Predetermination for Gingival Recession
Condition: Gingival Recessions
MeSH terms: Gingival Recession
Study type: Interventional

Summary: 
      Background: The aim of present clinical study was to evaluate the predictive values of
      baseline inter-dental papilla height (IPH), avascular exposed root surface area (AERSA) and
      inter-dental clinical attachment loss (CAL) measurements on complete root coverage (CRC) of
      single gingival recession (GR) defects treated with coronally advanced flap and connective
      tissue graft technique (CAF+CTG).

      Material and Methods: The study group included 65 females and 57 males, aged between 20 and
      42 years. A total of 122 recession defects without CAL and with an amount of CAL equal or
      smaller to the buccal CAL , located at upper and lower incisors and canines were treated with
      CAF+CTG. IPH, AERSA and CAL parameters were analyzed for possible correlation with CRC after
      6 months.
    

Detailed description: 
      The coronally advanced flap (CAF) with connective tissue graft (CTG) has been confirmed as
      the gold standard for treatment of gingival recessions ). CTG-based procedures provide the
      best outcomes with superior percentages of mean root coverage (MRC) and complete root
      coverage (CRC) and keratinized tissue (KT) gain. Data in previous reports show CRC range from
      18% to 83% after CAF+CTG in Miller Classes I and II defects which are associated with no
      inter-dental clinical attachment loss (interdental-CAL) (Recession Type 1-RT1)

      The use of CTG under CAF significantly enhances the probability to achieve CRC (%57) in
      recessions in which interdental-CAL is equal or smaller than the buccal attachment loss
      (Recession Type 2-RT2). It has been emphasized that CRC percentage was very similar to the
      result (60%) of a multicentre study on the treatment of RT1 recessions (Cortellini et al.
      2009). Moreover, CRC was higher than most of the reports on treatment of RT1 or Miller I and
      II defects (more than 80%) when baseline interdental-CAL was between 1 and 3 mm Therefore,
      various CRC outcomes of the literature indicate that there is need for additional defect
      defining criteria for predicting the outcomes of root coverage (RC) in RT 1 and RT2
      (interdental-CAL≤ 3mm) recession defects.

      Predetermination of final RC which is important for distinguishing 'expected versus actual'
      amount of RC was found to be related to inter-dental papilla height (IPH) and inter-dental
      clinical attachment level (ICAL) by the clinical studies which reported correlation between
      these two anatomical characteristics and CRC. Recently a new predictive classification of
      gingival recessions using the baseline avascular exposed root surface area (AERSA) as an
      identification criterion has been proposed. AERSA resulted as a strong predictor of final RC
      after laterally positioned flap (LPF) leading to a prognostic model with AERSA explaining 86%
      of the mean root coverage. In addition, due to anatomic variations, some Miller Class I
      defects may have larger AERSA than Miller Class II and III defects or there may be smaller
      Miller Class III defects than Miller Class I and II defects which may significantly influence
      the treatment results. These results could help to explain the outcome variations among
      previous studies.

      The prognostic anticipation of a certain amount of RC is a complex process including
      patient-related, tooth/site-related (GRD, root abrasion, ICAL, tooth type, the dimension of
      inter-dental papilla, AERSA) and technique-related (e.g. quality of the CTG) factors and
      operator's skill. It is essential to define the most potent prognostic factors' combination
      which can increase the success and predictability rates, to make CAF+CTG the most convenient
      RC technique for patients and clinicians. Therefore the aim of this study was to explore the
      predictive values of baseline IPH, AERSA and ICAL measurements on the final RC outcomes after
      CAF+CTG in RT1 and RT2 class GR defects.
    

Intervention name(s): Coronally advanced flap with connective tissue graft
Intervention type(s): Other
Intervention description(s): Two oblique, divergent releasing incisions extending beyond the mucogingival junction were performed. An intra-sulcular incision was performed at the buccal aspect of the involved tooth. Subsequently, a partial-thickness flap was raised beyond the MGJ. The papilla adjacent to the involved tooth were then de-epithelialized.
The CTG was harvested using a single incision approach from the palate. The graft was positioned on the instrumented root surface immediately apical of the CEJ and then stabilized using a sling compressive crossing suture. The flap was coronally displaced 1-2 mm above the CEJ. A sling suture was placed to stabilize the flap in a coronal position, followed by interrupted sutures on the releasing incisions with an apico-coronal direction.
Other intervention name(s): CAF+CTG
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: Single (Investigator)
Primary purpose: Diagnostic
Keywords: prognostic factors