666. https://doi.org/10.1111/j.1600-051X.2011.01732.x
doi: 10.1111/j.1600-051X.2011.01732.x
pubmed: 21507033
Zuhr O, Fickl S, Wachtel H et al (2007) Covering of gingival recessions with a modified microsurgical tunnel technique: case report. Int J Periodontics Restor Dent 27:457–463
Tözüm TF, Dini FM (2003) Treatment of adjacent gingival recessions with subepithelial connective tissue grafts and the modified tunnel technique
Aroca S, Molnár B, Windisch P et al (2013) Treatment of multiple adjacent Miller class I and II gingival recessions with a modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial. J Clin Periodontol 40:713–720. https://doi.org/10.1111/jcpe.12112
doi: 10.1111/jcpe.12112
pubmed: 23627374
Sculean A, Cosgarea R, Stähli A et al (2014) The modified coronally advanced tunnel combined with an enamel matrix derivative and subepithelial connective tissue graft for the treatment of isolated mandibular Miller Class I and II gingival recessions: a report of 16 cases. Quintessence Int, 45(10), 829–835. Quintessence international (Berlin, Germany: 1985):829–835
Sculean A, Cosgarea R, Stähli A et al (2016) Treatment of multiple adjacent maxillary Miller Class I, II, and III gingival recessions with the modified coronally advanced tunnel, enamel matrix derivative, and subepithelial connective tissue graft: a report of 12 cases. Quintessence Int (Berlin Germany: 1985) 47:653–659. https://doi.org/10.3290/j.qi.a36562
doi: 10.3290/j.qi.a36562
Sculean A, Cosgarea R, Katsaros C et al (2017) Treatment of single and multiple Miller Class I and III gingival recessions at crown-restored teeth in maxillary esthetic areas
Stähli A, Imber J-C, Raptis E et al (2020) Effect of enamel matrix derivative on wound healing following gingival recession coverage using the modified coronally advanced tunnel and subepithelial connective tissue graft: a randomised, controlled, clinical study. Clin Oral Invest 24:1043–1051. https://doi.org/10.1007/s00784-019-03008-6
doi: 10.1007/s00784-019-03008-6
Chambrone L, Tatakis DN (2015) Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 86:8–51. https://doi.org/10.1902/jop.2015.130674
doi: 10.1902/jop.2015.130674
Vincent-Bugnas S, Laurent J, Naman E et al (2021) Treatment of multiple gingival recessions with xenogeneic acellular dermal matrix compared to connective tissue graft: a randomized split-mouth clinical trial. J Periodontal Implant Sci 51:77–87. https://doi.org/10.5051/jpis.2002400120
doi: 10.5051/jpis.2002400120
pubmed: 33913631
Imber J-C, Kasaj A (2021) Treatment of Gingival recession: when and how? Int Dent J 71:178–187. https://doi.org/10.1111/idj.12617
doi: 10.1111/idj.12617
pubmed: 34024328
pmcid: 9275303
Guarnieri R, Reda R, Di Nardo D et al (2022) In Vitro Direct and Indirect cytotoxicity comparative analysis of one pre-hydrated versus one dried acellular porcine dermal matrix. Mater (Basel) 15. https://doi.org/10.3390/ma15051937
Suárez-López Amo D, Rodriguez F, Asa’ad JC F et al (2019) Comparison of two soft tissue substitutes for the treatment of gingival recession defects: an animal histological study. J Appl Oral Sci 27:e20180584. https://doi.org/10.1590/1678-7757-2018-0584
doi: 10.1590/1678-7757-2018-0584
Maluta R, Monteiro MF, Peruzzo DC et al (2021) Root coverage of multiple gingival recessions treated with coronally advanced flap associated with xenogeneic acellular dermal matrix or connective tissue graft: a 6-month split-mouth controlled and randomized clinical trial. Clin Oral Investig 25:5765–5773. https://doi.org/10.1007/s00784-021-03879-8
doi: 10.1007/s00784-021-03879-8
pubmed: 33723662
Miguel MMV, Ferraz LFF, Rossato A et al (2022) Comparison between connective tissue graft and xenogeneic acellular dermal matrix to treat single gingival recession: a data reanalysis of randomized clinical trials. J Esthetic Restor Dentistry 34:1156–1165. https://doi.org/10.1111/jerd.12936
doi: 10.1111/jerd.12936
Pietruska M, Skurska A, Podlewski Ł et al (2019) Clinical evaluation of Miller class I and II recessions treatment with the use of modified coronally advanced tunnel technique with either collagen matrix or subepithelial connective tissue graft: a randomized clinical study. J Clin Periodontol 46:86–95. https://doi.org/10.1111/jcpe.13031
doi: 10.1111/jcpe.13031
pubmed: 30362599
Kuralt M, Gašperšič R, Fidler A (2021) The precision of gingival recession measurements is increased by an automated curvature analysis method. BMC Oral Health 21:505. https://doi.org/10.1186/s12903-021-01858-9
doi: 10.1186/s12903-021-01858-9
pubmed: 34620155
pmcid: 8499415
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. 0022–3492 77:714–721. https://doi.org/10.1902/jop.2006.050038
Pini-Prato G, Franceschi D, Cairo F et al (2010) Classification of dental surface defects in areas of gingival recession. J Periodontol 81:885–890. https://doi.org/10.1902/jop.2010.090631
doi: 10.1902/jop.2010.090631
pubmed: 20450362
Rebele SF, Zuhr O, Schneider D et al (2014) Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part II. Volumetric studies on healing dynamics and gingival dimensions. J Clin Periodontol 41:593–603. https://doi.org/10.1111/jcpe.12254
doi: 10.1111/jcpe.12254
pubmed: 24708338
Kuralt M, Gašperšič R, Fidler A (2022) Methods and parameters for digital evaluation of gingival recession: a critical review. J Dent 118:103793. https://doi.org/10.1016/j.jdent.2021.103793
doi: 10.1016/j.jdent.2021.103793
pubmed: 34481931
Iglhaut G, Allen EP, Sculean A et al (2023) Root Coverage using a Novel Porcine Acellular dermal matrix: Case reports of different minimally invasive techniques with a 3-Year follow-up. Int J Periodontics Restor Dent 43:47–54. https://doi.org/10.11607/prd.5769
doi: 10.11607/prd.5769
Cairo F, Rotundo R, Miller PD et al (2009) Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. 0022–3492 80:705–710. https://doi.org/10.1902/jop.2009.080565
Di Gianfilippo R, Wang I-C, Steigmann L et al (2021) Efficacy of microsurgery and comparison to macrosurgery for gingival recession treatment: a systematic review with meta-analysis. Clin Oral Invest 25:4269–4280. https://doi.org/10.1007/s00784-021-03954-0
doi: 10.1007/s00784-021-03954-0
Xue F, Zhang R, Cai Y et al (2021) Three-dimensional quantitative measurement of buccal augmented tissue with modified coronally advanced tunnel technique and de-epithelialized gingival graft: a prospective case series. BMC Oral Health 21:157. https://doi.org/10.1186/s12903-021-01522-2
doi: 10.1186/s12903-021-01522-2
pubmed: 33765988
pmcid: 7992864
Aroca S, Keglevich T, Nikolidakis D et al (2010) Treatment of class III multiple gingival recessions: a randomized-clinical trial. J Clin Periodontol 37:88–97. https://doi.org/10.1111/j.1600-051X.2009.01492.x
doi: 10.1111/j.1600-051X.2009.01492.x
pubmed: 19968743
Koo TK, Li MY (2016) A Guideline of selecting and reporting Intraclass correlation coefficients for Reliability Research. J Chiropr Med 15:155–163. https://doi.org/10.1016/j.jcm.2016.02.012
doi: 10.1016/j.jcm.2016.02.012
pubmed: 27330520
pmcid: 4913118
Cieślik-Wegemund M, Wierucka-Młynarczyk B, Tanasiewicz M et al (2016) Tunnel technique with collagen matrix compared with connective tissue graft for treatment of Periodontal recession: a Randomized Clinical Trial. J Periodontol 87:1436–1443. https://doi.org/10.1902/jop.2016.150676
doi: 10.1902/jop.2016.150676
pubmed: 27424564
Moslemi N, Mousavi Jazi M, Haghighati F et al (2011) Acellular dermal matrix allograft versus subepithelial connective tissue graft in treatment of gingival recessions: a 5-year randomized clinical study. J Clin Periodontol 38:1122–1129. https://doi.org/10.1111/j.1600-051X.2011.01789.x
doi: 10.1111/j.1600-051X.2011.01789.x
pubmed: 22092784
Paolantonio M, Dolci M, Esposito P et al (2002) Subpedicle acellular dermal matrix graft and autogenous connective tissue graft in the treatment of gingival recessions: a comparative 1-year clinical study. 0022–3492 73:1299–1307. https://doi.org/10.1902/jop.2002.73.11.1299
Aichelmann-Reidy ME, Yukna RA, Evans GH et al (2001) Clinical evaluation of acellular allograft dermis for the treatment of human gingival recession. 0022-3492 72:998–1005. https://doi.org/10.1902/jop.2001.72.8.998
doi: 10.1902/jop.2001.72.8.998
pubmed: 11525450
Chambrone L, de Castro Pinto RCN, Chambrone LA (2019) The concepts of evidence-based periodontal plastic surgery: application of the principles of evidence-based dentistry for the treatment of recession-type defects. Periodontol 2000 79:81–106. https://doi.org/10.1111/prd.12248
doi: 10.1111/prd.12248
pubmed: 30892767
Fageeh HN, Meshni AA, Jamal HA et al (2019) The accuracy and reliability of digital measurements of gingival recession versus conventional methods. BMC Oral Health 19:154. https://doi.org/10.1186/s12903-019-0851-0
doi: 10.1186/s12903-019-0851-0
pubmed: 31311544
pmcid: 6636111
Dritsas K, Halazonetis D, Ghamri M et al (2023) Accurate gingival recession quantification using 3D digital dental models. Clin Oral Invest 27:1697–1705. https://doi.org/10.1007/s00784-022-04795-1
doi: 10.1007/s00784-022-04795-1
Paolantonio M (2002) Treatment of gingival recessions by combined periodontal regenerative technique, guided tissue regeneration, and subpedicle connective tissue graft. A comparative clinical study. 0022-3492 73:53–62. https://doi.org/10.1902/jop.2002.73.1.53
doi: 10.1902/jop.2002.73.1.53
pubmed: 11846201
Zweers J, Thomas RZ, Slot DE et al (2014) Characteristics of periodontal biotype, its dimensions, associations and prevalence: a systematic review. J Clin Periodontol 41:958–971. https://doi.org/10.1111/jcpe.12275
doi: 10.1111/jcpe.12275
pubmed: 24836578
Fons-Badal C, Alonso Pérez-Barquero J, Martínez-Martínez N et al (2020) A novel, fully digital approach to quantifying volume gain after soft tissue graft surgery. A pilot study. J Clin Periodontol 47:614–620. https://doi.org/10.1111/jcpe.13235
doi: 10.1111/jcpe.13235
pubmed: 31860133
Zuhr O, Rebele SF, Vach K et al (2020) Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 2-year results of an RCT using 3D digital measuring for volumetric comparison of gingival dimensions. J Clin Periodontol 47:1144–1158. https://doi.org/10.1111/jcpe.13328
doi: 10.1111/jcpe.13328
pubmed: 32510644
Cosgarea R (2021) Long-term results after treatment of multiple adjacent gingival recessions with the modified coronally advanced tunnel and a porcine acellular dermal matrix
Chambrone LA, Chambrone L (2006) Subepithelial connective tissue grafts in the treatment of multiple recession-type defects. 0022-3492 77:909–916. https://doi.org/10.1902/jop.2006.050249
doi: 10.1902/jop.2006.050249
pubmed: 16671886
Aroca S, Barbieri A, Clementini M et al (2018) Treatment of class III multiple gingival recessions: prognostic factors for achieving a complete root coverage. J Clin Periodontol 45:861–868. https://doi.org/10.1111/jcpe.12923
doi: 10.1111/jcpe.12923
pubmed: 29757468
Cosgarea et al. (2016) Clinical evaluation of a porcine acellular dermal matrix for the treatment of multiple adjacent class I, II, and III gingival recessions using the modified coronally
Clauser C, Nieri M, Franceschi D et al (2003) Evidence-based mucogingival therapy. Part 2: ordinary and individual patient data meta-analyses of surgical treatment of recession using complete root coverage as the outcome variable. 0022–3492 74:741–756. https://doi.org/10.1902/jop.2003.74.5.741