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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.

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OBJECTIVES: To evaluate the treatment of gingival recessions by semilunar coronally positioned flap plus enamel matrix derivative (SCPF + EMD). MATERIALS AND METHODS: Thirty patients with class I localized gingival recession were included. They were randomly allocated in two groups: SCPF + EMD and SCPF. Recession height (RH), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), probing depth (PD), and clinical attachment level (CAL) were measured at baseline, 6 and 12 months post-surgery. Patient/professional evaluation of esthetics and root sensitivity was performed. RESULTS: After 12 months, mean root coverage was 1.98 ± 0.33 mm for SCPF + EMD (90.86 ± 14.69%) and 1.85 ± 0.41 mm (79.76 ± 17.44%) for SCPF (p > 0.05). The esthetic evaluation by the patient showed preference for SCPF + EMD. According to the professional evaluation (QCE), the use of EMD decreases the appearance of postoperative scar tissue line. There was a significant reduction in root hypersensitivity with no further complaints by the patients. CONCLUSIONS: The addition of EMD provides significantly better esthetics to SCPF, according to patient and professional assessments. SCPF + EMD is effective but not superior to SCPF for root coverage, after 12 months. CLINICAL RELEVANCE: Previous clinical trials showed that the combination of EMD with coronally advanced flaps may enhance the outcome of root coverage. There is a lack of studies testing the combination of EMD with SCPF. The combination SCPF + EMD provides better esthetics when compared to the SCPF and is effective, but not superior, to SCPF for root coverage, after 12 months. TRIAL REGISTRATION: NCT02459704.

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INTRODUCTION: Treatment of multiple recession-type defects (MRTDs) developed subsequent to orthodontic therapy requires a solid knowledge of the anatomy/characteristics of the defects. Surgical approaches based on the use of subepithelial connective tissue grafts (SCTGs) are considered the "gold standard" for the treatment of MRTDs, but their use may be limited by the availability of donor tissue. The objective of this case report is to present the outcomes of treatment achieved by a SCTG in a patient presenting MRTDs in all four quadrants of the mouth. CASE PRESENTATION: A non-smoking 23-year-old female patient presenting 15 Miller Class I or II gingival recessions (GRs) at anterior and posterior teeth of the maxilla and mandible, developed after orthodontic therapy, was referred for treatment in March 2013. Defects were treated using four SCTG-based procedures using grafts harvested from two donor sites at different time frames. Twenty-four months after treatment, gingival thickness modification led to esthetic and functional results. CONCLUSION: The use of SCTGs harvested twice from the same donor site for the treatment of MRTDs led to safe and predictable outcomes (i.e., clinically significant gains in GR depth, attachment level, and esthetics).

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BACKGROUND: This paper aims to create a "bridge" between research and practice by developing a practical, extensive, and clinically relevant study that translates evidence-based findings on soft tissue root coverage (RC) of recession-type defects to daily clinical practice. METHODS: This review is prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused questions. A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE and EMBASE databases up to and including June 2013. Systematic reviews (SRs), randomized clinical trials, controlled clinical trials, case series, and case reports evaluating recession areas that were treated by means of RC procedures were considered eligible for inclusion through the three parts of the study (part I, an overview of the base of SRs; part II, an alternative random-effects meta-analyses on mean percentage of RC and sites exhibiting complete RC; and part III, an SR of non-randomized trials exploring other conditions not extensively evaluated by previous SRs). Data on Class I, II, III, and IV recessions, type of histologic attachment achieved with treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions, tooth type and location, long-term effectiveness outcomes, unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes were assessed as well. RESULTS: Of the 2,456 potentially eligible trials, 234 were included. Data on Class I, II, III, and IV gingival recessions, histologic attachment achieved after treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions/biomodification, tooth type and location, long-term effectiveness outcomes and unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes (i.e., esthetic, visual analog scale, complications, hypersensitivity, patients perceptions) were assessed. Subepithelial connective tissue (CT)-based procedures and coronally advanced flap plus acellular dermal matrix grafts, enamel matrix derivative, or collagen matrix led to the best improvements of recession depth, clinical attachment level (CAL) gain, and keratinized tissue (KT). Some conditions, such as smoking and use of magnification, may affect RC outcomes. CONCLUSIONS: All RC procedures can provide significant reduction in recession depth and CAL gain for Miller Class I and II recession-type defects. Subepithelial CT graft-based procedures provided the best outcomes for clinical practice because of their superior percentages of mean and complete RC, as well as significant increase of KT.

Assuntos