This clinical study was designed to determine whether the thickness of the flap can influence root coverage when gingival recessions associated with traumatic toothbrushing are treated using a coronally advanced flap (CAF). Nineteen patients, aged from 25 to 57 years, with high levels of oral hygiene (full-mouth plaque scores <20%) were selected for the study. Each patient contributed with one Miller Class I or II maxillary or mandibular recession. A total of 19 recessions > or =2 mm were treated. After local anesthesia and before flap elevation, the exposed root surface was planed with a sharp curet. A trapezoidal full- and partial-thickness flap was then elevated, displaced coronally, and sutured to cover the treated root surface. Before suturing, flap thickness was measured in the alveolar mucosa with a gauge. After surgery, all patients were recalled for control and professional prophylaxis once a week during the first month and monthly up to the third month. The mean initial recession depth was 3.0+/-0.9 mm. Mean flap thickness (FT) was 0.7+/-0.2 mm. Three months later, mean recession depth was 0.6+/-0.6 (P <0.0001) and mean recession reduction was 2.4+/-0.7 mm. Mean root coverage was 82+/-17%. Flap thickness >0.8 mm was associated with 100% of root coverage. The results of this study indicate that there is a direct relation between flap thickness and recession reduction (P <0.0001).

The purpose of this study was to identify factors which might affect the healing response in intrabony defects treated with guided tissue regeneration. Selected sites presented with deep periodontal lesions with 1, 2, and 3 wall combination intrabony component of 6.1 +/- 2.5 mm. The significance of patient, tooth, and defect characteristics and surgical parameters as predictor variables affecting the regenerative outcome before and following the removal of the barrier membrane was assessed. Outcome was measured as tissue gain under the membrane, regenerated probing attachment level (PAL), and bone fill. The total depth of the intrabony component and the radiographic defect angle significantly affected the amount of tissue gain. Seventy-five percent (75%) of the variability of regenerated PAL and bone fill was explained in terms of tissue gain under the membrane, radiographic width of the defect angle, full mouth bleeding score, and presence or absence of flap coverage of the newly formed tissue. Control of the identified predictor variables might improve the extent and predictability of guided tissue regeneration in the treatment of deep intrabony defects.

This retrospective study examined the effect of cigarette smoking on the healing response following guided tissue regeneration (GTR) in deep infrabony defects. 71 defects in 51 patients underwent GTR with teflon membranes. 20 patients (32 defects) smoked more than 10 cigarettes per day, while 31 patients (39 defects) did not smoke. Clinical measurements were available at baseline, at membrane removal and at the 1‐year follow‐up. The oral hygiene of both groups was good, but smokers had significantly higher full mouth plaque scores. No significant differences were observed between smokers and non‐smokers in terms of % of tissue gained at membrane removal. At the 1‐year follow up, however, smokers gained significantly less probing attachment level than non‐smokers (2.1 ± 1.2 mm compared with 5.2 ± 1.9 mm). A multivariate model, correcting for the oral hygiene level of the patients and the depth of the infrabony component, indicated that smoking was in itself a significant factor in determining the clinical outcome. A risk‐assessment analysis indicated that smokers had a significantly greater risk than non‐smokers to display a reduced probing attachment level gain following GTR. It is concluded that cigarette smoking is associated with a reduced healing response after GTR treatment, and may be responsible, at least in part, for the observed results.

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: 644-650. doi: 10.1111/j.1600-051X.2010.01559.x Abstract Aim: The aim of this long-term study was to compare the clinical outcomes of coronally advanced flap (CAF) alone versus coronally advanced flap plus connective tissue graft (CAF1CTG) in the treatment of multiple gingival recessions using a splitmouth design over 5 years of follow-up. Materials and Methods: A total of 13 patients (mean age 31.4 years) showing multiple bilateral gingival recessions were treated. On one side, CAF1CTG was used, while in the contra-lateral side, a CAF alone was applied. Clinical outcomes were evaluated at the 6-month, 1-year and 5-year follow-ups. Results: A total of 93 Miller class I, II and III gingival recessions were treated. In the CAF1CTG-treated sites, the baseline gingival recession was 3.6 AE 1.3 mm, while in the CAF-treated sites, it was 2.9 AE 1.3 mm (p 5 0.0034). No difference in terms of the number of sites with complete root coverage (CRC) was reported (OR 5 0.49, p 5 0.1772) at the 6-month follow-up. At the 5-year follow-up, CAF1CTG-treated sites showed a higher percentage of sites with CRC (52%) than CAF-treated sites (35%) (OR 5 3.94; p 5 0.0239). An apical relapse of the gingival margin in CAFtreated sites was observed while a coronal improvement of the margin was noted in CAF1CTG-treated sites between the 6-month and the 5-year follow-ups. Conclusions: CAF1CTG provided better CRC than CAF alone in the treatment of multiple gingival recessions at the 5-year follow-up.

Both treatments can provide CRC in single gingival recession with inter-dental CAL loss. The application of CTG under CAF resulted in predictable CRC when inter-dental CAL was ≤ 3 mm.