clinical, patient-centered outcomes and laser doppler flowmetry using two types of sctg

Conditions: Gingival Recession, Generalized

Summary: 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.

Eligibility criteria:
inclusion criteria: * systemically healthy patients between 18 and 70 years * clinical diagnosis of bilateral multiple gingival recessions, recession type (rt) 1 (cairo et al. 2011) with at least one gingival recession ≥ 2 mm on each side, including canines and premolars. exclusion criteria: * abnormal teeth position * smokers, pregnant or nursing women * parafunctional habits * plaque and bleeding indexes (ainamo \& bay, 1975) above 20% * previous periodontal surgeries on selected sites.

Keywords: connective tissue randomized controlled trial gingival recession patient outcome assessment