RESUMO
OBJECTIVES: There are few studies comparing xenogeneic acellular dermal matrixes (XDMs) with connective tissue graft (CTG) to treat single gingival recession (GR). The present study involved a reanalysis of previous studies and comparison of CTG or XDM to treat single RT1/GR. MATERIALS AND METHODS: Fifty patients from three previous randomized clinical trials treated either by CTG (n = 25) or XDM (n = 25) were evaluated after 6-month. Clinical, patient-centered, and esthetic parameters were assessed. Pearson's correlation and regression analyses were also performed. RESULTS: Greater recession reduction (RecRed), percentage of root coverage (%RC), and complete root coverage (CRC) were observed in the CTG group (p ≤ 0.02). Gingival thickness (GT) and keratinized tissue width (KTW) gains were higher in the CTG group. The CTG group showed better esthetic at 6-month. Logistic analyses reported that GT([OR] = 1.6473 ) and papilla height (PH) (OR = 8.20) are predictors of CRC. GT*XDM interaction was a negative predictor of CRC (OR = 7.105-5 ). GT at baseline acted as a predictor of RecRed in both groups (p = 0.03). The XDM graft impacted RecRed and %RC negatively. Baseline PH was a predictor of %RC for both grafts. CONCLUSION: CTG was superior for treating RT1/GR, providing better root coverage outcomes and tissue gains over time. GT, PH, and graft type were classified as predictors of CRC. CLINICAL SIGNIFICANCE: CTG presented better outcomes to treat single RT1 gingival recession when compared to the XDM.
Assuntos
Derme Acelular , Retração Gengival , Humanos , Retração Gengival/cirurgia , Raiz Dentária , Retalhos Cirúrgicos , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto , Tecido Conjuntivo/transplante , GengivaRESUMO
BACKGROUND: Xenogeneic matrices (XMs) have been increasingly used for root coverage procedures. This study compared the use of two types of XM (collagen matrix [CM] and xenogeneic acellular dermal matrix [XDM]) associated with the coronally advanced flap technique (CAF) to treat single gingival recessions. METHODS: Seventy-five patients presenting single RT1 gingival recession were treated by CAF (control group, n = 25), CAF+CM (test group 1, n = 25), or CAF+XDM (test group 2, n = 25) and completed 6-month follow-up. Clinical, patient-centered, and esthetic assessments were performed and intra- and intergroup differences were analyzed. RESULTS: At 6 months, the mean recession reduction for CAF, CAF+CM, and CAF+XDM was 2.4 ± 0.8 mm, 2.4 ± 0.9 mm and 2.1 ± 0.8 mm, respectively (P > 0.05). The corresponding mean percentage of root coverage was 78.9% ± 26.2% for CAF, 78.0% ± 28.5% for CAF+CM, and 65.6% ± 26.9% for CAF+XDM (P > 0.05). Dentin hypersensitivity and esthetic conditions showed significantly improvements in all groups. Test groups presented significant gains in gingival thickness (GT; CAF+CM: 0.4 ± 0.3 mm; CAF+XDM: 0.4 ± 0.2 mm) compared to the control group (CAF: 0.0 ± 0.1 mm; P < 0.05). CONCLUSION: The CAF, CAF+CM, and CAF+XDM treatments each provided similar results in the treatment of single gingival recessions. The addition of either CM or XDM to CAF increases the GT.
Assuntos
Retração Gengival , Colágeno/uso terapêutico , Tecido Conjuntivo , Estética Dentária , Gengiva/cirurgia , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Humanos , Raiz Dentária/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: The purpose of this case series is to present a technique to harvest palatal connective tissue grafts (CTGs) that concurrently provides several advantages over previously described techniques when applied to treat gingival recessions. CASE SERIES: Twenty patients were treated with root coverage procedures using CTGs harvested with the modified double blade harvesting technique (MDBHT). A double blade knife with two surgical blades set 1 mm apart was used in this case series. The palatal connective tissue was accessed through a horizontal incision and an envelope flap that was closed by primary intention. The grafts were measured immediately after harvesting with a periodontal probe. The overall mean length was 28.8 ± 7.8 mm and graft thickness was homogeneous and near to 1 mm in all the cases. Graft mean apicocoronal height was 5.0 ± 0.8 mm and 5.3 ± 1 mm at the molar and premolar levels, respectively. Clinical wound healing was evaluated at 7 days post-surgically and showed a modified early-wound healing index mean value of 3.0 ± 1.0. CONCLUSIONS: The introduced MDBHT consistently rendered grafts of uniform thickness and sufficient dimensions, while excluding epithelial tissue and the deeper aspects of the submucosa, thus avoiding rich fatty and glandular tissues. MDBHT allowed for donor site healing with minimal discomfort and without complications.
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Retração Gengival , Tecido Conjuntivo/cirurgia , Humanos , Palato , Retalhos Cirúrgicos , Instrumentos CirúrgicosRESUMO
INTRODUCTION: Gingival recession (GR) is one of the most common esthetic concerns for patients, and several surgical procedures have been developed for its treatment. It has been widely demonstrated that root coverage of shallow Miller class I and II areas of gingival recession is generally predictable, but the treatment of deep recessions associated with lack of attached keratinized tissue remains a challenge even for skilled surgeons. Although this type of recessions can be treated with tunneling procedures, because of their size, covering the connective tissue grafts (CTGs) with displaced flaps provide better graft nutrition and improve the outcome. The purpose of this case series is to present an alternative treatment to the traditional laterally displaced flap and tunneling techniques used for deep narrow recessions: The "laterally stretched flap" (LSF) with CTG. CASE PRESENTATION: Five healthy patients with isolated Miller Class II narrow deep gingival recessions were included in the case series. All the defects were treated with LSF and CTG. Complete root coverage (CRC) was achieved in 80% of the cases (4/5). Keratinized tissue increase was obtained in all the cases. The follow-up was between one and three years. CONCLUSIONS: Within the limitations of this case series, LSF + CTG demonstrated to be a promising technique for the treatment of narrow deep recessions. The lack of vertical incisions and an envelope approach renders a more stable wound with minimal scar formation and patient discomfort.
Assuntos
Tecido Conjuntivo , Retração Gengival , Incisivo , Tecido Conjuntivo/transplante , Estética Dentária , Retração Gengival/cirurgia , Humanos , Resultado do TratamentoRESUMO
INTRODUCTION: This case report presents the successful multidisciplinary treatment of a maxillary lateral incisor with a deep and narrow recession involving the root apex associated with pulpal necrosis. The tooth initially considered with a hopeless prognosis, was treated with a combined periodontal plastic, regenerative, and endodontic surgical procedure. CASE PRESENTATION: A recently reported technique, the laterally stretched (LAST) flap with a connective tissue graft (CTG) technique for root coverage, was combined with enamel matrix derivative (EMD) for periodontal regeneration of the periapical lesion, that complemented an apicoectomy with retrograde sealing. The 6-year follow-up evidenced root coverage (RC) of 91.6% and increased keratinized tissue. Clinical and radiographic evaluation showed resolution of the periapical process. CONCLUSIONS: A severe gingival recession with endodontic involvement can be repaired if adequate control of the endodontic infection is obtained. The LAST flap, originally described for lower anterior teeth, was used successfully in a maxillary tooth, under extreme circumstances.