A Novel Volumetric Analysis Using CAD/CAM Scanners in Gingival Recession Treatment
Condition: Gingival Recession
MeSH terms: Gingival Recession
Study type: Interventional

Summary: 
      Aim: In this ramdomised clinical trial (RCT), the aim was to compare clinical periodontal
      data of subepithelial connective tissue graft (SCTG) group and SCGT+enamel matrix derivatives
      (EMD) group in terms of gained gingiva volume (GGV) and gained gingiva surface area (GGSA) by
      scanners of computer-aided design/computer-aided manufacturing (CAD/CAM) devices.

      Materials and Methods: A total of 35 Miller class I-II gingival recession defects were
      involved in this study (n=17 in SCTG group, n=18 in SCTG+EMD group). In addition to
      periodontal clinical parameters, three dimensional (3D) images were recorded using CAD/CAM
      system before the treatment, at the 1st month and at the 6th months after the treatment. The
      images were superimposed using softwares and GGV, GGSA were calculated.
    

Detailed description: 
      Study populations:

      In this study, totally 35 gingival recession (GR) defects in 35 patients, who applied with
      complaints of poor aesthetic and/or root surface sensitivity. Following patients were
      admitted to the study: individuals should have no systemic disease, should be non-smokers of
      cigarette or tobacco products, not in a pregnancy, have not used any antibiotics or
      medications with an impact on the immune system within last 6 months, have GR classified as
      Miller class I or class II, have GR depth of ≥2mm , have no decay or restoration on the vital
      teeth which will be operated, have no operation history with regard to GRs for related tooth
      area. The materials and methods of this study were approved by the Non-Drug Clinical
      Researches Ethics Committee of Yüzüncü Yıl University (B.30.2.YYU.0.01.00.00/32).

      Study Groups:

      In SCTG group 17 of GRs defects and in SCTG+EMD group 18 GRs defects were treated. While GRs
      in SCTG group was treated by SCTG and CPF combination therapy, EMD (Emdogain, Straumann,
      Basel, Switzerland) was additionally used in GR treatments of SCTG+EMD group. Patients were
      randomized by complete randomization method (SPSS 15; SPSS Inc., Chicago, IL, USA) to assign
      them into groups.

      Pre-surgical Procedure:

      Patients were informed about the potential causes of GRs. Causative habits of GR have been
      eliminated. Baseline periodontal treatments of the patients were performed. Plaque index (PI)
      , gingival index (GI) , probing pocket depth (PPD) (mm), clinical attachment level (CAL) (mm)
      were recorded before periodontal treatment. We prepared patients with total PI scores less
      than 15% for the surgical procedure (O'Leary et al 1972). Pre-treatment 3D soft tissue images
      were taken by CEREC Omnicam (Sirona Dental Systems GmbH, Bensheim, Germany) from intra-oral
      region. Recipient zone was prepared using the Langer method. SCTG was extracted ipsilaterally
      with the operation site from the palatal region between distal of canine and mesial of 1st
      molar tooth. Incision was performed in parallel with free gingival margin using Harris graft
      knife (Harris Double Blade Graft Knife, H & H Company, Ontario, CA, USA). Harvested graft was
      implanted to recipient zone so that its periosteal side faces with root surface and overhangs
      defect borders by 1mm. In order to remove the smear layer on the root surface of the teeth in
      SCTG+EMD group, 24% EDTA (Prefgel, Straumann, Basel, Switzerland) was applied for two minutes
      onto the root surface and operation site was washed with normal saline in order to remove any
      residual EDTA. EMD was applied to entire root surface compatible with manufacturer's
      instructions .

      Post-surgical Procedure:

      3D images and clinical parameter values were recorded during follow-up examinations at the
      1st and the 6th month after the periodontal surgery. 3D images of soft tissue were taken
      intraorally with CEREC Omnicam® device at the commencement of treatment as well as at the
      post-operative 1st and 6th months . The measurements were recorded as in rst.img format which
      is a file extension of CEREC system®. The operation site was cut out from the image which was
      recorded at the 1st and at the 6th month. Images of each patient which were taken in three
      different time points were overlapped on Mimics 10 software. GGV and GGSA measurements were
      made on the overlapped images. the GGV and GGSA were calculated the difference in tissue as
      obtained after overlapping the 3D images by the software. Changes at the 1st and the 6th
      month after treatment were calculated with respect to pre-treatment images .
    

Intervention name(s): SCTG+EMD; SCTG
Intervention type(s): Procedure; Procedure
Intervention description(s): Miller class I-II gingival recession defects were operated with SCTG+EMD; Miller class I-II gingival recession defects were operated with SCTG only and
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Gingival recession; Subepithelial connective tissue grafts; CAD/CAM