The Effect of Using Two Different Suturing Techniques on Free Gingival Marginal Stability

The Effect of Using Two Different Suturing Techniques on Free Gingival Marginal Stability After Esthetic Crown Lengthening for Treatment of Gummy Smile (Randomized Clinical Trial)

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.

Study Overview

• Status: Completed
• Conditions: Altered Passive Eruption of Teeth
• Intervention / Treatment: Procedure: vertical mattress suturing technique; Procedure: figure of eight suturing technique

Detailed Description

Thirty patients (26 females, 4 males), who were candidates for esthetic crown lengthening, participated in this prospective clinical trial.

Group I (15 patients) (vertical mattress suturing technique) :

Esthetic crown lengthening procedure: internal bevel, sulcular and interdental incisions, flap elevation, bone removal then External vertical mattress suture was done (periosteal suture).

Group II (15 patients) (Figure of eight suturing technique) :

Esthetic crown lengthening procedure: internal bevel, sulcular and interdental incisions, flap elevation, bone removal then modified interrupted suture was done (Figure of eight suture).

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt
    • Faculty of dentistry Ain Shams University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 40 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Patients complaining from gummy smile (altered passive eruption)
• Bone level is 2 mm or less from the cemento enamel junction
• Teeth included were free from any periodontal destruction
• Good compliance with the plaque control instructions following initial therapy.
• Availability for follow up and maintenance program

Exclusion Criteria:

• Presence of systemic diseases which could influence the outcome of the therapy (American society of anesthesiologists I, ASA I).
• Patient suffering from periodontitis stage 4 grade c.
• Presence of smoking habit.
• Presence of occlusion interference.
• Pregnant females and lactating females. .
• Vulnerable groups of patients (handicapped, mentally retarded, prisoners).
• Restored teeth.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: vertical mattress suturing technique; vertical mattress suturing technique is done to close the flap	Procedure: vertical mattress suturing technique; vertical mattress suturing technique used for flap closure after esthetic crown lengthening
Active Comparator: figure of eight suturing technique; figure of eight suturing technique is done to close the flap	Procedure: figure of eight suturing technique; figure of eight suturing technique used for flap closure after esthetic crown lengthening

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
evaluation of the marginal soft tissue levels rebound	determination of soft tissue rebound: is measured as the difference between (the level of free gingival margin after suturing) and (the level of the free gingival margin 6 months post surgical) both measured from fixed reference point on the stent to the free gingival margin	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Supracrestal gingival tissue	the difference between the bone level and the free gingival margin (measured from a fixed reference point on the stent)	6 months
Patient satisfaction	questionnaire (After surgery); Is the patient satisfied with the gingival display during talking and smiling, teeth display during talking and smiling (not at all, slightly, somewhat, very and extremely).; How was the procedure experience (much worse, worse, same as I thought, better and much better).	at 6 months post surgical

Collaborators and Investigators

• Sponsor: Ain Shams University
• Investigators: Study Director: ahmed gamal, professor, Faculty of dentistry Ain Shams University

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2017
• Primary Completion (Actual): June 1, 2018
• Study Completion (Actual): November 1, 2019

Study Registration Dates

• First Submitted: December 30, 2019
• First Submitted That Met QC Criteria: January 4, 2020
• First Posted (Actual): January 7, 2020

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 9, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Keywords: suturing technique; esthetic crown lengthening; vertical mattress suturing technique; figure of eight suturing technique; tissue rebound; supracrestal gingival tissue; free gingival margin
• Additional Relevant MeSH Terms: Skin Diseases; Exanthema
• Other Study ID Numbers: PER16-35M

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: when the study is done the results will be published with the protocol
• IPD Sharing Time Frame: the data will be available starting next month and for 1 year
• IPD Sharing Access Criteria: the keywords esthetic crown lengthening, suturing techniques in dentistry
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No