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

Zucchelli, Giovanni; Tavelli, Lorenzo; Ravidà, Andrea; Stefanini, Martina; Amo, Fernando Suárez-López Del; Wang, Hom‐Lay

doi:10.1002/jper.18-0201

Cited by 37 publications

(28 citation statements)

References 72 publications

(133 reference statements)

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“…A recent article from our group has corroborated the importance of tooth location in CAF for isolated GRs, reporting that canines and incisors were related to a higher mRC and CRC than posterior teeth . The present study confirms these finding also when CAF is performed for MAGRs.…”

Section: Discussionsupporting

confidence: 88%

“…39,40 A recent article from our group has corroborated the importance of tooth location in CAF for isolated GRs, reporting that canines and incisors were related to a higher mRC and CRC than posterior teeth. 27 The present study confirms these finding also when CAF is performed for MAGRs. In particular, the second sextant showed the greatest mRC and CRC in both CAF and CAF + CTG groups compared with the other sextants.…”

Section: Discussionsupporting

confidence: 87%

“…In particular, the second sextant showed the greatest mRC and CRC in both CAF and CAF + CTG groups compared with the other sextants. A possible explanation may be the unfavorable anatomic conditions such as marginal frenulum, high muscle pull, higher flap tension, and shallow vestibule that are frequently encountered in the mandibular incisors area, as compared with their rare occurrence in the maxillary anterior region . These conditions may negatively impact root coverage outcomes .…”

Section: Discussionmentioning

confidence: 99%

“…However, the lack of vertical releasing incisions may pose a challenge in achieving a tension‐free flap, one of the main key factors in periodontal plastic surgery and in bone regeneration . In addition, other anatomical conditions including root prominence, limited KTW and reduced vestibule depth, which are commonly found in posterior areas may also negatively affect the predictability of root coverage procedures . These speculations may explain the lower outcomes observed for teeth in the distal part of the flap, both in the eCAF and vCAF design, regardless adding a CTG.…”

Section: Discussionmentioning

confidence: 99%

“…9,24 The influence of tooth location on root coverage outcomes has been frequently suggested by several clinicians 17,25,26 and recently, Zucchelli and coworkers have demonstrated that the tooth site plays a role in determining the mean root coverage (mRC) and the CRC following CAF for localized GR. 27 However, the impact of tooth location on CAF in the treatment of MAGRs has not yet been extensively explored. Aroca et al observed the best results in terms of mRC were obtained in the anterior maxilla, while the maxillary molars showed the worst outcomes.…”

Section: Introductionmentioning

confidence: 99%

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

Zucchelli

Tavelli

Barootchi

et al. 2019

Journal of Periodontology

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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.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Zucchelli

Tavelli

Barootchi

et al. 2019

Journal of Periodontology

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Novel Surgical Approach for Root Coverage of Single Deep Recessions on Mandibular Incisors: Gingival Pedicle With Split‐Thickness Tunnel Technique

Agusto

Simpson

Salman

et al. 2019

Clin Adv Periodontics

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IntroductionGingival recession is a very common mucogingival defect in the adult population, with mandibular central and lateral incisors being the most frequently affected teeth. Limited information is available about the management of isolated deep recession lesions in the mandibular anterior area, where the predictability of the root coverage is reduced by unfavorable anatomical conditions. The purpose of this case report is to present a novel surgical technique for deep labial recessions on mandibular incisors, based on a gingival pedicle with split‐thickness tunneling (GPST), in combination with connective tissue graft (CTG).Case PresentationA 25‐year‐old female patient presented with a Class II Miller isolated buccal recession on #24, 5 × 3 mm. The recipient site design consisted of a laterally positioned flap with a width of 4 mm, in combination with a split‐thickness tunnel preparation that reached the mesial line angle of #25 and extended beyond the mucogingival junction. A CTG (13 × 7 mm) was harvested from the palate and properly adapted over the root surface. Graft and flap were secured with internal mattress and single‐interrupted sutures. Complete root coverage was obtained and maintained at 6 months with excellent esthetic outcomes.ConclusionThis novel surgical approach, based on the combination of laterally displaced pedicle flap and tunneling in addition to CTG, seems to lead to promising results for the treatment of single deep mandibular anterior recessions.

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Gingival pedicle with split‐thickness tunnel technique: A retrospective case series for single mandibular anterior recessions

Schincaglia

Agusto

Thacker

et al. 2022

Clin Adv Periodontics

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IntroductionGingival recessions in the mandibular anterior sextant are a common clinical finding, but mucogingival treatment in this location is particularly challenging, due to several anatomical and surgical difficulties. In the present case series, a novel technique, called gingival pedicle with split‐thickness tunnel (GPST), was retrospectively evaluated.Case SeriesFifteen patients presenting with a single buccal RT1 or RT2 gingival recession of a depth of ≥3 mm in the mandibular anterior sextant were treated by means of the GPST technique. Clinical periodontal parameters at baseline and at the last follow‐up evaluation visit (6–84 months) were compared. Early healing was uneventful in all cases, and no complications such as flap dehiscence or loss of connective tissue graft were observed. Mean root coverage (mRC) was 98.1% ± 7.38%, corresponding to a statistically significant recession reduction (ΔRD) of 4.53 ± 1.19 mm. Complete root coverage was achieved in 14 of 15 cases. The gain in keratinized tissue width amounted to 3.13 ± 0.99 mm and was statistically significant, whereas no significant change in periodontal probing depth was observed after treatment.ConclusionIn conclusion, treatment with GPST technique seems to achieve a favorable and predictable clinical improvement in gingival recessions on mandibular anterior teeth.Why are these cases new information? Limited information is available about the management of isolated deep labial recessions in the mandibular anterior teeth. A novel surgical approach, called GPST technique, is described in a case series to specifically address this type of defect. What are the keys to successful management of these cases? Horizontal incision ≥ RECwidth Cut‐back preparation helps to mobilize the flap without tension. CTG width ≥ 3 times RECwidth CTG height ≥ RECdepth Proper graft and flap stabilization need to be achieved. What are the primary limitations to success in these cases? Limited mesio‐distal dimensions, which do not allow to obtain a pedicle with adequate horizontal width Very thin biotype may not be suitable because of the risk of inadequate flap vascularization.

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

Abstract: Tooth location plays an important role on mRC and CRC following CAF. The addition of CTG or substitutes, especially with biological agents (EMD), enhance the clinical outcomes compared to CAF alone.

Cited by 37 publications

References 72 publications

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

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

Novel Surgical Approach for Root Coverage of Single Deep Recessions on Mandibular Incisors: Gingival Pedicle With Split‐Thickness Tunnel Technique

Gingival pedicle with split‐thickness tunnel technique: A retrospective case series for single mandibular anterior recessions

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