Root coverage using a connective tissue graft with epithelial striation in combination with enamel matrix derivatives - a long-term retrospective clinical interventional study

Abstract

Background The application of a connective tissue graft with epithelial striation (CTG-ES) has been shown to improve the outcome of root coverage (RC) using the coronally advanced flap (CAF) and adjunctive administration of enamel matrix derivatives (EMD). Aim of the present study was to evaluate the long-term (mean: 16.19 ± 1.80 years, range: 13 to 18 years) stability of this treatment method with special focus on the location of the gingival margin and the width of keratinized tissue (WKT). Methods 16 patients (10 female, 6 male, aged 35.36 ± 14.70 years at surgery) with 25 Miller class I or II gingival recession (GR) defects were treated using the CAF combined with the CTG-ES and EMD. The clinical measurements recorded at baseline (t0), 6 months (t1), and 13 to 18 years (t2) after surgery included recession depth (RED), probing pocket depth (PPD), clinical attachment level (CAL), and WKT. In addition, the number of sites with complete RC (CRC) and the mean RC (MRC) were documented at t1 and t2. The statistical analysis was performed using a linear mixed model. Results The RED (t0: 4.52 ± 1.56 mm; t1: 0.36 ± 0.76 mm; t2: 0.30 ± 0.60 mm) and CAL (t0: 6.16 ± 1.62 mm; t1: 1.86 ± 0.87 mm; t2: 1.54 ± 0.92 mm) were significantly reduced at t1 and t2 compared to t0 ( p < 0.001). The PPD was significantly reduced at t2 compared to t0 ( p = 0.016). The WKT (t0: 1.18 ± 1.28 mm; t1: 3.26 ± 0.98 mm; t2: 4.26 ± 1.83 mm) significantly increased from t0 to t1, from t0 to t2 (p < 0.001) and from t1 to t2 ( p = 0.007). A CRC was recorded at 19 sites (76.0%) at t1 and t2. The MRC was 93.6 ± 12.8% at t1 and 93.3 ± 13.3% at t2. Conclusions The use of the CAF combined with CTG-ES and EMD leads to stable long-term outcomes on teeth with Miller Class I or II GR defects. The CTG-ES represents a hybrid graft with increased position stability and advantageous properties for the healing process. We assume that the ES is responsible for the increase of the WKT.

Treatment of Gingival Recession with Hypersensitivity using Free Soft-tissue Graft Procedures

“…Comprehensive reviews between these techniques clearly indicated that there were no significant differences in efficacy and reported results show a high variability because of selection of defects, magnitude of defects, location of recession, mean initial depth and operator skill. [23][24][25][26][27] Our study showed statistically significant reduction of gingival recession, with concomitant attachment gain, following treatment with all tested surgical techniques which is supported by other authors [25][26][27]. Both surgical techniques showed the highest percentage gain in coverage of recession depth as well as gain in keratinized gingiva.…”

“…Although many comparisons have been made using different surgical approaches, of both coronally advanced flap and the subepithelial connective tissue graft techniques for root coverage [19][20][21][22][23]. In the literature lacks studies that directly compare these and other techniques.…”

Toothbrushing‐induced vestibular ulcerations with severe gingival defects

“…All these led us to making a trial treatment, thus, avoiding invasive examination. The weakness of our management is that the patient cannot complete the periodontal treatment, although connective tissue grafting to improve root coverage can be expected 10,11 …”

Surgical management of autogenous bone block graft exposure followed by prosthetic rehabilitation of thin residual ridge

“…It provides better position and stability and augments healing process. [ 8 ] Recently, a subperiosteal peri-implant-augmented layer technique has been reported for coverage of minor peri-implant bone dehiscence. [ 9 ] In the present case, the area of exposure was relatively large, and the underlying bone was a block graft undergoing integration with the recipient site making employment of such techniques difficult.…”