Long‐term stability of gingival margin and periodontal soft‐tissue phenotype achieved after mucogingival therapy: A systematic review

BackgroundTo analyze the evidence about the influence of the suturing technique and material in terms of the percentage of mean root coverage (%MRC) following root coverage therapy in teeth diagnosed with single/localized gingival recession defects (GRD) via a monolaminar coronally advanced flap.MethodsThe protocol of this systematic review was registered in PROSPERO (CRD42024514043). A literature search was conducted to identify investigations that fulfilled the eligibility criteria. Variables of interest were extracted, subsequently categorized, and qualitatively analyzed.ResultsA total of 15 randomized clinical trials, including 301 localized GRD in non‐molar sites classified as Miller class I‐II/RT1, in 253 patients were included. The studies reporting the combination of sling and single interrupted sutures, or interrupted sutures alone showed an MRC of 70.2%±16.6%, and 74.1%±0.75%, respectively. The highest MRC was observed in the studies using polyglactin 910 with a pooled value of 76.6% ± 15.3%, and monofilament materials, with a pooled MRC of 74.8%±7.1%. When the suturing diameter was evaluated, the highest pooled MRC with values of 79.1%±9.8% was observed with the use of 5‐0.ConclusionsFor the treatment of single/localized GRD in non‐molar sites via a monolaminar coronally advanced flap, the use of a combination of sling and single interrupted sutures, or single interrupted sutures, polyglactin 910 or monofilament materials, and material diameter of 5‐0 showed a higher MRC as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.Key points There were no differences in the percentage of root coverage achieved between the use of sling and single interrupted, versus single interrupted sutures alone on the treatment of single/localized GRD in non‐molar sites. Polyglactin 910 and monofilament sutures resulted in a higher percentage of root coverage achieved as compared to expanded polytetrafluoroethylene, and silk with/without dressing. The use of 5‐0 material diameter showed the highest percentage of root coverage achieved. Plain language summaryThis study was primarily aimed at evaluating how different suturing techniques and materials could affect the percentage of root coverage in single/localized recession defects, without the use of soft tissue substitutes or autogenous soft tissue grafts. After the pooled analyses of 15 randomized clinical trials that fulfilled the inclusion criteria, we observed that the adequate selection of suturing techniques, materials, and size could lead to a higher percentage of root coverage. Specifically, the use of single interrupted with or without sling sutures at the most coronal portion, Polyglactin 910 or monofilament materials, and size of 5‐0 showed a higher percentage of root coverage as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.

Effect of suturing in root coverage via coronally advanced flaps: A systematic review

Ariceta,

Chambrone,

Stuhr

et al. 2024

Advanced platelet‐rich fibrin versus connective tissue graft in maxillary gingival recession management

Tadepalli,

Ramachandran,

Parthasarathy

et al. 2024

BackgroundPlatelet concentrates have gained significant attention in periodontology due to their regenerative properties. This randomized clinical trial was aimed to compare the clinical efficacy of advanced platelet‐rich fibrin (A‐PRF) and connective tissue graft (CTG) in the management of recession defects. The objectives were to compare changes in recession height and root coverage percentage between the groups.MethodsSystemically healthy individuals presenting Cairo's RT1/RT2 gingival recession defects in the maxilla (n = 40) were treated with either A‐PRF or CTG in combination with coronally advanced flap (CAF). Clinical parameters were measured at baseline, 3 months, and 6 months. Mean and complete root coverage percentages were calculated at 3 and 6 months.ResultsIn both the test (CAF + A‐PRF) and control (CAF + CTG) groups, a statistically significant reduction in mean recession height was seen from baseline values of 2.90 ± 0.55 mm and 3.15 ± 0.87 mm to 0.80 ± 0.95 mm and 0.15 ± 0.48 mm at 6 months, respectively (p < 0.001). In the test group, 10 sites had complete root coverage at 6 months with mean root coverage of 73.76 ± 29.58%. In the control group, 18 of 20 sites had complete root coverage with mean root coverage of 93.35 ± 23.1%. The control sites had a significantly greater reduction in recession height and higher mean and complete root coverage percentages at 6 months (p < 0.05).ConclusionsThe study findings suggest that, the CTG had resulted in superior outcomes than A‐PRF along with CAF.Key points Question: To compare the efficacy of advanced platelet‐rich fibrin (A‐PRF) with connective tissue graft (CTG) in the management of gingival recession defects. Finding: Both interventions showed satisfactory healing. At 6 months, the CTG group demonstrated superior results than the A‐PRF group. Meaning: CTG has a greater therapeutic potential than A‐PRF in the management of gingival recessions. Plain language summaryPlatelet‐derived membranes are widely used in various dental therapies due to their healing properties. Limited studies have been conducted using the novel platelet preparations in the management of receding gums. This study compared the effects of advanced platelet‐rich fibrin membrane with conventional soft tissue harvested from the palate in the treatment of gum recession. Twenty‐three patients requiring gum augmentation were recruited and treated with either platelet‐derived membrane (test group) or tissue harvested from their palate (control group). Clinical parameters were measured at baseline (before intervention), 3 months, and 6 months. Both treatment modalities resulted in significant gum coverage at the end of 6 months. On comparison, the control sites had significantly greater improvements in all the measured clinical parameters indicating that tissue obtained from the palate had superior therapeutic potential.

The laterally closed coronally advanced flap: A case study

Tunkel,

Latimer,

de Stavola

et al. 2024

BackgroundSeveral methods have been described for treating deep Cairo Class RT1 recessions. Most involve relieving incisions, which cause scar tissue formation or use a tunneled approach. This report introduces a modified technique for treating a single deep recession beyond the mucogingival margin. The approach uses a laterally closed coronally advanced flap (LCAF) without relieving incisions, combined with a subepithelial connective tissue graft and enamel matrix derivative.MethodsA 28‐year‐old woman was referred to our periodontal practice for the treatment of a progressive deep Cairo Class I recession with hypersensitivity and limited access to hygiene measures. The root coverage procedure was performed using a modified LCAF, combined with a connective tissue graft from the palate and enamel matrix derivative. The case was followed for 6 months.ResultsThe healing process was uneventful. Six months after surgery, the root surfaces remained completely covered. Hypersensitivity resolved entirely, and there was only a slight formation of visible scar tissue.ConclusionsThis modified technique of an LCAF is a feasible and effective method for treating single deep RT1 recessions. By avoiding visible relieving incisions, scar tissue formation is minimized. The preparation of an LCAF allows for adequate coronal advancement.Key points As far as our knowledge, this is the first description of a laterally closed coronally advanced flap (LCAF) combining the advantage of a minimalized scarring root coverage with a simplified coronally advancement for recessions exceeding the mucogingival junction. This modified technique combines the advantages of a lateral closing with a CAF for covering deep class RT1 recessions. Meticulous handling of the delicate pedicles combined with a coronal advancement of at least 2 mm beyond the cemento‐enamel junction is the key factor for the successful adaption of this technique. Plain language summaryDeep gum recessions originating from traumatic hygiene measures can cause hypersensitivity and limit patients´ access to oral hygiene. Especially in deep recessions, the common surgical techniques have shortcomings due to a post‐surgical lack of keratinized gingiva or visible scar tissue formation. This case study shows the treatment of a 28‐year‐old woman´s deep recession on a mandibular front tooth introducing a modified surgical technique for covering deep gum recessions exceeding the area of the keratinized gingiva (so‐called deep Cairo RT1 recessions). This new technique uses a “laterally closed coronally advanced flap” (LCAF), which combines a curtain‐similar lateral closing of the flap pedicles with a coronal advancement to cover the recession without making cuts that can lead to scars. It is combined with a tissue graft from the patient's palate and a special protein to regenerate the periodontium. Six months after surgery, complete root coverage was achieved without remaining hypersensitivity and with restored access for oral hygiene measures. Minimal visible scar tissue formed. This case study demonstrates that the LCAF is a feasible technique for covering single deep gum recessions exceeding the keratinized area of the gingiva.