Is Treatment of Gingival Recession Predictable

The purpose of this study is to offer a method for prediction the result of treatment of gingival recessions using coronally advanced flap (CAF) and platelet rich fibrin membrane (PRFm) with CAF and connective tissue graft (CTG). The reported work gets answers to the following open questions: Is the treatment of mucogingival defects a predictable procedure? Is the jaw a factor affecting the outcome of coronally advanced flap root coverage procedure? To achieve this goal the authors followed the Creeping Attachment clinical parameter six months postoperatively. Keywords - Biostatistics, split mouth randomized controlled study, ANOVA-like model, Bayesian analysis, heterogeneous-variance model, two-way interactions. I. Introduction Gingival recession is a common manifestation in most populations. Gingival recession may be a concern for patients for a number of reasons such as root hypersensitivity, erosion, root caries, and aesthetics. Multiple gingival recessions may be a concern for patients with a high lip smile line. Studies on this surgical challenge mostly concern the treatment of recession defects. Multiple adjacent recession-type defects present a further challenge because several recessions must be treated at a single surgical session to minimize patient discomfort. Gingival recession affects a significant proportion of the adult population including those with a good standard of oral hygiene. In addition to its unfavorable effect on aesthetics and self-esteem, gingival recession also is associated with destructive periodontal diseases, root caries and fear of losing teeth. Clinical evaluations of the treatment of isolated and adjacent multiple gingival recessions based on both a Coronally Advanced Flap (CAF) alone or connective tissue graft (CTG) and in combination with a Platelet-Rich Fibrin (CAF + PRF) membrane are presented in (1-5). The aim of these studies was to determine whether the addition of an autologous platelet rich fibrin (PRF) membrane to a coronally advanced flap (CAF) would improve the clinical outcome in terms of root coverage in the treatment of isolated and adjacent multiple gingival recessions. Systemically healthy subjects each with single Miller's class I or II buccal recession defect were randomly assigned to control (CAF+CTG) or test (CAF + PRF) group. All patients who had been included in the study have received the treatment and turned up regularly for re-evaluation. Mean and standard deviation for the clinical variables have been calculated for each treatment. The aim of the study described in (4) and (9) was to determine whether the addition of an autologous platelet rich fibrin (PRF) membrane to a coronally advanced flap (CAF) would improve the clinical outcome in terms of root coverage in the treatment of isolated gingival recession. The result of this split mouth randomized controlled study evaluating the adjunctive effect of platelet rich fibrin to coronally advanced flap in Miller's class I or II recession defects is described in (3). The statistical analysis was performed using frequent statistics with R software. The significance of the difference within and between groups before and after treatment was evaluated with the paired t test. Differences were considered statistically significant at level of significance 0.05. II. Creeping Attachment Phenomenon Root coverage is a desired outcome of treatment. The root coverage may result from a mechanism known as creeping attachment, which is the postoperative migration of the gingival marginal tissue in a coronal direction over portions of a previously denuded root. This phenomenon can be detected up to 4 years after graft surgery. Gingival grafting is a well-established pure mucogingival procedure for increasing the width of attached gingiva. Since its introduction in 1963, the procedure has proven reliable in increasing attached gingiva and stopping progressive gingival recession. However, only a few cases of creeping attachment after gingival grafting have been reported in the dental literature. Matter and Cimasoni described 5 factors that seemed to have a definite influence on creeping attachment: width of the recession, position of the graft, interproximal bone resorption, position of the tooth and the patient's dental hygiene (6). Creeping attachment typically occurs within one to twelve months after the graft surgery. The amount of creeping attachment is unpredictable. In order to elucidate the mechanism of