Gingival Recessions Clinical Trial
Official title:
Predetermınatıon of Root Coverage for Recessıons Treated wıth Coronally Advanced Flap wıth Connectıve Tissue Graft: An Exploratıve Study
Background: The aim of present clinical study was to evaluate the predictive values of
baseline inter-dental papilla height (IPH), avascular exposed root surface area (AERSA) and
inter-dental clinical attachment loss (CAL) measurements on complete root coverage (CRC) of
single gingival recession (GR) defects treated with coronally advanced flap and connective
tissue graft technique (CAF+CTG).
Material and Methods: The study group included 65 females and 57 males, aged between 20 and
42 years. A total of 122 recession defects without CAL and with an amount of CAL equal or
smaller to the buccal CAL , located at upper and lower incisors and canines were treated
with CAF+CTG. IPH, AERSA and CAL parameters were analyzed for possible correlation with CRC
after 6 months.
The coronally advanced flap (CAF) with connective tissue graft (CTG) has been confirmed as
the gold standard for treatment of gingival recessions ). CTG-based procedures provide the
best outcomes with superior percentages of mean root coverage (MRC) and complete root
coverage (CRC) and keratinized tissue (KT) gain. Data in previous reports show CRC range
from 18% to 83% after CAF+CTG in Miller Classes I and II defects which are associated with
no inter-dental clinical attachment loss (interdental-CAL) (Recession Type 1-RT1)
The use of CTG under CAF significantly enhances the probability to achieve CRC (%57) in
recessions in which interdental-CAL is equal or smaller than the buccal attachment loss
(Recession Type 2-RT2). It has been emphasized that CRC percentage was very similar to the
result (60%) of a multicentre study on the treatment of RT1 recessions (Cortellini et al.
2009). Moreover, CRC was higher than most of the reports on treatment of RT1 or Miller I and
II defects (more than 80%) when baseline interdental-CAL was between 1 and 3 mm Therefore,
various CRC outcomes of the literature indicate that there is need for additional defect
defining criteria for predicting the outcomes of root coverage (RC) in RT 1 and RT2
(interdental-CAL≤ 3mm) recession defects.
Predetermination of final RC which is important for distinguishing 'expected versus actual'
amount of RC was found to be related to inter-dental papilla height (IPH) and inter-dental
clinical attachment level (ICAL) by the clinical studies which reported correlation between
these two anatomical characteristics and CRC. Recently a new predictive classification of
gingival recessions using the baseline avascular exposed root surface area (AERSA) as an
identification criterion has been proposed. AERSA resulted as a strong predictor of final RC
after laterally positioned flap (LPF) leading to a prognostic model with AERSA explaining
86% of the mean root coverage. In addition, due to anatomic variations, some Miller Class I
defects may have larger AERSA than Miller Class II and III defects or there may be smaller
Miller Class III defects than Miller Class I and II defects which may significantly
influence the treatment results. These results could help to explain the outcome variations
among previous studies.
The prognostic anticipation of a certain amount of RC is a complex process including
patient-related, tooth/site-related (GRD, root abrasion, ICAL, tooth type, the dimension of
inter-dental papilla, AERSA) and technique-related (e.g. quality of the CTG) factors and
operator's skill. It is essential to define the most potent prognostic factors' combination
which can increase the success and predictability rates, to make CAF+CTG the most convenient
RC technique for patients and clinicians. Therefore the aim of this study was to explore the
predictive values of baseline IPH, AERSA and ICAL measurements on the final RC outcomes
after CAF+CTG in RT1 and RT2 class GR defects.
;
Allocation: Non-Randomized, Intervention Model: Single Group Assignment, Masking: Single Blind (Investigator), Primary Purpose: Diagnostic
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