The Effect of Using Two Different Suturing Techniques on Free Gingival Marginal Stability
Condition: Altered Passive Eruption of Teeth
MeSH terms: Exanthema
Study type: Interventional

Summary: 
      Gummy smile is one of the major esthetic problems nowadays; it is due to several causes that
      either dental or skeletal. Etiology of the gummy smile is altered passive eruption, vertical
      maxillary excess, different gingival enlargement conditions, deficient maxillary lip length
      and excessive maxillary lip mobility, dento alveolar extrusion, combination of all these
      factors.

      Altered passive eruption is considered to be one of the most major causes, it is classified
      into two types according to the location of the mucogingival junction with respect to the
      bone crest and each type has two subtypes . Esthetic crown lengthening is the treatment of
      choice for subtype B in both types as bone removal is mandatory to create a space for the
      biological width.

      Most of the studies stated that there is some degree of relapse of the gingival tissues after
      the procedures in the follow ups, that relapse was related to the biotype of the gingival
      tissues, the flap placement close or far from the bone can be correlated to the suturing
      technique used for closure of the tissues.

      In the investigator's study comparing of two different suturing technique was done to
      evaluated their effect on gingival tissue relapse, 30 patients (26 females and 4 males) were
      divided between 2 groups each group consisted of 15 patients. In the first group periosteal
      suturing technique was done in the second figure of eight (modified interrupted) suturing
      technique was.

      Evaluation of the tissue relapse was done through the assessment of the amount of the
      attached gingival tissues level of gingival margin and marginal tissue contour before and
      after the surgery.

      The results of the study showed that tissue relapse was more in the periosteal suturing
      technique group that was related to the pressure on the tissues due to the fixation of the
      suture at the periostium, the papillary tissue also showed more inflammation in the follow up
      period prior to suture removal. The figure of eight group showed less relapse and tissue
      inflammation as it prevents flap edge overlap and is tension free therefore better blood
      supply to the tissue.

      Patients were generally satisfied post-surgical with their smile, gingival tissue visibility
      and teeth dimensions inspite of the relapse but it was better than prior to surgery. Also
      they would recommend it to other patients complaining from the same problem.
    

Detailed description: 
      Thirty patients (26 females, 4 males), who were candidates for esthetic crown lengthening,
      participated in this prospective clinical trial.

      Group 1 (15 patients) (Periosteal suture) :

      Esthetic crown lengthening procedure: internal bevel, sulcular and interdental incisions,
      flap elevation, bone removal then External vertical mattress suture was done (periosteal
      suture).

      Group 2 (15 patients) (Figure of eight suture) :

      Esthetic crown lengthening procedure: internal bevel, sulcular and interdental incisions,
      flap elevation, bone removal then modified interrupted suture was done (Figure of eight
      suture).
    

Intervention name(s): esthetic crown leghthening
Intervention type(s): Procedure
Intervention description(s): two different suturing technique used for flap closure after esthetic crown lengthening
Other intervention name(s): periosteal suture; figure of eight suture
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 2 arms undergoing the same surgical procedure but with different suturing techniques for flap closure
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: aesthetic crown lengthening; suturing technique