The assessment of the influence of vertical incisions on the aesthetic outcome of the Miller class I and <scp>II</scp> recession treatment: a split‐mouth study

Skurska, Anna; Dolińska, Ewa; Sulewska, Magdalena; Milewski, Robert; Pietruski, J; Sobaniec, Stefan; Pietruska, Małgorzata

doi:10.1111/jcpe.12440

Cited by 15 publications

(16 citation statements)

References 31 publications

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“…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. In line with our findings, a recent clinical trial found that vertical incisions did not affect clinical and esthetic outcomes of MAGRs treated with CAF + CTG . As suggested by Sanz and Simion, it may be concluded that although the choice of flap design depends on the GR depth, location, and number of teeth involved, avoiding vertical releasing incisions should be recommended to reduce the damage to the blood supply .…”

Section: Discussionsupporting

confidence: 89%

“…While performing two vertical releasing incisions can increase flap mobilization by 124.2% of its original length, in an angiographic study evaluating the tropism of flaps with different design, Mörman and Ciancio observed a reduced revascularization when verticals incisions were performed . The eCAF was introduced for the treatment of MAGRs to avoid the vertical incisions which may the impair vascular supply to the flap in its lateral part, and reduce the risk of keloid formation . 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 .…”

Section: Discussionmentioning

confidence: 99%

“…According to a recent meta‐analysis, the CAF was able to yield superior outcomes in terms of complete root coverage (CRC) than the tunnel approach . The CAF for the treatment of MAGRs has been performed with either two vertical releasing incisions or an envelope approach, with oblique or horizontal incisions at the papillae, alone or with the addition of a connective tissue graft (CTG) or substitute materials …”

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: 89%

Section: Discussionmentioning

confidence: 99%

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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“…Other than coronally positioned flaps, flap designs used include tunnel technique [12,13], modified coronally advanced tunnel (MCAT) technique [26], modified coronally advanced flap (MCAF) technique by Zucchelli and De Sanctis [17,29], and a modified coronally positioned flap with a horizontal incision in the alveolar mucosa [20]. While most studies evaluated their outcome between 6 and 12 months postoperatively, 5-year results were reported by Zucchelli et al with mean root coverage of 97% [22].…”

Section: Root Coverage Procedures and Predictability Subepithelial Comentioning

confidence: 92%

“…Studies using subepithelial connective tissue graft (SCTG) on multiple Miller Class I and II gingival recession defects show mean percent root coverage ranging from 77 to 98%, with only 4 out of 17 studies reporting less than 90% [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Other than coronally positioned flaps, flap designs used include tunnel technique [12,13], modified coronally advanced tunnel (MCAT) technique [26], modified coronally advanced flap (MCAF) technique by Zucchelli and De Sanctis [17,29], and a modified coronally positioned flap with a horizontal incision in the alveolar mucosa [20].…”

Section: Root Coverage Procedures and Predictability Subepithelial Comentioning

confidence: 99%

Root Coverage Procedures for Multiple Recession Defects

Lai

Greenwell

2017

Curr Oral Health Rep

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Purpose of Review The demand for root coverage in multiple gingival recession defects has increased in recent years. Compared to isolated recession, multiple gingival recession defects are much more challenging due to various limiting factors and require more sophisticated surgical techniques. This review aims to address recent progress in the management of multiple recession defects. Recent Findings The subepithelial connective tissue graft (SCTG) procedure, while effective, is limited due to tissue availability and patient preference to avoid a donor harvest site. Different surgical techniques and biological materials have been studied in an attempt to find ideal alternatives. Summary Based on the studies reviewed, the SCTG procedure still remains the gold standard in terms of percent root coverage. Acellular dermal matrix allograft in conjunction with different flap designs has shown comparable, satisfactory results up to 1 year postoperatively. Other materials such as porcine collagen matrix and enamel matrix derivative also show some promise. Well-designed studies with long-term outcomes are still needed.

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Root coverage stability: A systematic overview of controlled clinical trials with at least 5 years of follow‐up

Bertl

Spineli

Mohandis

et al. 2021

Clinical & Exp Dental Res

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Objectives: To systematically assess the long-term outcome (≥5 years) of root coverage procedures reported in controlled clinical trials. Material and Methods: Literature search was performed according to the PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) controlled (CT) or randomised controlled clinical trials (RCT); (c) root coverage procedure with ≥5 years follow-up; and (d) clinical treatment effect size and/or patientrelated outcome measures (PROMs) reported. Results: Four CT and 14 RCT with a follow-up of 5-20 years fulfilled the eligibility criteria; sample size per study ranged from 8 to 70 patients contributing with 18-149 sites. Coronally advanced flap (CAF) and CAF + connective tissue graft (CTG) were the prevalent treatments (i.e., in 24 and 38% of the groups, respectively), while other flap designs and adjuncts (i.e., enamel matrix derivative, bone graft, collagen membrane) were represented only once. For single Miller class I/II gingival recessions (GR), CAF + CTG appeared advantageous compared to other techniques, and provided low residual recession depths (i.e., ≤0.5 mm), and complete root coverage in ≥2/3 of the patients; similar tendency was observed for multiple GR. No data on Miller class III/IV GR is available. No meta-analysis was feasible due to lack of similarity in the clinical and methodological characteristics across the trials and observed comparisons of interventions. Conclusions: CAF + CTG appears to be the 'gold standard' technique for the treatment of single and multiple Miller class I/II GR also in regard to long-term (i.e., ≥5 years of follow-up) treatment outcomes. There is little information regarding the performance, on the long-term, of other techniques and adjuncts.

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The assessment of the influence of vertical incisions on the aesthetic outcome of the Miller class I and II recession treatment: a split‐mouth study

Abstract: MCAF with CTG and CAF with CTG allow obtaining satisfactory and comparable root coverage as well as an aesthetic outcome without the negative effect of vertical incisions on the appearance of soft tissue.

Cited by 15 publications

References 31 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

Root Coverage Procedures for Multiple Recession Defects

Root coverage stability: A systematic overview of controlled clinical trials with at least 5 years of follow‐up

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