RESUMO
The aim of this systematic review (SR) compared the effect of xenogeneic collagen matrix (XCM) vs. connective tissue graft (CTG) for the treatment of multiple gingival recession (MGR) Miller Class I and II or Cairo type I. Five databases were searched up to August 2022 for randomized clinical trials (RCTs) comparing the clinical effects of XCM vs. CTG in the treatment of MGR. The random effects model of mean differences was used to determine reduction of gingival recession (GR), gain in keratinized tissue width (KTW), gain in gingival thickness (GT) and gain in clinical attachment level (CAL). The risk ratio was used to complete root coverage (CRC) at 6 and 12 months. 10 RCTs, representing 1095 and 649 GR at 6 and 12 months, respectively, were included in this SR. The meta-analysis showed no statistically significant difference in GR reduction, KTW gain GT gain or CAL gain between groups at 6 months. However, at 12 months of follow-up, differences favoring the control group were observed (p < 0.05). CRC was significantly higher in the CTG group at 6 and 12 months. Regarding dentine hypersensitivity (DH), no statistically significant differences were found between groups at 6 and 12 months of follow-up (p < 0.05). At 12 months, CTG showed significantly superior clinical results in the treatment of MGR: however, this difference was not observed in the decrease of DH.
Assuntos
Retração Gengival , Humanos , Retração Gengival/cirurgia , Resultado do Tratamento , Retalhos Cirúrgicos , Raiz Dentária , Colágeno/uso terapêutico , Tecido Conjuntivo/transplante , GengivaRESUMO
La recesión gingival es considerada como una deformidad o condición mucogingival, la Academia Americana de Periodontología, define a la recesión gingival como el desplazamiento del margen del tejido blando apical a la unión cemento-esmalte con la exposición de la superficie radicular. El tratamiento de las recesiones gingivales es un motivo de consulta común debido a razones estéticas, hipersensibilidad dentinaria, molestias durante el cepillado e incluso temor a la pérdida dentaria. Es una situación clínica común, 60% de la población humana tiene algún tipo de recesión gingival. Al realizar el examen clínico a paciente masculino de 55 años, se observó una recesión gingival tipo 1 (RT1) sin pérdida de inserción interproximal de la clasificación de Cairo. Se realizó el colgajo posicionado coronalmente (CPC) utilizando una matriz dérmica acelular (MDA) de origen humano OrACELL®. Se obtuvo resultado favorable en el recubrimiento de recesiones gingivales múltiples; considerándolos como una buena alternativa frente a los injertos gingivales autógenos. Concluyendo que, el uso de la matriz dérmica acelular para el tratamiento de la recesión gingival tipo 1 es una adecuada opción para el recubrimiento radicular. Se recomiendan más estudios a largo plazo para ver la estabilidad de los resultados obtenidos con la MDA (AU)
Gingival recession, considered a deformity or mucogingival condition, the American Academy of Periodontology, defines gingival recession as the exposure of the root surface resulting from migration of the gingival margin apical to the cementoenamel junction (CEJ). The treatment of gingival recessions is a common reason for consultation due to aesthetic reasons, dentin hypersensitivity, discomfort during brushing and even fear of tooth loss. It is a common clinical situation, 60% of the human population has some kind of gingival recession. Clinical examination of a 55-year-old male patient showed a type 1 gingival recession (RT1) without loss of interproximal insertion of the Cairo classification. Coronally advanced flap (CAF) was performed using an acellular dermal matrix (ADM) of human origin OrACELL®. Favorable results were obtained in the coating of multiple gingival recessions; considering them as a good alternative to autogenous gingival grafts. Concluding that, the use of the acellular dermal matrix for the treatment of gingival recession type 1, is a suitable option for root lining. Further long-term studies are recommended to see the elasticity of MDA outcomes (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Retração Gengival/terapia , Raiz Dentária/lesões , Perda da Inserção Periodontal/diagnóstico , Retração Gengival/classificaçãoRESUMO
AIM: To compare the outcomes of modified coronally advanced flap (mCAF) combined with either xenogeneic dermal matrix (XDM) or connective tissue graft (CTG) for the treatment of multiple adjacent gingival recessions (MAGRs). MATERIALS AND METHODS: Forty-two patients, in whom 130 maxillary (MAGRs) of type (RT1) were found, were randomly allocated to the two groups. Clinical, esthetic, and patient-centered outcomes were evaluated at baseline, 6, and 12 months post-treatment. RESULT: Group CAF+ CTG exhibited a higher mean root coverage value (mRC) (91.79%) (primary outcome variable) than group CAF+XDM (80.19%) without statistically significant difference at 12 months (p=0.06). The control group also had significantly higher percentage of teeth in which complete root coverage (CRC) and mean gain of gingival thickness (GT) were achieved, than the test group (p<0.05). With respect to patient-centered outcomes, patients of the test group reported having experienced significantly less pain than those of the control group until 7 days (p<0.05). Both surgical approaches were capable of significantly decreasing dentin hypersensitivity (p<0.05). No difference between groups was found in the esthetic score analysis (p>0.05). Mean surgical time was lower in the test group (p<0.05). CONCLUSION: The two treatments showed similar mRC. However, CAF+CTG was superior to CAF+XDM in providing CRC and in gaining GT. CAF+XDM demonstrated advantages over CAF+CTG with regard to patient morbidity and surgical time. CLINICAL RELEVANCE: Application of XDM provided a better patient experience and shortened the time to recovery after coronally advanced flaps for coverage of multiple adjacent recessions. However, CTG resulted in improved percentages of complete root coverage. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (REBEC) number: RBR-974c9j.
Assuntos
Retração Gengival , Tecido Conjuntivo , Estética Dentária , Gengiva , Retração Gengival/cirurgia , Humanos , Raiz Dentária , Resultado do TratamentoRESUMO
INTRODUCTION: There is limited evidence related to the long-term treatment outcomes of acellular dermal matrix graft (ADMG) plus coronally advanced flap (CAF) for the treatment of multiple recession defects. The aim of this case report is to assess the short- and long-term clinical outcomes of Miller Class I multiple gingival recession-type defects in the maxilla treated with ADMG plus CAF. CASE PRESENTATION: A 36-year-old female patient smoking < five cigarettes per day presented multiple adjacent Miller Class I gingival recession in the left maxilla and was referred for treatment with chief complaints of dental hypersensitivity and esthetics. Root coverage was achieved by ADMG + CAF and the patient underwent a 10-year follow-up. CONCLUSIONS: Within the limits of this case report, mean root coverage obtained at 6 months could not be maintained in the long term. A significant relapse was detected after 10 years, from 80% complete root coverage (CRC) at 6 months to 40% at 10 years. Monitoring, compliance, and reinstructions in oral hygiene techniques seem mandatory for minimizing relapse of gingival recessions after root coverage procedures.
Assuntos
Derme Acelular , Estética Dentária , Retração Gengival , Adulto , Feminino , Gengiva , Retração Gengival/terapia , Humanos , Raiz Dentária , Resultado do TratamentoRESUMO
l procedimiento de cobertura radicular para tratar recesiones gingivales es el tratamiento ideal según la literatura actualizada, siendo más utilizado el colgajo de avance coronal con diferentes resultados clínicos y estéticos que ponen en duda si realizar este procedimiento sumando a un injerto de tejido conectivo se van a obtener resultados más predecibles y más estéticos en cuanto a la eliminación del defecto. En este reporte un paciente de 24 años de edad, masculino, refiere hipersensibilidad y disconformidad estética en la zona de la recesión gingival. En este caso se utilizará el cubrimiento radicular con colgajo de avance coronal más injerto de tejido conectivo autólogo. A los seis meses de sanado el paciente refiere mejoras en cuanto a: sensibilidad, control de placa y estética.
he root coverage procedure to treat gingival recessions is the best line of treatment, being the most used the coronal advanced flap. There have been multiple clinical and aesthetic results that cast doubt on whether this procedure by adding a connective tissue graft will be a more predictable and more aesthetic regarding defect removal. In this case report a patient 24-year-old male refers hypersensitivity and aesthetic discomfort in the area of gingival recession. An autologous graft with a coronal flap advancement of connective tissue will be used. After six months of healing the patient reports improvements in: sensitivity, plaque control and aesthetics.
RESUMO
Las recesiones gingivales son un hallazgo clínico muy frecuente que ocasionan problemas estéticos, hipersensibilidad dentaria y dificultad para llevar a cabo una correcta higiene oral en los pacientes. Uno de los objetivos de la terapia periodontal es corregir quirúrgicamente las recesiones; se han descrito una variedad de enfoques quirúrgicos como métodos efectivos para cubrir las superficies radiculares expuestas, siendo el injerto libre de tejido conectivo una de las técnicas que hoy en día ofrece un buen porcentaje de éxito y predecibilidad. Se presenta el caso de un paciente con retracción del margen gingival en el maxilar superior derecho; se describe el procedimiento quirúrgico usando una técnica bilaminar empleando un injerto subepitelial de tejido conectivo bajo un colgajo de espesor parcial posicionado coronalmente, y se obtienen buenos resultados estéticos y cobertura radicular.
Gingival recession is a very often clinic complaint which frecuently cause esthetic problems, hypersensibility and inadecuate oral hygiene to patients. One of the objetives of periodontal therapy is to correct gingival recession, for their treatment some techniques of mucogingival surgery have been designed, being the connective tissue graft, so far, one that offers good percentage of success as well as great predictibility. This clinical report describes a patient with gingival recession on the maxillar right side. A radicular covering using a bilaminar technique with a subepithelial connective tissue graft combined with a coronally advanced flap is used in order to solve the case providing good aesthetic results and root coverage.
RESUMO
O objetivo do presente trabalho foi avaliar clinicamente, o enxerto de tecido conjuntivo subepitelial (CO), o Alloderm® (ALL) e o retalho reposicionado coronariamente (RPC) quando utilizados no tratamento da recessão gengival tipo classe I de Miller. Trinta pacientes participaram do estudo. Os pacientes foram distribuídos em três grupos de 10 pacientes. Dez pacientes com idade média de 38.7(±10.3) anos foram tratados pela técnica do RPC, incluindo 18 recessões. Dez pacientes com idade média de 40.2(+/-9.9) anos foram tratados pela técnica do CO, totalizando 23 recessões. Dez pacientes com idade média de 37.7(±11.2) anos foram tratados através da utilização do ALL, totalizando 18 recessões. Os pacientes não poderiam apresentar cárie sobre a superfície radicular exposta, a junção amelocementária deveria ser visível e identificável, não poderia ter sido submetido a nenhum tipo de tratamento cirúrgico nos elementos envolvidos no experimento nos últimos 24 meses e não apresentar bolsa periodontal ou tratamento endodôntico nos elementos dentários candidatos à cobertura das superfícies radiculares expostas. As seguintes mensurações foram realizadas: índice de placa (IP), índice gengival (IG), profundidade de bolsa à sondagem (PBS), nível de inserção à sondagem (NIS), largura de gengiva ceratinizada (GI), profundidade da recessão gengival (PRG), posição da linha muco-gengival (PLMG). As medidas de IP, IG, PBS, NIS, GI, PRG e PLMG, foram executadas com sonda periodontal calibrada nos dias 0, 30, 60, 90, 120 e 180, exceto PBS e NIS que não foram mensuradas no dia 30. Avaliações subjetivas relativas ao resultado estético alcançado foram realizadas pelo operador e pelo paciente no sexto mês pós-operatório. O teste T de Student para amostras pareadas foi utilizado nas análises intragrupos e o ANOVA foi utilizado nas análises entre os grupos (p<0.05). Os resultados mostraram uma cobertura radicular média de 66.8% para o grupo RPC, enquanto a cobertura radicular média dos grupos ALL e CO foi de 75.9% e de 87.9%, respectivamente. Não houve diferença estatisticamente significante entre os valores de cobertura radicular média entre os grupos ALL e CO. Os valores para o grupo CO eram significantemente maiores que o do grupo RPC. Os valores médios de ganho de inserção clínica de 4.2(±0.9) mm e de 3.5(±1.0) mm dos grupos CO e ALL, respectivamente, foram significantemente maiores que os valores de 2.1(±0.7) mm do grupo RPC. O aumento médio de largura de gengiva ceratinizada foi de 1.41(±0.3) mm no grupo CO e de 1.3(±0.2) mm no grupo ALL, não havendo diferença significativa entre os dois grupos. Não houve alteração na largura de gengiva ceratinizada no grupo RPC. Concluindo, as técnicas de CO e ALL apresentaram resultados clínicos semelhantes e superiores ao RPC em relação ao ganho de inserção clínica, aumento na largura de gengiva ceratinizada e cobertura radicular
The aim of the present study was to clinically evaluate the subepithelial connective tissue graft (CTG), Alloderm (ALL) and coronally advanced flap (CAF) in the treatment of gingival recessions Class I of Miller. 30 patients were included in the study, and were divided in 3 groups of 10 patients. 10 patients with mean age of 38.7 (± 10,3) years were treated with CAF, including 18 defects. 10 patients with mean age of 40.2(± 9.9) years were treated with CTG, including 23 defects, while 10 patients with mean age of 37.7(±11.2) were treated with ALL, including 18 gingival recessions. The patients should not have caries over the denuded root surface, the cementoename junction should visible and easily identified, should not have received any surgical treatment during the last 24 months, and not have periodontal pockets or endodontic treatment at the tested teeth. The following measurements were performed: Plaque index (PI), gingival index (GI), probing pocket depth (PPD), probing attachment level (PAL), width of keratinized gingiva (KG), depth of gingival recession (GR) and position of the mucogingival junction (MGJ). PI, GI, PPD, PAL, KG, GR, MGJ were made with a calibrated periodontal probe on days 0, 30, 60, 90, 120 and 180. PPD and PAL were not measured on day 30. Subjective evaluations were performed by the patient and the dentist on day 180. Paired T Test was used to observe differences within the groups in the different time periods, and ANOVA was performed to analyze differences between the 3 surgical procedures (p<0.05). The results showed that the mean root coverage was 66.8% for the CAF group, while the corresponding values for ALL and CTG were 775.9% and 81.4%, respectively. There was no significant difference between the values of ALL and CO, but the mean values for root coverage of CO group were statistically higher than the CAF group. The mean values of clinical attachment gain of 4.2 (± 0.9) mm and 3.5 (± 1.0) mm in CTG and ALL groups, respectively, were statistically higher than the corresponding values for CAF group (2.1 ± 0.7 mm). There was no significant difference between the mean increase of KG of 1.4 (± 0.3) mm in CTG group and 1.3(± 0.2) mm in ALL group. KG was not different in the CAF group. In conclusion, CTG and ALL procedures presented similar and better results than CAF procedure in relation to clinical attachment gain, increase in the width of KG and the % of root coverage