Gingival Recession, Generalized Clinical Trial
Official title:
Efficiency of Platelet-Rich Plasma (PRP) on Acellular Dermal Matrix Application With Coronally Advanced Flap in the Treatment of Multiple Adjacent Gingival Recessions:a Double-masked Randomized Controlled Clinical Trial
The aim of this study was to evaluate the effectiveness of platelet rich plasma (PRP)
combined with coronally advanced flap plus acellular dermal matrix application (CAF+ADM) in
the treatment of multiple adjacent gingival recessions (MAGRs).
12 patients with 84 Miller Class I or II recession defects were participated. Sites were
randomly assigned into CAF+ADM+PRP or CAF+ADM groups. Gingival recession depth (GRD),
recession width (GRW), width of keratinized tissue (WKT), creeping attachment (CRA), root
coverage (RC) as well as plaque index, gingival index, probing depth (PD), and clinical
attachment level (CAL) were recorded at baseline and 3rd,6th and 12th months
postoperatively. The data were analyzed statistically.
Several methods have been demonstrated for the treatment of gingival recession defects with
the use of PRP. In an 8-month randomized controlled trial, it was reported that there was no
significant difference between PRP and CTG treated groups in terms of root coverage of
Miller Class 1 or II buccal recession defects. However, in the same study contour and
texture of soft tissue showed valuable enhancement in PRP group. The use of PRP together
with ADM in the treatment of MAGRs may alleviate the need for autogenous donor tissue.
Shepherd et al. compared coronally positioned tunnel technique and ADM application with and
without PRP for the treatment of single gingival recession defects and reported no
statistically significant root coverage difference between groups.
Although there are numerous root coverage procedures to treat the conditions, predictable
coverage of multiple adjacent gingival recessions still remains a challenge for the
clinician. The aim of this randomized, controlled, clinical trial was to compare the CAF
plus ADM application together with and without PRP to determine whether the PRP provided an
advantage in terms of gaining coverage of deep and wide recession defects in the treatment
of MAGRs.
In the present study, using a controlled blinded split-mouth design, 14 patients with
multiple Miller Class I or II adjacent recession defects ≥ 3mm deep on bilateral operation
sites were randomly operated either with CAF+ADM+PRP or only CAF+ADM as test and control
groups respectively. Two patients who failed to return for all postoperative visits were
exited from the study.
Finally12 patients who had adjacent Miller Class 1 or II (Miller) recession defects ≥ 3mm
deep on non-molar teeth in the same dental arch at least two bilateral site, underwent
through root coverage surgery and were followed for 12 months. The study sample consisted of
84 teeth associated with total of 12 patients; seven patients each showing a pair of three
teeth, four patients each showing a pair of four teeth, and one patient showing a pair of
five teeth with adjacent multiple recessions deep on the buccal aspect of each tooth. The
treated teeth were 26 incisors, 24 canines and 34 first premolars. Standardized radiographs
were taken to evaluate the interproximal alveolar bone level. At baseline, 3, 6 and 12
months after the surgeries; Miller classification of the recession defect (Miller, 1985),
plaque index (PI) (Silness and Loe, 1964), gingival index (GI) (Loe, 1967) probing depth
(PD), clinical attachment level(CAL), Probing depth(PD), gingival margin (GM), Gingival
recession width (GRW) were recorded. The pre-surgical evaluation included an analysis of the
patient's tooth brushing technique and habits. At the teeth showing gingival recessions, a
coronally directed roll technique using a soft toothbrush was indicated to minimize the
tooth brushing trauma to the gingival margin. Pre-surgical therapy included scaling, root
planning, polishing and general oral hygiene instruction. All surgical procedures were
performed with Coronally Advanced Flap technique.
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