The influence of tooth location on the outcomes of multiple adjacent gingival recessions treated with coronally advanced flap: A multicenter re-analysis study

Giovanni Zucchelli, Lorenzo Tavelli, Shayan Barootchi, Martina Stefanini, Giulio Rasperini, Cristina Valles, José Nart, Hom-Lay Wang, Giovanni Zucchelli, Lorenzo Tavelli, Shayan Barootchi, Martina Stefanini, Giulio Rasperini, Cristina Valles, José Nart, Hom-Lay Wang

Abstract

Background: Tooth location has been shown to play a significant role on root coverage outcomes. However, whether this has an impact on the outcomes of coronally advanced flap (CAF) for treating multiple adjacent gingival recessions (MAGRs) remains to be determined. The aim of this study was to investigate the impact of tooth location, flap design, and flap extension on the outcomes of MAGRs following CAF with or without a connective tissue graft (CTG).

Methods: A re-analysis of six previously published clinical trials evaluating the outcomes of CAF in the treatment of MAGRs was performed using mixed regression and logistics to assess the influence of potentially influential factors on the treatment outcomes.

Results: Six hundred and nine MAGRs in 166 patients were evaluated. The anterior maxilla (second sextant) was associated to the highest mean root coverage (mRC) and complete root coverage (CRC) outcome (P < 0.05). In addition, the maxillary teeth showed significantly greater mRC and CRC than teeth in the mandible (with the lower anterior [fifth sextant] showing the lowest outcomes) (P < 0.05). A higher mRC was observed for the anterior teeth compared with posterior dentition (P < 0.05). While CAF + CTG achieved better results than CAF alone, no differences were found when the flap was performed with or without vertical releasing incisions (P > 0.05). Lastly, teeth in the distal part of the flap showed lower mRC and CRC than teeth in the central or mesial position (P < 0.05).

Conclusions: Tooth location was found to play a key role in determining the amount of root coverage achievable, with maxillary canines and incisors being associated with the highest outcomes compared with other sextants. Maxillary MAGRs showed greater mRC and CRC than mandibular MAGRs.

Keywords: dental esthetics; evidence-based dentistry; gingival recession; surgical flaps; tooth root.

© 2019 American Academy of Periodontology.

References

REFERENCES

    1. Lawrence HP, Hunt RJ, Beck JD. Three-year root caries incidence and risk modeling in older adults in North Carolina. J Public Health Dent. 1995;55:69-78.
    1. Susin C, Haas AN, Oppermann RV, Haugejorden O, Albandar JM. Gingival recession: epidemiology and risk indicators in a representative urban Brazilian population. J Periodontol. 2004;75:1377-1386.
    1. Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations. J Periodontol. 2018;89(Suppl 1):S204-S213.
    1. Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000. 2015;68:333-368.
    1. Albandar JM, Kingman A. Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol. 1999;70:30-43.
    1. Gorman WJ. Prevalence and etiology of gingival recession. J Periodontol. 1967;38:316-322.
    1. Murray JJ. Gingival recession in tooth types in high fluoride and low fluoride areas. J Periodontal Res. 1973;8:243-251.
    1. Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol. 2000;71:1506-1514.
    1. Tonetti MS, Cortellini P, Pellegrini G, et al. Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life. J Clin Periodontol. 2018;45:78-88.
    1. Cairo F, Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol. 2008;35:136-162.
    1. Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review J Clin Periodontol. 2014;41(Suppl 15):S44-S62.
    1. Chambrone L, Sukekava F, Araujo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review. J Periodontol. 2010;81:452-478.
    1. Chambrone L, Lima LA, Pustiglioni FE, Chambrone LA. Systematic review of periodontal plastic surgery in the treatment of multiple recession-type defects. J Can Dent Assoc. 2009;75:203a-203f.
    1. Graziani F, Gennai S, Roldan S, et al. Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions. J Clin Periodontol. 2014;41(suppl 15):S63-76.
    1. Cairo F. Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontol 2000. 2017;75:296-316.
    1. Bernimoulin JP, Luscher B, Muhlemann HR. Coronally repositioned periodontal flap. Clinical evaluation after one year. J Clin Periodontol. 1975;2:1-13.
    1. de Sanctis M, Clementini M. Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014;41(suppl 15):S108-122.
    1. Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M. Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol. 2009;80:1083-1094.
    1. Tavelli L, Barootchi S, Nguyen TV, Tattan M, Ravida A, Wang HL. Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: a systematic review and a meta-analysis. J Periodontol. 2018;89(9):1075-1090.
    1. Skurska A, Dolinska E, Sulewska M, et al. 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. 2015;42:756-763.
    1. Barrella GE, Kolbe MF, Ribeiro FV, et al. Coronally advanced flap with two different techniques for the treatment of multiple gingival recessions: a pilot prospective comparative case series. Quintessence Int. 2016;47:39-50.
    1. Cairo F, Cortellini P, Pilloni A, et al. Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial. J Clin Periodontol. 2016;43:849-856.
    1. Zucchelli G, Mounssif I, Mazzotti C, et al. 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. 2014;41:396-403.
    1. Thombre V, Koudale SB, Bhongade ML. Comparative evaluation of the effectiveness of coronally positioned flap with or without acellular dermal matrix allograft in the treatment of multiple marginal gingival recession defects. Int J Periodontics Restorative Dent. 2013;33:e88-94.
    1. Huang LH, Neiva RE, Wang HL. Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol. 2005;76:1729-1734.
    1. Aroca S, Barbieri A, Clementini M, Renouard F, de Sanctis M. Treatment of class III multiple gingival recessions: prognostic factors for achieving a complete root coverage. J Clin Periodontol. 2018;45:861-868.
    1. Zucchelli G, Tavelli L, Ravida A, Stefanini M, Suarez-Lopez Del Amo F, Wang HL. Influence of tooth location on coronally advanced flap procedures for root coverage. J Periodontol. 2018;89(12):1428-1441.
    1. Aroca S, Keglevich T, Barbieri B, Gera I, Etienne D. Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: a 6-month study. J Periodontol. 2009;80:244-252.
    1. de Lima V, Bierrenbach AL, Alencar GP, Andrade AL, Azevedo LCP. Increased risk of death and readmission after hospital discharge of critically ill patients in a developing country: a retrospective multicenter cohort study. Intensive Care Med. 2018;44:1090-1096.
    1. Hong JA, Kim MS, Cho MS, et al. Clinical features of idiopathic restrictive cardiomyopathy: a retrospective multicenter cohort study over 2 decades. Medicine (Baltimore). 2017;96:e7886.
    1. Eade T, Choudhury A, Pollack A, et al. Acute epithelial toxicity is prognostic for improved prostate cancer response to radiation therapy: a retrospective, multicenter. Cohort Study Int J Radiat Oncol Biol Phys. 2018;101:957-963.
    1. Stefanini M, Zucchelli G, Marzadori M, de Sanctis M. 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. 2018;38:25-33.
    1. Garces-McIntyre T, Carbonell JM, Vallcorba L, Santos A, Valles C, Nart J. Coronal advanced flap in combination with a connective tissue graft. Is the thickness of the flap a predictor for root coverage? a prospective clinical study. J Clin Periodontol. 2017;44:933-940.
    1. Byun HY, Oh TJ, Abuhussein HM, Yamashita J, Soehren SE, Wang HL. Significance of the epithelial collar on the subepithelial connective tissue graft. J Periodontol. 2009;80:924-932.
    1. Bates D, Mächler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015;67:48.
    1. Hofmanner P, Alessandri R, Laugisch O, et al. Predictability of surgical techniques used for coverage of multiple adjacent gingival recessions-a systematic review. Quintessence Int. 2012;43:545-554.
    1. Tavelli L, Barootchi S, Greenwell H, Wang HL. Is a soft tissue graft harvested from the maxillary tuberosity the approach of choice in an isolated site? J Periodontol. 2019;90:821-825.
    1. Rebele SF, Zuhr O, Schneider D, Jung RE, Hurzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. part II. Volumetric studies on healing dynamics and gingival dimensions. J Clin Periodontol. 2014;41:593-603.
    1. Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P. 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. 2010;37:644-650.
    1. Rasperini G, Acunzo R, Pellegrini G, et al. Predictor factors for long-term outcomes stability of coronally advanced flap with or without connective tissue graft in the treatment of single maxillary gingival recessions: 9 years results of a randomized controlled clinical trial. J Clin Periodontol. 2018;45:1107-1117.
    1. McGuire MK, Scheyer ET. Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects. J Periodontol. 2010;81:1108-1117.
    1. Chaparro A, De la Fuente M, Albers D, et al. Root coverage of multiple miller class I and II recession defects using acellular dermal matrix and tunneling technique in maxilla and mandible: a 1-year report. Int J Periodontics Restorative Dent. 2015;35:639-645.
    1. Burkhardt R, Lang NP. Fundamental principles in periodontal plastic surgery and mucosal augmentation-a narrative review. J Clin Periodontol. 2014;41(Suppl 15):S98-107.
    1. Park JC, Kim CS, Choi SH, Cho KS, Chai JK, Jung UW. Flap extension attained by vertical and periosteal-releasing incisions: a prospective cohort study. Clin Oral Implants Res. 2012;23:993-998.
    1. Mormann W, Ciancio SG. Blood supply of human gingiva following periodontal surgery. A fluorescein angiographic study. J Periodontol. 1977;48:681-692.
    1. Wang HL, Boyapati L. PASS principles for predictable bone regeneration. Implant Dent. 2006;15:8-17.
    1. Larato DC. Alveolar plate fenestrations and dehiscences of the human skull. Oral Surg Oral Med Oral Pathol. 1970;29:816-819.
    1. Sanz M, Simion M. Working Group 3 of the european workshop on p. surgical techniques on periodontal plastic surgery and soft tissue regeneration: consensus report of group 3 of the 10th European workshop on periodontology. J Clin Periodontol. 2014;41(Suppl 15):S92-97.
    1. Cortellini P, Tonetti M, Baldi C, et al. Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? a multi-centre, randomized, double-blind, clinical trial. J Clin Periodontol. 2009;36:68-79.
    1. Chambrone L, Prato GPP. Clinical insights about the evolution of root coverage procedures: the flap, the graft, and the surgery. J Periodontol. 2019;90(1):9-15.
    1. Baldi C, Pini-Prato G, Pagliaro U, et al. Coronally advanced flap procedure for root coverage. is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol. 1999;70:1077-1084.
    1. Stefanini M, Jepsen K, de Sanctis M, et al. Patient-reported outcomes and aesthetic evaluation of root coverage procedures: a 12-month follow-up of a randomized controlled clinical trial. J Clin Periodontol. 2016;43:1132-1141.
    1. Azaripour A, Kissinger M, Farina VS, et al. 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. 2016;43:1142-1150.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera