[Original in spanish ] Update of techniques for the treatment of periodontal recessions.
- Scandola , Debora 1
- Muñoz Corcuera , Marta 1
- Gil Abando, Gabriela 1
- González Ibarguren, Emilio 1
-
1
Universidad Europea de Madrid
info
ISSN: 2215-5740, 1659-0775
Any de publicació: 2024
Volum: 1
Número: 40
Pàgines: 18-29
Tipus: Article
Altres publicacions en: Odontología Vital
Resum
Background: Along the years, a remarkable variety of periodontal surgical protocols has been proposed, the focus of which has shifted from the mere resolution of a soft tissue defect to the performance of predictable and minimally invasive procedures. Initially, the free gingival graft was used. Subsequently, many different techniques were experimented, including those using soft tissue substitutes, such as the Alloderm membrane. Nowadays, the association of the connective tissue graft with the coronally advanced flap is considered the gold standard. Finally, the Pinhole technique, being a more conservative method in terms of tissue preservation and aesthetic outcome, was proposed. Objectives: The aim of this review was the comparison of the updated techniques for the treatment of multiple periodontal recessions, affecting both maxilla and mandible. The procedure outcome was assessed in terms of complete root coverage, recession reduction, gain in height and volume, aesthetic outcome, patient’s post-operative pain and morbidity of donor and recipient sites. Material and methods: Electronic and hand searches were performed to collect split- mouth studies, randomized controlled clinical trials, case series, pilot studies, periodontal books, case studies, systematic reviews and meta-analysis, including maxillary and mandibular multiple gingival recession defects of all four Miller’s classes, for its extensive evidence. Results: Thirty-four publications were included and data regarding the surgical techniques outcome were extracted from eighteen articles. The clinical evaluation analyzed the amount of complete root coverage, recession reduction and gain in height and volume, while the patient’s perspective was expressed in terms of aesthetic satisfaction and possible postoperative complications. Procedures in the last ten years showed better results in all the above-mentioned factors. Conclusion: Procedural predictability and long-lasting treatment stability embody the factors driving the technique election process and adding value to more updated procedures. Progress was observed both at an aesthetic level, by reducing the discrepancies between the surgical region and the surrounding tissue, and at a postoperative level, by reducing patient discomfort. The challenges inherent to this branch could soon find answers thanks to its prompt evolution, which allows for further advances to be conceived.
Referències bibliogràfiques
- Agarwal M, Kumar G, Manjunath R, Karthikeyan S, Gummaluri S. (2020). Pinhole surgical technique-A novel minimally invasive approach for treatment of multiple gingival recession defects: A case series. Contemp Clin Dent;11(1):97–100. https://doi.org/10.4103/ccd.ccd_449_19
- Alghamdi H, Babay N, Sukumaran A. (2009). Surgical management of gingival recession: A clinical update. Saud Dent J;21(2):83–94. https://doi.org/10.1016/j.sdentj.2009.07.006
- Azaripour A, Kissinger M, Farina VSL, van Noorden CJF, Gerhold-Ay A, Willershausen B, et al. (2016). Root coverage with connective tissue graft associated with coronally advanced flap or tunnel technique: a randomized, double-blind, mono-centre clinical trial. J Clin Periodontol;43(12):1142–1150. https://doi.org/10.1111/jcpe.12627
- Cairo F, Nieri M, Pagliaro U. (2014). Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol;41(15):44-62. https://doi.org/10.1111/jcpe.12182
- Caton J, Armitage G, Berglundh T, Chapple I, Jepsen S, Kornman K et al. (2018). A new classification scheme for periodontal and peri-implant diseases and conditions – Introduction key changes from the 1999 classification. J Clin Periodontol;45(45):1-8. https://doi.org/10.1111/jcpe.12935
- Cortellini P, Tonetti M, Pini Prato G. (2021). The partly epithelialized free gingival graft (pe-fgg) at lower incisors. A pilot study with implications for alignment of the mucogingival junction. J Clin Periodontol;39:674–80. https://doi.org/10.1111/j.1600-051X.2012.01896.x
- De Sanctis M, Clementini M. (2014). Flap approaches in plastic periodontal and implant surgery: critical elements in desing and execution. J Clin Periodontol;15:108–22. https://doi.org/10.1111/jcpe.12189
- Dodge A, Garcia J, Luepke P, Lai YL, Kassab MM. (2018). The Effect of Partially Exposed Connective Tissue Graft on Root-Coverage Outcomes: A Systematic Review and Meta-Analysis. Eur J Oral Sci;126(2):84-92. https://doi.org/10.1111/eos.12401
- Dominiak M, Gedrange T. (2014). New Perspectives in the Diagnostic of Gingival Recession. Adv Clin Exp Med;23(6):857-863. https://doi.org/10.17219/acem/27907
- Gobbato L, Nart J, Bressan E, Mazzocco F, Paniz G, Lops D. (2016). Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial. Clin Oral Invest;20:2191-2202. https://doi.org/10.1007/s00784-016-1721-7
- Imber J.C, Kasaj A.(2021). Treatment of Gingival Recession: When and How?. Int Dent J;71(3):178-187. https://doi.org/10.1111/idj.12617
- Mansouri SS, Moghaddas O, Torabi N, Ghafari K. (2019). Vestibular incisional subperiosteal tunnel access versus coronally advanced flap with connective tissue graft for root coverage of Miller’s class I and II gingival recession: A randomized clinical trial. J Adv Periodontal Implant Dent;11(1):12–20. https://doi.org/10.15171/japid.2019.003
- Osorio M, Soto E, Toledano M, Rivas M, Vallecillo C, García P, et al. (2022). Treating Gingival Recessions Using Coronally Advanced Flap or Tunnel Techniques with Autografts or Polymeric Substitutes: A Systematic Review and Meta-Analysis. Polymers. https://doi.org/10.3390/polym14071453
- Ozenci I, Ipci SD, Cakar G, Yilmaz S. (2015). Tunnel technique versus coronally advanced flap with acellular dermal matrix graft in the treatment of multiple gingival recessions. J Clin Periodontol;42(12):1135–1142. https://doi.org/10.1111/jcpe.12477
- Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P. (2010). Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: A split-mouth study with a 5-year follow-up. J Clin Periodontol;37(7):644–650. https://doi.org/10.1111/j.1600-051X.2010.01559.x
- Rajeswari S, Triveni M, Tarun Kumar A, Ravishankar P, Rajula M, Almeida L. (2021). Patient- centered comparative outcome analysis of platelet-rich fibrin-reinforced vestibular incision subperiosteal tunnel access technique and Zucchelli’s technique. J Indian Soc Periodontol;25(4):320–9. https://doi.org/10.4103/jisp.jisp_187_20
- Reddy, SSP. (2017). Pinhole Surgical Technique for treatment of marginal tissue recession: A case series. J Indian Soc Periodontol;11(1):97-100. https://doi.org/10.4103/jisp.jisp_138_17
- Skurska, A, Dolińska, E, Sulewska, M, Milewski, R, Pietruski, J, Sobaniec, S, et al. (2015). The assessment of the influence of vertical incisions on the aesthetic outcome of the Miller class I and II recession treatment: A split-mouth study. J Clin Periodontol;42(8):756–63. https://doi.org/10.1111/jcpe.12440 .
- Stefanini M, Zucchelli G, Marzadori M, de Sanctis M. (2018). Coronally Advanced Flap with Site-Specific Application of Connective Tissue Graft for the Treatment of Multiple Adjacent Gingival Recessions: A 3-Year Follow-Up Case Series. Int J Periodontics Restorative Dent;38(1):25–33. https://doi.org/10.11607/prd.3438
- Tavelli L, Ravida A, Lin GH, Suarez-Lopez del Amo F, Tattan M, Wang HL. (2019). Comparison between Subepithelial Connective Tissue Graft and De-epithelialized Gingival Graft: A systematic review and a meta-analysis. J Int Acad Periodontol;21(2):82-96. PMID: 31522155
- Tian W, Hu F, Zhou X. (2021). Comparative Evaluation of Connective Tissue Graft with Pouch/Tunnel Technique versus Connective Tissue Graft with Coronally Advanced Tunnel Flap for the Treatment of Maxillary Recession Cases in Severe Periodontitis. Tissue Eng Regen Med;18(6):1001–7. https://doi.org/10.1007/s13770-021-00375-8
- Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M. (2009). Coronally Advanced Flap With and Without Vertical Releasing Incisions for the Treatment of Multiple Gingival Recessions: A Comparative Controlled Randomized Clinical Trial. J Periodontol;80(7):1083–94. https://doi.org/10.1902/jop.2009.090041
- Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, et al. (2014). Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions: A comparative short- and long-term controlled randomized clinical trial. J Clin Periodontol;41(4):396–403. https://doi.org/10.1111/jcpe.12224
- Zuhr O, Rebele SF, Vach K, Petsos H, Hürzeler MB. (2020). Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 2-year results of an RCT using 3D digital measuring for volumetric comparison of gingival dimensions. J Clin Periodontol;47(9):1144–1158. https://doi.org/10.1111/jcpe.13328