Soft tissue phenotype modification predicts gingival margin long‐term (10‐year) stability: Longitudinal analysis of six randomized clinical trials

Abstract

Aim: To assess the prognostic value of soft tissue phenotype modification following root coverage procedures for predicting the long-term (10-year) behaviour of the gingival margin.Materials and Methods: Participants from six randomized clinical trials on root coverage procedures at the University of Michigan were re-invited for a longitudinal evaluation. Clinical measurements were obtained by two calibrated examiners. A data-driven approach to model selection with Akaike information criterion (AIC) was carried out via multilevel regression analyses and partial regression plotting for changes in the level of the gingival margin over time and interactions with the early (6-month) results of soft tissue phenotypic modification.Results: One-hundred and fifty-seven treated sites in 83 patients were re-assessed at the long-term recall. AIC-driven model selection and regression analyses demonstrated that 6-month keratinized tissue width (KTW) and gingival thickness (GT) influenced the trajectory of the gingival margin similarly in a concave manner; however, GT was the driving determinant that predicted significantly less relapse in the treatments, with stability of the treated gingival margin obtained beyond values of 1.46 mm. Conclusions: Among a compliant patient cohort, irrespective of the rendered therapy, the presence of at least 1.5 mm KTW and 1.46 mm GT was correlated with the longterm stability of the gingival margin.

Vertical soft tissue augmentation to treat implant esthetic complications: A prospective clinical and volumetric case series

“…3 Both peri-implant soft tissue dehiscences (PSTDs) 4,5 and gingival recessions (GRs) are highly prevalent clinical conditions. [6][7][8][9] Also, their main indication for treatment is patient's esthetic concerns. [10][11][12][13] GRs and PSTDs also share several common etiological factors, including lack of keratinized tissue, limited soft tissue thickness, buccal bone dehiscence and malposition, among others.…”

“…Nonetheless, soft tissue deformities around implants and teeth also have similar features 3 . Both peri‐implant soft tissue dehiscences (PSTDs) 4,5 and gingival recessions (GRs) are highly prevalent clinical conditions 6–9 . Also, their main indication for treatment is patient's esthetic concerns 10–13 .…”

Tunnel vs. coronally advanced flap in combination with a connective tissue graft for the treatment of multiple gingival recessions: a multi-center randomized clinical trial

“…Recent consensus workshops have identified the coronally advanced flap (CAF) (Zucchelli & Sanctis, 2000) as the gold standard technique for the treatment of multiple adjacent LGRs [9,10]. This surgical technique can be used alone, although better long-term results have been reported when it is combined with a CTG [12,[16][17][18].…”

PDGF‐BB‐enriched collagen matrix to treat multiple gingival recessions with the tunneled coronally advanced flap

“…The occurrence of a gingival recession (GR) is a common finding in clinical practice 1 . When it comes to treatment, the scientific literature is in agreement that irrespective of the outcome of therapy—whether root coverage, or modification of the soft tissue phenotype—the traditionally applied autogenous connective tissue graft (CTG) still ranks as the “gold standard” approach 2–4 . Nonetheless, with routine implementation of this technique, and with realization of the path of contemporary periodontics to be moving in a direction of minimal invasiveness and optimized patient‐centered outcomes, 5 many have recognized the drawbacks that are inherent, particularly the requirement of palatal harvesting 6,7 .…”

“…1 When it comes to treatment, the scientific literature is in agreement that irrespective of the outcome of therapy-whether root coverage, or modification of the soft tissue phenotype-the traditionally applied autogenous connective tissue graft (CTG) still ranks as the "gold standard" approach. [2][3][4] Nonetheless, with routine implementation of this technique, and with realization of the path of contemporary periodontics to be moving in a direction of minimal invasiveness and optimized patientcentered outcomes, 5 many have recognized the drawbacks that are inherent, particularly the requirement of palatal harvesting. 6,7 Namely, in a recent study, we found that some patients, even after a decade had surpassed the date of their original treatment, still remembered the pain they experienced after a palatal harvesting procedure, which also negatively impacted their decision to accept a similar therapy in current day.…”