Aesthetic assessment after root coverage of multiple adjacent recessions with coronally advanced flap with adjunctive collagen matrix or connective tissue graft: Randomized clinical trial

Abstract

Background Few studies have looked at professional assessment or patient perception of aesthetics after root coverage procedures. The addition of connective tissue grafts (CTG) seems to improve aesthetic outcomes. The objective of this a priori analysis was to compare aesthetics after addition of CTG or a collagen matrix (CMX) to coronally advanced flap (CAF). Methods Two independent, trained and calibrated assessors analysed baseline and 6‐month post‐operative Images from 183 subjects with 475 recessions from a previously reported multicentre multinational randomized clinical trial. The root coverage aesthetic score (RES) was assessed in its five constituent components after assessing the suitability of images blindly with regard to treatment assignment and centre. Data were analysed at the tooth and subject level. Results One hundred and fifty‐five subjects (81 CTG) and 393 teeth (207 CTG) were included in the analysis. CTG control subjects had higher total RES scores (mean adjusted difference of 1.3 ± 0.8 RES units, p = 0.002). Analyses of RES subcomponents showed that the CTG group had higher scores in terms of gingival margin position but that better marginal tissue contour (OR 3.0, 95% CI 1.2–7.7) and soft tissue texture (OR 3.3, 95% CI 1.9–5.8) was observed for the CMX group. No significant differences were observed for mucogingival alignment and gingival colour. Conclusion Better overall RES scores were observed for the CTG group. Better marginal tissue texture and marginal contour were observed in the CMX group. More research and development is needed to optimize materials to be used in conjunction with CAF to improve root coverage without negatively affecting tissue texture and marginal contour.

Autologous connective tissue graft or xenogenic collagen matrix with coronally advanced flaps for coverage of multiple adjacent gingival recession. 36‐month follow‐up of a randomized multicentre trial

“…The results of the present report together with the previous ones (Tonetti et al, 2018; Pelekos et al, 2019) of this trial show improved root coverage outcomes for both test and control treatments. Interpretation of the inter‐group difference is affected by the loss of power arising from the fact that only 8 study centres were available for the 3‐year follow‐up.…”

“…They confirm that application of CTG combined with a specifically designed CAF is probably the best approach for root coverage at multiple adjacent recessions (Tonetti et al, 2018). Use of a CMX, and avoidance of a CTG donor site, results in shorter time to recovery, less post‐operative morbidity (Tonetti et al, 2018) and more natural tissue texture and contour (Pelekos et al, 2019). CTG or CMX results in similar stability of outcomes between 6 and 36 months.…”

“…Results of a non‐inferiority trial comparing CMX with autologous grafting from the palate in multiple adjacent recessions indicated that subjects treated with CMX had a quicker recovery after surgery, but the trial failed to demonstrate non‐inferiority of CMX with respect to CTG (Tonetti et al, 2018). A follow‐up analysis focussing on professional assessment of aesthetic outcomes at 6 months showed that CTG gave better results for the root coverage component of the root coverage aesthetic score while CMX was better for marginal tissue contour and tissue texture (Pelekos et al, 2019).…”

Aesthetic‐And patient‐related outcomes following root coverage procedures: A systematic review and network meta‐analysis

“…A recent study evaluated the aesthetic outcomes from a multicenter randomized clinical trial comparing CAF + CTG versus CAF + XCM (Pelekos et al., 2019). Although CTG achieved an overall higher RES than XCM, the authors reported superior scores with XCM for STT and MTC (Pelekos et al., 2019). In line with this study, we observed that CAF + GS (either XCM or ADM) obtained better MTC than CAF alone.…”

“…This aspect needs to be kept in mind since emerging evidence suggests that CTG should not be considered as the panacea for the treatment of gingival recessions, since similar root coverage outcomes can be obtained with flap alone in the presence of a thick gingival phenotype (Cairo et al., 2020). A cost‐effective evaluation should be performed for each patient to decide the best treatment option considering the clinical, aesthetic‐ and patient‐related outcomes (Pelekos et al., 2019). Patients’ psychosocial factors, such as anxiety, depression, stress and well‐being, should also be take into account as they can affect the overall perception of the procedure, post‐surgical morbidity and medication consumption (Kloostra, Eber, Wang, & Inglehart, 2006).…”