Coronally Advanced Flap Alone or With Connective Tissue Graft in the Treatment of Single Gingival Recession Defects: A Long‐Term Randomized Clinical Trial

Kuiš, Davor; Šćiran, Ivana; Lajnert, Vlatka; Šnjarić, Damir; Prpić, Jelena; Pezelj-Ribarić, Sonja; Bošnjak, Andrija

doi:10.1902/jop.2013.120451

Cited by 37 publications

(43 citation statements)

References 22 publications

(82 reference statements)

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“…A total of 101 articles 30‐131 with 94 RCTs potentially eligible for inclusion into the pooled estimates were identified in the base of evidence, and their main characteristics (i.e., number and age of participants, interventions, follow‐up period, number of sites exhibiting CRC, MRC [percentage], use of RMAs, randomization, allocation concealment, masking of examiners, completeness of the follow‐up period, and risk of bias) are depicted in Table 2 30‐131 . Seven studies were reported in two articles each, and their data were reported under one study name 37,38,57,58,65,66,83,84,90,91,110,111,115,116 …”

Section: Summary Of What Other Srs Have Evaluatedmentioning

confidence: 99%

“…Of the 94 trials included in Table 2, 52 were included in the following sets of meta‐analyses: 1) ADMG/CM + CAF versus SCTG‐based procedures; 31,66,76,97,102,114 2) ADMG/CM + CAF versus CAF; 57,58,86,125 3) BS + GTR with resorbable membranes (RS) + CAF versus GTR with RS + CAF; 62,63,78,101 4) EMD + CAF versus CAF; 51,53,59,71,94,103,115,116 5) EMD + CAF versus SCTG + CAF; 30,32,90,91 6) GTR with RS + CAF versus CAF; 36,83,84 7) GTR (all types of membrane) + CAF versus SCTG‐based procedures; 35,43,55,74,96,101,107,109,117,122,123,126 8) SCTG‐based procedures versus CAF; 40,41,54,56,80 9) SCTG + CAF versus SCTG (epithelial collar); 44,47 10) SCTG‐based procedures, micro versus macro procedures; 42,46 and 11) SCTG‐based procedures versus FGG 70,100 . All of the comparisons were performed using studies reporting data on single defects, except for one comparison on EMD + CAF versus CAF 53,71 that could also be conducted using data on multiple recessions.…”

Section: Summary Of What Other Srs Have Evaluatedmentioning

confidence: 99%

“…An RCT on CAF (not included in part II because of its 3‐month follow‐up period) showed that the higher the flap tension, the lower the recession reduction (i.e., flap tension of 6.5 g led to 78% MRC and 18% CRC, whereas flaps sutured almost without flap tension [0.4 g] achieved 87% MRC and 45% CRC) 169 . Moreover, comparisons between conventional CAF versus semilunar‐design CAF showed that these procedures may reach MRC ranging from 57.8% 36 to 93.0% 59 and CRC ranging from 9.0% 56 to 78.9% 80 and MRC varying from 41.8% 112 to 90.0% 40 and CRC varying from 9.0% 112 to 52.9% 40 6 months after surgery, respectively.…”

Section: Summary Of What Other Srs Have Evaluatedmentioning

confidence: 99%

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Periodontal Soft Tissue Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop

Chambrone

Tatakis

2015

Journal of Periodontology

387

615

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Background: This paper aims to create a ''bridge'' between research and practice by developing a practical, extensive, and clinically relevant study that translates evidence-based findings on soft tissue root coverage (RC) of recession-type defects to daily clinical practice.Methods: This review is prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused questions. A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE and EMBASE databases up to and including June 2013. Systematic reviews (SRs), randomized clinical trials, controlled clinical trials, case series, and case reports evaluating recession areas that were treated by means of RC procedures were considered eligible for inclusion through the three parts of the study (part I, an overview of the base of SRs; part II, an alternative random-effects meta-analyses on mean percentage of RC and sites exhibiting complete RC; and part III, an SR of non-randomized trials exploring other conditions not extensively evaluated by previous SRs). Data on Class I, II, III, and IV recessions, type of histologic attachment achieved with treatment, recipient-and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions, tooth type and location, long-term effectiveness outcomes, unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes were assessed as well.Results: Of the 2,456 potentially eligible trials, 234 were included. Data on Class I, II, III, and IV gingival recessions, histologic attachment achieved after treatment, recipient-and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions/biomodification, tooth type and location, long-term effectiveness outcomes and unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes (i.e., esthetic, visual analog scale, complications, hypersensitivity, patients perceptions) were assessed. Subepithelial connective tissue (CT)-based procedures and coronally advanced flap plus acellular dermal matrix grafts, enamel matrix derivative, or collagen matrix led to the best improvements of recession depth, clinical attachment level (CAL) gain, and keratinized tissue (KT). Some conditions, such as smoking and use of magnification, may affect RC outcomes.Conclusions: All RC procedures can provide significant reduction in recession depth and CAL gain for Miller Class I and II recession-type defects. Subepithelial CT graft-based procedures provided the best outcomes for clinical practice because of their superior percentages of mean and complete RC, as well as significant increase of KT. J Periodontol 2015;86(Suppl.):S8-S51.

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Section: Summary Of What Other Srs Have Evaluatedmentioning

confidence: 99%

Section: Summary Of What Other Srs Have Evaluatedmentioning

confidence: 99%

Section: Summary Of What Other Srs Have Evaluatedmentioning

confidence: 99%

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Periodontal Soft Tissue Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop

Chambrone

Tatakis

2015

Journal of Periodontology

387

615

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“…Additional research on outcomes in Miller Class III and IV defects is needed. Data reporting should be stratified by Miller Class 5 . 3) There is limited evidence on patient‐reported outcomes.…”

Section: Research Priorities For the Futurementioning

confidence: 99%

Periodontal Soft Tissue Root Coverage Procedures: A Consensus Report From the AAP Regeneration Workshop

Tatakis¹,

Chambrone²,

Allen³

et al. 2015

Journal of Periodontology

148

156

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Background: Management of gingival recession defects, a common periodontal condition, using root coverage procedures is an important aspect of periodontal regenerative therapy. The goal of the periodontal soft tissue root coverage procedures group was to develop a consensus report based on the accompanying systematic review of root coverage procedures, including priorities for future research and identification of the best evidence available to manage different clinical scenarios. Methods: The group reviewed and discussed the accompanying systematic review, which covered treatment of single‐tooth recession defects, multiple‐tooth recession defects, and additional focused questions on relevant clinical topics. The consensus group members submitted additional material for consideration by the group in advance and at the time of the meeting. The group also identified priorities for future research. Results: All reviewed root coverage procedures provide significant reduction in recession depth, especially for Miller Class I and II recession defects. Subepithelial connective tissue graft (SCTG) procedures provide the best root coverage outcomes. Acellular dermal matrix graft (ADMG) or enamel matrix derivative (EMD) in conjunction with a coronally advanced flap (CAF) can serve as alternatives to autogenous donor tissue. Additional research is needed to do the following: 1) assess the treatment outcomes for multiple‐tooth recession defects, oral sites other than maxillary canine and premolar teeth, and Miller Class III and IV defects; 2) assess the role of patient‐ and site‐specific factors on procedure outcomes; and 3) obtain evidence on patient‐reported outcomes. Conclusions: Predictable root coverage is possible for single‐tooth and multiple‐tooth recession defects, with SCTG procedures providing the best root coverage outcomes. Alternatives to SCTG are supported by evidence of varying strength. Additional research is needed on treatment outcomes for specific oral sites. Clinical Recommendation: For Miller Class I and II single‐tooth recession defects, SCTG procedures provide the best outcomes, whereas ADMG or EMD in conjunction with CAF may be used as an alternative.

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“…Foi verificado que a cirurgia plástica periodontal, por meio de enxertos autógenos de tecido, tem sido mais efetiva no tratamento das recessões gengivais [3][4][5] . Existem diversas técnicas cirúrgicas para recobrimento radicular: retalho deslocado coronal (RDC), Deslizamento Lateral do Retalho (DLR), Enxerto Gengival Livre (EGL) e Enxerto de Conjuntivo Subepitelial (ECSE) 5,6 . O tratamento depende de um exame periodontal em que serão observados os seguintes parâmetros clínicos na região onde ocorre a recessão gengival: a quantidade de gengiva inserida e sua espessura, a presença ou a ausência de profundidade clínica de sondagem (PCS), o nível clínico de inserção (NCI), o contato oclusal prematuro e a classificação da recessão de acordo com Miller 7 .…”

Section: Introductionunclassified

Uso da cola-cirúrgica de base cianoacrílica como substituto da sutura na estabilização do enxerto gengival livre

Storrer

2014

Rev. da Fac. de Odontologia, UPF

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IntroduçãoO recobrimento das recessões radiculares ou o aumento da faixa de gengiva inserida em áreas que a raiz ficou desprovida de tecido gengival continua sendo um desafio na resolução de procedimentos mucogengivais. Diversos fatores podem levar à recessão gengival. A origem é multifatorial. Fatores predisponentes que podem contribuir como gatilhos no processo da recessão gengival são citados na literatura como as fenestrações ósseas associada ao tecido gengival de fina espessura, má-posição dentária, inserção alta de freio labial, vestíbulo raso, pequena faixa de gengiva inserida, escovação traumática e associação desses fatores à inflamação gengival 1 . As indicações cirúrgicas do recobrimento ou do aumento da faixa de gengiva inserida podem ser consideradas em casos que apresentem hipersensibilidade dentinária, cáries radiculares, inflamação da gengiva marginal, problemas que ocorrem devido à dificuldade de escovação, sendo sugerida, também, para melhorar a aparência estética em regiões anteriores 2 . Introdução: a recessão gengival é definida como a migração apical da margem da gengiva tendo como consequências a exposição radicular e a redução da faixa de gengiva inserida. O enxerto gengival livre (EGL) é uma opção de tratamento para esses casos. A estabilização do enxerto na área receptora pode influenciar o resul-

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Coronally Advanced Flap Alone or With Connective Tissue Graft in the Treatment of Single Gingival Recession Defects: A Long‐Term Randomized Clinical Trial

Cited by 37 publications

References 22 publications

Periodontal Soft Tissue Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop

Periodontal Soft Tissue Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop

Periodontal Soft Tissue Root Coverage Procedures: A Consensus Report From the AAP Regeneration Workshop

Uso da cola-cirúrgica de base cianoacrílica como substituto da sutura na estabilização do enxerto gengival livre

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