Treatment of Gingival Recession With Titanium Reinforced Barrier Membranes Versus Connective Tissue Grafts

Abstract

It was the aim of this study to compare barrier membrane therapy with connective tissue grafts in the treatment of recession defects. Fifteen patients with 2 paired vestibular recession defects participated in the study. After thorough scaling and root surface conditioning with tetracycline-HCl, defects were randomly assigned to 1 of 2 treatment modalities. In one of the defects, a trapezoidal mucoperiosteal flap was prepared, and a titanium reinforced expanded polytetrafluoroethylene membrane was adapted to the defect and secured by a sling suture. The membrane was subsequently covered by a coronally positioned flap secured with crown attached sutures. The other defect was treated with a connective tissue graft employing the "envelope technique." Twelve months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. Gingival recession decreased from 3.6+/-0.7 mm to 0.5+/-0.5 mm for membrane treated defects and from 3.6+/-1.0 mm to 0.5+/-0.5 mm following use of grafts, corresponding to mean root coverages of 87.1% and 86.9%, respectively. Mean gains of keratinized tissue of 1.5 mm (membrane) and 2.5 mm (graft) could be observed. Thus, the results of this study demonstrate that both titanium reinforced barrier membranes and connective tissue grafts can be successfully used to treat periodontal recession defects.

Comparative Histologic Analysis of Coronally Advanced Flap With and Without Collagen Membrane for Root Coverage

“…38 Postoperative membrane exposure has been shown negatively related to the amount of root coverage achieved. 39 In our study, none of GTRC-treated sites had membrane exposure due to the efforts made to relieve the inherent tissue tension, obtaining primary coverage without any tension.…”

Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller Class I and II recession-type defects?

“…56,59 Furthermore, membrane exposure may impair the amount of root coverage expected. One paper evaluating the results achieved with non-resorbable membranes 50 reported mean root coverage of 75% in defects with membrane exposure, as opposed to a mean root coverage of 97% in defects where membrane exposure did not occur. It appears that the elimination of the re-entry procedures may prevent the risks of mechanical trauma to the newly formed tissue during the early phases of healing process, while avoiding a second surgical stress for the patient.…”

“…[22][23][24][25][26][27][28][29][30][31][32][33][34] Three RCTs reported the results from samples containing less than 10 patients per group at final examination, 13,35,36 two studies were classified as randomized non-controlled trials, 37,38 two presented a follow-up period <6 months, 39,40 two did not present a patientbased analysis 41,42 and one included recession areas containing teeth with restorations. 43 Of the 23 included studies, 5,12,15,44-63 fifteen had a splitmouth group study design 5,15,[44][45][46][40][41][42][43][44][45][46][47][48][49][50][51][52][53]57,58,[60][61][62]63 and seventeen were conducted at university dental clinics 5,12,44,…”

“…Adverse effects were reported as membrane exposure, 15,50,59 postsurgical swelling, 15,52,60 pain 50,44,56,62 and necrosis of the primary palatal flap during the early phase of healing 52 related to the donor sites of SCTG.…”

Soft Tissue Grafting Around Teeth and Implants

“…However, most studies that compared GTR and SCTG concluded that SCTG resulted in statistically better root coverage, width of keratinized gingiva, and complete root coverage. [76][77][78][79] Tenyear follow-up comparing SCTG and GTR for root coverage found that the long-term stability of root coverage (ie, the reduction of recession depth) and esthetic results perceived by patients were significantly better using SCTG compared with GTR surgery using bioabsorbable barriers. 80 …”