Gingival Recession, Generalized Clinical Trial
Official title:
Clinical, Patient-centered Outcomes and Laser Doppler Flowmetry Using Double Blade Scalpel (DBS) and De-epithelized (DE) SCTG Associated With Coronally Advanced Flap (CAF): a Split-mouth Randomized Clinical Trial
This split-mouth randomized clinical trial compared two different types of subepithelial connective tissue grafts (SCTG) considering clinical parameters and patient-centered outcomes in patients with bilateral RT 1 multiple gingival recessions after 6 months postoperatively. 21 patients with 84 sites were surgically treated with coronally advanced flap (CAF) associated with SCTG harvested by: double blade scalpel (DBS) and de-epithelized (DE) SCTG. Periodontal clinical parameters and aesthetics were evaluated by a calibrated periodontist at baseline and after 6 months. Patient-centered outcomes related to pain/discomfort and aesthetics were assessed with Visual Analogue Scale (VAS) after 7 days and 6 months, respectively. Gingival blood flows were analyzed by Laser Doppler flowmetry (FLD) at baseline and 2, 7 and 14 days postoperatively.
Clinical parameters and patient-centered outcomes
Periodontal clinical examination was performed by a blind and calibrated examiner
(intra-class correlation coefficient = 0.72) using a North Carolina periodontal probe
(PCPUNC-Hu-Friedy®). Periodontal parameters were evaluated at baseline and after 6 months
postoperatively and included:
1. Recession depth (RD) - Distance in millimeters of cemento-enamel junction (CEJ) to
gingival margin measured at the midbuccal aspect of the tooth;
2. Recession width (RW) - Distance between interproximal gingival margins of GR with
periodontal probe positioned at CEJ;
3. Probing depth (PD) - Distance in millimeters from the gingival margin to the bottom of
the gingival sulcus;
4. Clinical attachment level (CAL) - Distance in millimeters from the CEJ to the bottom of
the gingival sulcus;
5. Keratinized tissue width (KTW) - Distance in millimeters from the gingival margin to the
mucogingival junction measured at the midbuccal aspect of the tooth;
6. Keratinized tissue thickness (KTT): determined 1.5 mm apically to gingival margin with
an anesthesia needle and a rubber endodontic stop inserted perpendicularly into the soft
tissue and measured with a digital caliper.
The index proposed by Zucchelli & DeSanctis (2000) was used to calculate percentage of root
coverage (%RC), as follows:
RRC=(100.(RD baseline-RD 6 months))/(RD baseline) Patient centered outcomes and professional
assessment were evaluated with visual analog scales (VAS). VAS was administered verbally to
the patients to assess aesthetics and postoperative pain/discomfort. Patients were asked to
make a mark in a scale between 0 (not satisfied or extreme pain) and 10 (very satisfied or no
pain). Pain and discomfort were recorded after 7 days and patient´s aesthetic evaluation
after 6 months. An experienced periodontist (intra-class correlation coefficient = 0.95)
evaluated aesthetic outcome after 6 months.
The Laser Doppler flowmetry (LDF) technique (VMS-LDF2 DUAL CHANNEL- Laser Doppler Blood Flow
and Temperature Monitor (Moor instruments- process number-FAPESP 2012/13331-2) was used to
evaluate blood flow on the recipient sites. LDF is equipped with a laser diode that emits in
the infrared spectrum range (Maximum power - 2.5mW, wavelenghts 785nm±10nm). Measurements
with LDF were performed with two probes for 1 minute and 30 seconds. These measurements were
recorded three times for each site with intervals of one minute.
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