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BackgroundTo analyze the evidence about the influence of the suturing technique and material in terms of the percentage of mean root coverage (%MRC) following root coverage therapy in teeth diagnosed with single/localized gingival recession defects (GRD) via a monolaminar coronally advanced flap.MethodsThe protocol of this systematic review was registered in PROSPERO (CRD42024514043). A literature search was conducted to identify investigations that fulfilled the eligibility criteria. Variables of interest were extracted, subsequently categorized, and qualitatively analyzed.ResultsA total of 15 randomized clinical trials, including 301 localized GRD in non‐molar sites classified as Miller class I‐II/RT1, in 253 patients were included. The studies reporting the combination of sling and single interrupted sutures, or interrupted sutures alone showed an MRC of 70.2%±16.6%, and 74.1%±0.75%, respectively. The highest MRC was observed in the studies using polyglactin 910 with a pooled value of 76.6% ± 15.3%, and monofilament materials, with a pooled MRC of 74.8%±7.1%. When the suturing diameter was evaluated, the highest pooled MRC with values of 79.1%±9.8% was observed with the use of 5‐0.ConclusionsFor the treatment of single/localized GRD in non‐molar sites via a monolaminar coronally advanced flap, the use of a combination of sling and single interrupted sutures, or single interrupted sutures, polyglactin 910 or monofilament materials, and material diameter of 5‐0 showed a higher MRC as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.Key points There were no differences in the percentage of root coverage achieved between the use of sling and single interrupted, versus single interrupted sutures alone on the treatment of single/localized GRD in non‐molar sites. Polyglactin 910 and monofilament sutures resulted in a higher percentage of root coverage achieved as compared to expanded polytetrafluoroethylene, and silk with/without dressing. The use of 5‐0 material diameter showed the highest percentage of root coverage achieved. Plain language summaryThis study was primarily aimed at evaluating how different suturing techniques and materials could affect the percentage of root coverage in single/localized recession defects, without the use of soft tissue substitutes or autogenous soft tissue grafts. After the pooled analyses of 15 randomized clinical trials that fulfilled the inclusion criteria, we observed that the adequate selection of suturing techniques, materials, and size could lead to a higher percentage of root coverage. Specifically, the use of single interrupted with or without sling sutures at the most coronal portion, Polyglactin 910 or monofilament materials, and size of 5‐0 showed a higher percentage of root coverage as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.
BackgroundTo analyze the evidence about the influence of the suturing technique and material in terms of the percentage of mean root coverage (%MRC) following root coverage therapy in teeth diagnosed with single/localized gingival recession defects (GRD) via a monolaminar coronally advanced flap.MethodsThe protocol of this systematic review was registered in PROSPERO (CRD42024514043). A literature search was conducted to identify investigations that fulfilled the eligibility criteria. Variables of interest were extracted, subsequently categorized, and qualitatively analyzed.ResultsA total of 15 randomized clinical trials, including 301 localized GRD in non‐molar sites classified as Miller class I‐II/RT1, in 253 patients were included. The studies reporting the combination of sling and single interrupted sutures, or interrupted sutures alone showed an MRC of 70.2%±16.6%, and 74.1%±0.75%, respectively. The highest MRC was observed in the studies using polyglactin 910 with a pooled value of 76.6% ± 15.3%, and monofilament materials, with a pooled MRC of 74.8%±7.1%. When the suturing diameter was evaluated, the highest pooled MRC with values of 79.1%±9.8% was observed with the use of 5‐0.ConclusionsFor the treatment of single/localized GRD in non‐molar sites via a monolaminar coronally advanced flap, the use of a combination of sling and single interrupted sutures, or single interrupted sutures, polyglactin 910 or monofilament materials, and material diameter of 5‐0 showed a higher MRC as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.Key points There were no differences in the percentage of root coverage achieved between the use of sling and single interrupted, versus single interrupted sutures alone on the treatment of single/localized GRD in non‐molar sites. Polyglactin 910 and monofilament sutures resulted in a higher percentage of root coverage achieved as compared to expanded polytetrafluoroethylene, and silk with/without dressing. The use of 5‐0 material diameter showed the highest percentage of root coverage achieved. Plain language summaryThis study was primarily aimed at evaluating how different suturing techniques and materials could affect the percentage of root coverage in single/localized recession defects, without the use of soft tissue substitutes or autogenous soft tissue grafts. After the pooled analyses of 15 randomized clinical trials that fulfilled the inclusion criteria, we observed that the adequate selection of suturing techniques, materials, and size could lead to a higher percentage of root coverage. Specifically, the use of single interrupted with or without sling sutures at the most coronal portion, Polyglactin 910 or monofilament materials, and size of 5‐0 showed a higher percentage of root coverage as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.
BackgroundTo assess how the diagnostic reproducibility of the 2018 Classification of Gingival Recession Defects (GRD) could be applied when comparing in‐person chairside measurements with photographic measurements.MethodsThirty‐four GRD were photographed and evaluated by 4 masked operators. For each case, the operators measured twice recession type (RT), recession depth (RD), keratinized tissue width (KTW), gingival thickness (GT), detectability of the cemento–enamel junction (CEJ), and presence of root steps (RSs), chairside, and on photographs. Intraclass correlation coefficient (ICC) with 95% confidence intervals (CI) was calculated for RD and KTW; Kappa with 95% CI was used for GT, CEJ, and RS; quadratic weighted Kappa with 95% CI was used for RT.ResultsRD, KTW, and RT showed excellent overall intra‐operator agreement (> 0.93), and from good to excellent overall inter‐operator agreement (> 0.80), for both clinical and photographic measurements. Agreements were lower for GT, CEJ, and RS. Overall clinical and photographic agreements were within 0.1 difference for every variable, except for inter‐operator agreement for RS which was 0.72 for clinical measurements and 0.45 for photographic measurements. The lowest overall agreement between clinical versus photographic measurements existed for CEJ (0.28) and RS (0.35).ConclusionsVariables composing the 2018 Classification of GRD are reproducible, both clinically and on photographs, with comparable agreements. The overall agreement was higher for KTW, RD, and RT, and lower for GT, CEJ, and RS, for both clinical and photographic measurements. The comparison between chairside and photographic evaluations indicated fair to excellent agreement for most variables, with CEJ and RS showing fair agreement.Plain Language SummaryAs digital diagnostics evolve to facilitate clinical diagnostic measurement, we aimed to assess the effectiveness of intraoral photography for diagnosing gingival recession defects (GRD) according to the 2018 Classification of GRD, compared to traditional clinical examination.Standardized photographs of thirty‐four GRD cases were captured. Four masked operators evaluated the same gingival recessions twice in a clinical setting and twice using photographs. Measurement repeatability within and between operators was calculated for both clinical and photographic settings, and the two settings were compared.Continuous measurements such as recession depth and keratinized tissue width, as well as the evaluation of interproximal attachment height (recession type), showed excellent agreement both clinically and photographically. Agreement was lower for gingival thickness and the detectability of tooth anatomical landmarks, such as the cemento‐enamel junction and the presence of root steps. Overall, the agreement between chairside and photographic evaluations was generally good, but lower when evaluating tooth anatomical landmarks.The variables composing the 2018 Classification of GRD are reproducible in both clinical and photographic settings, with comparable levels of agreement. However, there was consistently worse agreement for gingival thickness and when evaluating tooth anatomical landmarks.
ObjectiveThis updated version of a systematic review (SR) originally published in 2009 evaluated the effect of smoking on the clinical outcomes achieved with root coverage (RC) procedures in the treatment of gingival recession (GR) defects.Materials and MethodsThis SR includes randomized controlled trials, controlled clinical trials, and case series with a minimum follow‐up of 6 months. Eligible studies involved GR defects without interproximal tissue loss submitted to RC procedures, as well as outcome measures from smokers (i.e., those smoking 10 or more cigarettes per day at baseline) and nonsmokers, recorded separately. Three electronic databases were searched up to March 31, 2024. Random effects meta‐analyses were conducted thoroughly.ResultsA total of 12 studies reporting on 181 smokers and 162 nonsmokers, submitted to different RC procedures, were included. Half of these trials were originally included in the 2009 SR, whereas the other half (six studies) were included in this update. Nonsmokers experienced greater reductions in GR and gains in clinical attachment level compared to smokers. Pooled estimates comparing smokers and nonsmokers who received coronally advanced flap (CAF) alone and subepithelial connective tissue graft (SCTG) + CAF showed that nonsmokers achieved greater mean root coverage (MRC) in both treatments. Significant differences in MRC of 10.85% (95% CI, 1.92 to 19.77) and 22.04 (95% CI, 14.25 to 29.83), favoring nonsmokers, were identified for CAF and SCTG + CAF, respectively. Similarly, nonsmokers treated with SCTG + CAF displayed superior number of sites exhibiting complete root coverage (CRF) when compared with smokers (risk ratio, 4.12; 95% CI, 1.73 to 9.80).ConclusionsSmoking negatively impacts the outcomes of RC procedures, particularly those achieved by SCTG‐based procedures.Clinical SignificanceSmoking was linked to poorer RC outcomes. These outcomes highlight the critical need to integrate smoking cessation into periodontal treatment plans.
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