Long term assessment of root coverage stability using connective tissue graft with or without an epithelial collar for gingival recession treatment. A 12‐year follow‐up from a randomized clinical trial

Abstract

Aim To evaluate the long term root coverage outcomes of coronally advanced flap plus a connective tissue graft with (CAF + CTG) or without an epithelial collar (CAF + ECTG), and evaluate the adjacent treated sites included in the flap. Methods Seventeen of the original 20 subjects included in the randomized clinical trial were available at 12 years (43 sites). Mean root coverage (mRC), keratinized tissue width (KTW), gingival thickness (GT) on the grafted and adjacent sites were evaluated and compared with baseline and 6 months. Result There was a reduction in the mRC at all sites: 16.52% in the CAF + CTG (p > .05), 19.42% in the CAF + ECTG (p < .05) and 34.12% in the CAF‐alone (adjacent treated sites) group (p < .05). No significant differences were observed within the groups for changes in KTW, GT and clinical attachment level (CAL) (p > .05). Keratinized tissue width at baseline and at 6 months was found to be predictors for the stability of the gingival margin in the long term. Conclusions CAF + CTG and CAF + ECTG were found equally efficacious in maintaining the levels of the gingival margin with a small amount of relapse over the period of 12 years while CAF‐alone sites showed a greater gingival recession (GR) reoccurrence.

Gingival phenotype modification therapies on natural teeth: A network meta‐analysis

“…83 The importance of the obtained KT has been demonstrated in a recent article from our group, in which KT ≥2 mm at 6 months was found to be a predictor for stability of the gingival margin 12 years following treatment with ADM. 12 The importance of PMT while treating GR is based on the fact that thin phenotypes are at greater risk for developing GRs 84,85 and may also be more prone to recession recurrence after the root coverage treatment, as a thicker marginal soft tissue may better tolerate traumatic toothbrushing in patients that cannot correct their brushing technique. 11,12 An observational study has confirmed a correlation between thin GT and higher incidence of GRs in young adults as an important etiologic factor for GRs, and their recurrence. 86 In a 12-year follow-up from an RCT, it was observed that sites treated with a CTG resulted in an increased GT that was maintained over time, compared with their adjacent sites that were included in the flap but had not received a graft.…”

“…8,[60][61][62][63][64] While previous reports have found initial KT and GT to play a role in the likelihood of obtaining complete root coverage, [65][66][67][68] recent studies have shown that these parameters can also affect the stability of the gingival margin over time. [10][11][12]69 Nonetheless, little is known in regard to which technique is more effective in increasing KT or GT and whether PMT is maintained over time. Data from clinical studies suggest that autogenous grafts result in increased GT, 11,[70][71][72] and graft substitutes, such as ADM and CM, are more effective in increasing GT than KT.…”

“…[10][11][12]69 Nonetheless, little is known in regard to which technique is more effective in increasing KT or GT and whether PMT is maintained over time. Data from clinical studies suggest that autogenous grafts result in increased GT, 11,[70][71][72] and graft substitutes, such as ADM and CM, are more effective in increasing GT than KT. 12,73,74 However, a definitive conclusion has not been, and cannot be drawn individually from independent studies due to a limited sample size and lack of comparisons between all possible treatment approaches (e.g., ADM versus CM).…”

“…7 Despite a lacking consensus of what treatment is truly superior for GT augmentation, or if the augmented thickness is sustainable over time, it has been shown that periodontal plastic procedures with the use of autogenous grafts (whether free gingival grafts [FGG] or connective tissue grafts [CTGs]) or substitutes (acellular dermal matrix [ADM] or collagen matrices [CM]) can significantly increase the amount of GT. [8][9][10][11][12][13] While previous reports have documented the relapse of recession treatment over time and the factors associated with it, 11,12,14 studies concerning the associated role of GT, its potential benefits with regard to gingival margin stability, periodontal/gingival health are scarce in the literature.…”

Epidemiology of mid‐buccal gingival recessions in NHANES according to the 2018 World Workshop Classification System

“…Mid‐buccal gingival recessions, especially in case of RT1 gingival recessions, have been associated with a traumatic aetiology and with patient's aesthetic impairment and discomfort (Zucchelli & Mounssif, 2015). In fact, many surgical interventions have been designed and studied for their efficacy to reconstruct the buccal loss of attachment and attain complete root coverage (Barootchi et al., 2019; Cairo, Nieri, & Pagliaro, 2014; Cortellini et al., 2009; Rasperini et al., 2011, 2018, 2020; Sanz & Simion, 2014; Tatakis et al., 2015; Tavelli, Barootchi, Cairo, et al, 2019; Tavelli, Barootchi, Di Gianfilippo, et al, 2019; Tavelli et al., 2018; Tonetti & Jepsen, 2014). Gingival recessions involving inter‐dental attachment loss (mainly RT3, due to periodontitis) have however shown limited reconstructive potential using these surgical approaches (Cairo et al., 2012, 2015; Prato, Rotundo, Cortellini, Tinti, & Azzi, 2004; Zucchelli et al., 2010).…”