Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split‐mouth study with a 5‐year follow‐up

Abstract

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. doi: 10.1111/j.1600-051X.2010.01559.x Abstract Aim: The aim of this long-term study was to compare the clinical outcomes of coronally advanced flap (CAF) alone versus coronally advanced flap plus connective tissue graft (CAF1CTG) in the treatment of multiple gingival recessions using a splitmouth design over 5 years of follow-up. Materials and Methods: A total of 13 patients (mean age 31.4 years) showing multiple bilateral gingival recessions were treated. On one side, CAF1CTG was used, while in the contra-lateral side, a CAF alone was applied. Clinical outcomes were evaluated at the 6-month, 1-year and 5-year follow-ups. Results: A total of 93 Miller class I, II and III gingival recessions were treated. In the CAF1CTG-treated sites, the baseline gingival recession was 3.6 AE 1.3 mm, while in the CAF-treated sites, it was 2.9 AE 1.3 mm (p 5 0.0034). No difference in terms of the number of sites with complete root coverage (CRC) was reported (OR 5 0.49, p 5 0.1772) at the 6-month follow-up. At the 5-year follow-up, CAF1CTG-treated sites showed a higher percentage of sites with CRC (52%) than CAF-treated sites (35%) (OR 5 3.94; p 5 0.0239). An apical relapse of the gingival margin in CAFtreated sites was observed while a coronal improvement of the margin was noted in CAF1CTG-treated sites between the 6-month and the 5-year follow-ups. Conclusions: CAF1CTG provided better CRC than CAF alone in the treatment of multiple gingival recessions at the 5-year follow-up.

Influence of tooth location on coronally advanced flap procedures for root coverage

“…Despite numerous beneficial effects of CTG when compared to different soft tissue grafting substitutes, the main advantage of a graft beneath the flap may be the “scaffold effect” that promotes wound healing with favorable thickening of the gingiva . It has been showed that increased marginal soft tissue thickness, which is typically observed when a graft is positioned below the flap, is positively related to higher mRC and to a tendency of the gingival margin to coronally migrate over time . In agreement with Cairo et al., the present study confirm the efficacy of CAF, especially when a CTG with or without EMD is added .…”

Vista technique and Platelet-Rich Fibrin Membrane for Treatment of Multiple Adjacent Gingival Recessions - 6 month follow-up.

“…The final values for KGW are statistically significant in comparison to the preoperative ones - Table #1. All these results above are in conjunction with the results of other similar studies [16,17,18,22,24,25] Our results, while different, are still to the ones reported by other authors [23,26] when treating multiple gingival recessions with Zucchelli's technique without the use of connective tissue graft (CTG) or collagen membrane. The mean percent of root coverage (RC%) on the first and the third month after the surgery has a good result with a steady increase in its values - Table #1.…”

Comparison of two power densities on the healing of palatal wounds after connective tissue graft removal: randomized clinical trial

“…The literature reports that the CTG technique is the goldstandard treatment modality for gingival recession because it can reach root coverage rates of up to 100 % [8,9] and keep those results stable, even in the long term [10]. However, CTG can also cause morbidity and discomfort for the patient in the palatine region, as a consequence of connective tissue graft removal.…”