Clinical evaluation of expanded mesh connective tissue graft in the treatment for multiple adjacent gingival recessions in the esthetic zone

Abstract

Background:Multiple approaches have been used to replace lost, damaged or diseased gingival tissues. The connective tissue graft (CTG) procedure is the golden standard method for root coverage. Although multiple sites often need grafting, the palatal mucosa supplies only a limited area of grafting material. To overcome this limitation, expanded mesh graft provides a method whereby a graft can be stretched to cover a large area. The aim of this study was to evaluate the effectiveness and the predictability of expanded mesh CTG (e-MCTG) in the treatment of adjacent multiple gingival recessions.Materials and Methods:Sixteen patients aged 20–50 years contributed to 55 sites, each site falling into at least three adjacent Miller's Class 1 or Class 2 gingival recession. The CTG obtained from the palatal mucosa was expanded to cover the recipient bed, which was 1.5 times larger than the graft. Clinical measurements were recorded at baseline and 3 months, 12 months postoperatively.Results:A mean coverage of 1.96 mm ± 0.66 mm and 2.22 mm ± 0.68 mm was obtained at the end of 3rd and 12th month, respectively. Twelve months after surgery a statistically significant increase in CAL (2.2 mm ± 0.68 mm, P < 0.001) and increasing WKT (1.75 ± 0.78, P < 0.001) were obtained. In 80% of the treated sites, 100% root coverage was achieved (mean 93.5%).Conclusions:The results of this study demonstrated that multiple adjacent recessions were treated by using e-MCTG technique can be applied and highly predictable root coverage can be achieved.

Root Coverage Procedures for Multiple Recession Defects

“…To overcome the limited amount of SCTG underneath palatal tissue, Shanmugam et al expanded the harvested graft by making alternating incisions on each edge to cover the recipient bed completely [16]. The expanded mesh-CTG technique yielded mean root coverage of 94% at 12 months postoperatively.…”

“…Studies using subepithelial connective tissue graft (SCTG) on multiple Miller Class I and II gingival recession defects show mean percent root coverage ranging from 77 to 98%, with only 4 out of 17 studies reporting less than 90% [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Other than coronally positioned flaps, flap designs used include tunnel technique [12,13], modified coronally advanced tunnel (MCAT) technique [26], modified coronally advanced flap (MCAF) technique by Zucchelli and De Sanctis [17,29], and a modified coronally positioned flap with a horizontal incision in the alveolar mucosa [20].…”

Tratamento de recessões gengivais múltiplas em área estética: relato de caso / Treatment of multiple gingival recessions in aesthetic area: case report

“…5 É essencial perceber a presença e o tipo de RG, e seguidamente, diagnosticar a origem e sua causa, com intuito de removêla, e assim tratando-a com eficiência. 6 Existem inúmeras técnicas cirúrgicas como o enxerto gengival livre, retalho reposicionado coronalmente, lateralmente, em envelope, são descritas como uma alternativa de eliminar ou corrigir os defeitos, possibilitando um recobrimento radicular parcial ou total. A fim de aumentar a previsibilidade das técnicas, tem sido indicada o uso de enxertos de tecido conjuntivo sob os retalhos pediculados.…”