Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 10- to 27-year long-term study.

BACKGROUND: The aim of this retrospective long-term split-mouth study was to compare the periodontal conditions of sites treated with gingival-augmentation procedures to untreated homologous contralateral sites over a long period of time (10 to 27 years). METHODS: Fifty-five subjects with 73 sites (test group) lacking attached gingiva associated with recessions were treated by means of submarginal free gingival grafts (SMFGGs) and marginal free gingival grafts (MFGGs). The 73 contralateral homologous sites (control group), with or without recession and with or without attached gingiva, were not treated. Patients were recalled every 4 months during the follow-up period (10 to 27 years). Clinical variables, including recession depth, amount of keratinized tissue (KT), and probing depth (PD), were measured in treated and untreated sites at baseline, at 1 year, and at the end of the follow-up period. RESULTS: At the end of the follow-up period, recession was reduced in all treated sites (1.5 +/- 1.0 mm for SMFGG and 1.3 +/- 0.9 mm for MFGG), whereas it was increased in the untreated sites (-0.7 +/- 0.7 mm for SMFGG and -1.0 +/- 0.5 mm for MFGG). In the treated sites, the increased KT remained quite stable during the follow-up period. PD remained stable (1 mm) in the treated and untreated sites. CONCLUSIONS: The sites treated with gingival-augmentation surgery showed a tendency for coronal displacement of the gingival margin with a reduction in recession. The contralateral untreated sites showed a tendency for apical displacement of the gingival margin with an increase in the existing recessions.

Periodontal regeneration of human intrabony defects. IV. Determinants of healing response.

The purpose of this study was to identify factors which might affect the healing response in intrabony defects treated with guided tissue regeneration. Selected sites presented with deep periodontal lesions with 1, 2, and 3 wall combination intrabony component of 6.1 +/- 2.5 mm. The significance of patient, tooth, and defect characteristics and surgical parameters as predictor variables affecting the regenerative outcome before and following the removal of the barrier membrane was assessed. Outcome was measured as tissue gain under the membrane, regenerated probing attachment level (PAL), and bone fill. The total depth of the intrabony component and the radiographic defect angle significantly affected the amount of tissue gain. Seventy-five percent (75%) of the variability of regenerated PAL and bone fill was explained in terms of tissue gain under the membrane, radiographic width of the defect angle, full mouth bleeding score, and presence or absence of flap coverage of the newly formed tissue. Control of the identified predictor variables might improve the extent and predictability of guided tissue regeneration in the treatment of deep intrabony defects.

Interproximal free gingival grafts after membrane removal in guided tissue regeneration treatment of intrabony defects. A randomized controlled clinical trial.

The purpose of this controlled clinical trial was to compare the efficacy of two surgical approaches to protect the regenerated tissue following membrane removal in guided tissue regeneration (GTR) treated intrabony defects. Twenty-eight (28) defects, one each in 28 patients were randomly assigned after placement of the membrane to one of two treatment groups by blocking to prognostic variables. The test group received free gingival grafts on the interproximal regenerated tissue. In the control group the surgical flaps were coronally positioned over the regenerated tissue. The two groups were well balanced with respect to all prognostic variables. The results indicated that: 1) similar amounts of regenerated tissue were obtained in the two groups at membrane removal (7.6 +/- 2.8 mm, test; 8.3 +/- 2.3 mm, control); 2) a significantly greater amount of probing attachment level gain was observed in the test group (5.0 +/- 2.1 mm, test; 3.7 +/- 2.1 mm, control). This study indicated that placement of free gingival grafts on the interdental regenerated tissue further improves the clinical outcome of GTR in deep intrabony defects.

Fibrin and fibronectin sealing system in a guided tissue regeneration procedure. A case report.

A case is reported showing an iatrogenic, chronic abscess of six years' duration associated with a bony defect between the maxillary right central and lateral incisors. The osseous defect was treated by a guided tissue regeneration procedure with the use of a fibrin and fibronectin sealing system. The system was employed to fix the membranes and keep them apart from the root surface, thereby maintaining room for bone regeneration. This operation resulted in a 9-mm clinical attachment gain and in an 11-mm filling of the osseous defect. The second surgical stage after a three-month reentry procedure was strictly for cosmetic improvement by means of a free gingival graft.

Periodontal regeneration of human intrabony defects with bioresorbable membranes. A controlled clinical trial.

The purpose of this controlled clinical trial was to compare the clinical efficacy of 3 treatment modalities in the treatment of deep interproximal intrabony defects. Thirty-six (36) defects in 36 patients were randomly assigned to 1 of 3 treatment groups by blocking to prognostic variables. The test was treated with bioresorbable membranes positioned coronal to the interproximal bone crest; the second group (membrane control) was treated with conventional non-resorbable (ePTFE) barrier membranes applied coronal to the alveolar crest; the third group (flap Control) was treated with an access flap procedure (MWF). No differences were observed in terms of baseline oral hygiene and defect characteristics among the 3 groups, indicating that the blocking approach was effective. A stringent infection control program was enforced for 1 year. The results indicated that: 1) at 1 year all treatment modalities resulted in clinically significant improvements in clinical attachment levels (CAL) and reductions in probing depths; 2) a statistically significant treatment effect (P < 0.0001, ANOVA) was observed comparing the test (4.6 +/- 1.2 mm), the membrane control (5.2 +/- 1.4 mm), and the flap control groups (2.3 +/- 0.8 mm) in terms of CAL gain; 3) differences in terms of CAL gain between the test (bioresorbable) and the membrane control (ePTFE) groups were not statistically significant (P = 0.19, t-test); 4) both the test and the membrane control groups gained significantly more CAL at 1 year than the MWF group (P < 0.0001, t-test). CAL gains > or = 4 mm were observed in 83.3% of cases in both GTR groups, while CAL gains of this magnitude were not detected in the MWF group. We concluded that clinically significant CAL gains can be obtained with GTR procedures using both bioresorbable and non-resorbable membranes. Patients' morbidity, however, was lower in the group treated with bioresorbable membranes.

Periodontal regeneration of human intrabony defects with titanium reinforced membranes. A controlled clinical trial.

The purpose of this controlled clinical trial was to compare the clinical efficacy of 3 treatment modalities in the treatment of deep interproximal intrabony defects. Forty-five (45) defects in 45 patients were randomly assigned to 1 of 3 treatment groups by blocking to prognostic variables. The test group was treated with titanium reinforced membranes positioned just apical to the cemento-enamel junction and the modified papilla preservation technique; the second group received conventional expanded polytetrafluoroethylene (ePTFE) barrier membranes applied at the alveolar crest; the third group was treated with an access flap procedure. The groups were well balanced with respect to all prognostic variables. During the 1-year observation period, patients were subjected to a stringent infection control program including: professional tooth cleaning every week for the first 6 weeks (all groups) and in the 4 weeks following membrane removal (guided tissue regeneration groups), then at monthly intervals (all groups). The results indicated that: 1) all treatment modalities resulted in clinical and statistically significant improvements in clinical attachment level (CAL) and probing depths (PD) at 1 year; 2) a significantly greater amount of CAL gain (P = 0.0003, analysis of variance) was observed in the test group (5.3 +/- 2.2 mm) with respect to both the ePTFE group (4.1 +/- 1.8 mm) and the flap control group 2.5 +/- 0.8; 3) in the test group the 1 year CAL (4.7 +/- 1.8 mm) was located more coronally than the baseline position of the interproximal alveolar crest (5.9 +/- 2 mm; P = 0.003, t test).(ABSTRACT TRUNCATED AT 250 WORDS)

Periodontal regeneration of human infrabony defects. I. Clinical measures.

A series of investigations was undertaken to evaluate the extent and predictability of periodontal regeneration with barrier membranes in deep infrabony defects. This study reports the clinical outcomes in terms of probing attachment level (PAL) gains, probing pocket depth (PPD) reduction, and recession (REC) of marginal gingiva. Forty deep 1, 2, and 3-wall combination infrabony defects treated with membranes were evaluated 1 year postoperatively following a strict plaque control regimen (mean plaque score = 6.1%, bleeding score = 4% at 1 year). A PAL gain of 6.1 +/- 2.5 mm along with a PPD reduction of 5.9 +/- 2.5 mm were observed. A PAL gain of 2 mm or more was detected in almost 90% of the treated sites. No site lost attachment. Residual PPD was 3 mm or shallower in 95% of the sites. It is concluded that treatment of deep infrabony defects according to the principles of guided tissue regeneration and a strict plaque control regimen represents an efficacious and predictable treatment alternative.

Periodontal regeneration of human infrabony defects. II. Re-entry procedures and bone measures.

This paper evaluates the osseous healing response of 40 infrabony defects treated with guided tissue regeneration. The selected sites presented with deep periodontal lesions with a 1-, 2-, and 3-wall combination infrabony component of 6.1 +/- 2.5 mm. Baseline intrasurgical clinical measurements were compared with intrasurgical clinical measurements obtained at the 1 year surgical re-entry. A significant regeneration of bone of 4.3 +/- 2.5 mm was observed, along with a 0.4 +/- 1.9 mm resorption of the alveolar bone crest, which resulted in a 4.7 mm reduction of the original infrabony defect. Almost 90% of the sites showed a bone gain of 2 mm or more, while no site lost supporting bone; 73 +/- 31.2% of the original defect was filled with bone. The 3- and 2-wall components were filled 95 +/- 6.2% and 82 +/- 18.7% of their original depth, respectively; however, the 1-wall component was filled only 39 +/- 62.4%. It is concluded that treatment of infrabony defects according to the principles of guided tissue regeneration and a strict plaque control regimen resulted in clinically significant and highly predictable bone regeneration.

Guided tissue regeneration in the treatment of human facial recession. A 12-case report.

A guided tissue regeneration procedure was used to treat human buccal recessions, 3 to 7 mm deep, in 12 patients. No procedure for increasing the width of keratinized tissue was performed prior to treatment. A thick bipedicled flap was raised with a semilunar incision in the alveolar mucosa and a marginal incision was extended to the adjacent papilla. The root surface was made concave by curets and burs to create space for regeneration. The membrane was fixed to the cemento-enamel junction and covered by the flap which consisted of the residual gingiva and of alveolar mucosa. The membranes were removed 4 weeks after placement. The patients were recalled 6 months after the reentry procedure. The average reduction in recession was 2.50 mm (P less than 0.01) and the average attachment gain was 2.84 (P less than 0.01). Pocket depth was slightly reduced (0.33 mm), although the degree of reduction was not of statistical significance. The width of keratinized tissue increased slightly (0.83 mm). These results demonstrate the possibility of treating human buccal recessions by means of a guided tissue regeneration procedure, with predictable recession reduction and attachment gain. A minimal amount of keratinized tissue was needed.

Human fibrin glue versus sutures in periodontal surgery.

A fibrin-sealing system consisting of symmetrical flap and graft procedures versus silk sutures in a split-mouth clinical trial was tested in 51 patients. Clinical parameters and operative times were recorded and compared. In clinical use, the fibrin glue provided quick hemostasis and adequate tissue adhesion on the whole inner surface of grafts or flaps. Its use saved remarkable amounts of time and made it easier to fix tissues in difficult areas. The time saved ranged from 3 to 19.5 minutes per procedure, and 1 to 8.5 minutes per tooth. The convenience of the fibrin glue was especially appreciated in pedicle flap procedures.

Mucogingival interceptive surgery of buccally-erupted premolars in patients scheduled for orthodontic treatment. I. A 7-year longitudinal study.

BACKGROUND: Mucogingival interceptive therapy in patients with buccally erupting teeth is performed to prevent the ectopic permanent tooth from developing periodontal lesions. The keratinized tissue entrapped between the erupting tooth and the deciduous tooth is retained to maintain a satisfactory width of the gingiva for the permanent tooth. The aim of the present study on buccally-erupted premolars scheduled for orthodontics was to evaluate the keratinized tissue width 3 months, 2 years, and 7 years subsequent to mucogingival interceptive therapy and orthodontic treatment. METHODS: Twenty-nine patients participated. Three different surgical techniques were used according to specific indications. Eight patients were treated with double pedicle flaps (DPF), 10 patients with apically positioned flaps (APF), and 11 with free gingival grafts (FGG). RESULTS: The amount of keratinized tissue on the treated (test) sites was not significantly less than on the control (untreated) sites showing normally erupting premolars at all observation periods. All 3 surgical procedures appeared to be effective in saving the keratinized tissue for the permanent tooth. Preoperative periodontal parameters such as gingival width, probing depth, and bleeding on probing significantly influenced the outcome 3 months after surgery (P <0.01). CONCLUSIONS: Mucogingival interceptive surgery is an effective approach to conserve the keratinized buccal gingiva of ectopically erupting premolars.

Mucogingival interceptive surgery of buccally-erupted premolars in patients scheduled for orthodontic treatment. II. Surgically treated versus nonsurgically treated cases.

BACKGROUND: The aim of this 2-year longitudinal study was to compare the width of keratinized gingiva after orthodontic therapy for buccally erupting premolars that had been pretreated by extraction of deciduous teeth alone versus interceptive mucogingival surgery. METHODS: In 8 patients (aged 9 to 12 years) who presented with bilateral buccal eruption of homologous teeth (premolars), one side was randomly treated with extraction of the deciduous molar and mucogingival surgery (test site), while the other side was treated only by extraction of the deciduous molar (control site). All of the subjects underwent orthodontic treatment with fixed appliances. RESULTS: At the baseline visit prior to any treatment, there was no significant difference between the mean amount of keratinized gingiva at test sites (3.06 mm) and control sites (2.93 mm). Two years later, upon completion of orthodontic treatment, there was a significant difference between test (2.93 mm) and control (1.37 mm) sites in the mean width of keratinized tissue. In the control (untreated) group, 2 sites exhibited 1 mm of gingival recession after orthodontic treatment. CONCLUSIONS: Mucogingival interceptive surgery is an effective technique to maintain keratinized tissue in correspondence with buccally-erupted teeth.

Periodontal regeneration of human infrabony defects. III. Diagnostic strategies to detect bone gain.

Assessment of actual treatment outcome by simple and available diagnostic tests represents an important aspect in the evaluation of periodontal regenerative procedures. This report focuses on the diagnostic accuracy of different strategies to detect the original extent of bone loss and bone gain in deep vertical defects following guided tissue regeneration. Characteristics of probing attachment level and radiographic bone linear measurements were compared to a gold standard obtained as intrasurgical clinical measurements at baseline and at the 1 year re-entry operation. Radiographic linear measurements underestimated bone loss (CEJ-BD) in 55% of cases while the estimate was within 1 mm in 25% of cases. The goodness of agreement could be significantly described by a general linear model incorporating measures of defect morphology. The original level of bone loss could be best detected by an approach which consisted of adding 1.5 mm to the measured attachment level loss. Such an approach correctly estimated bone loss within 1 mm in 85% of sites. In terms of ability to detect bone gain, radiographic measurements underestimated bone gain in 55% and overestimated it in 15% of sites. Diagnostic accuracy was assessed at different threshold values of true gain. The sensitivity and specificity plots intersected at a threshold value of 2.7 mm bone gain. Conversely, measures of probing attachment level gain agreed with the gold standard within 1 mm 45% of times. Intersection of the specificity and sensitivity plots occurred at 3 mm. Classification tables are presented for both diagnostic tests at different threshold values.2+é

Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession.

A surgical technique involving membranes was used to treat localized human buccal recessions 3 mm to 8 mm. The results on 25 patients (test group) were evaluated 18 months postoperatively and compared with the results obtained in 25 other patients (control group) having undergone mucogingival surgery. In the test group, a trapezoidal flap with a large base was raised beyond the mucogingival junction. The exposed root surface was scaled thoroughly to a concave shape. A membrane was bent and adapted onto the concave root surface. The flap was sutured far coronally and the membrane removed one month later. The control patients underwent a 2-step procedure, consisting of a free gingival graft and a coronally positioned flap. The amount of root coverage obtained was similar in the 2 groups (test = 72.73%; control = 70.87%), although the clinical attachment gain (test = 5.12 mm; control = 3.56 mm) and pocket variation (test = 1 mm reduction; control = 0.06 mm increase) differed significantly (P < 0.001). The keratinized tissue width was greater in the control group. The regression analysis showed that the amount of covered root surface after treatment was in strict correlation with the depth of the original recession in the test group, while no correlation was found in the control group. The expected root coverage was greater in the test group when the recession was greater than 4.98 mm, while it was greater in the control group when the recession was less than 4.98 mm. These results indicate that a guided tissue regeneration procedure can be used to successfully treat recession. The membrane procedure compared favorably with the mucogingival surgery in the treatment of deep recession.

Coronally advanced flap procedure: is the interdental papilla a prognostic factor for root coverage?

BACKGROUND: This study was designed to verify if the dimension of the interdental papilla may be a prognostic factor for the clinical outcome of the coronally advanced flap (CAF) in the treatment of gingival recessions. METHODS: Thirty-three Miller Class I recessions were treated in 33 patients using the CAF procedure. Two types of measurements were performed: 1) clinical measurements (probing depth, recession depth, width of keratinized tissue, clinical attachment level) were recorded at baseline and 3 months after surgery and 2) all recessions were photographed and transformed into computer images. A specific software allowed recording of both linear and square measurements. The following digital measurements were recorded at baseline: 1) base, height, and area of the mesial and distal papillae adjacent to the involved tooth and 2) width/depth of the recession and the area of the exposed root surface of the involved tooth. The residual recession area, if any, was recorded 3 months after surgery. The digital measurements of the height and of the area of the papilla were used in statistical analysis (multiple linear regression and logistic regression) to evaluate a possible correlation with root coverage (mm2) and/or with complete root coverage. RESULTS: Root coverage was not significantly correlated to the papilla area (P= 0.3692) or to papilla height (P= 0.0968). The complete root coverage was not correlated to the papilla area (P= 0.3181), but it was correlated to papilla height (P= 0.0499). CONCLUSIONS: This study indicates that the root coverage following CAF procedure is not significantly correlated to papilla dimension. However, complete root coverage is significantly more frequent in sites with lower height of the adjacent papilla.

Retrospective evaluation of the influence of the interleukin-1 genotype on radiographic bone levels in treated periodontal patients over 10 years.

BACKGROUND: A difference in genetic susceptibility to plaque accumulation has been advocated to explain different responses to periodontal therapy. The purpose of this study is to assess the role of the interleukin-1 (IL-1) polymorphism on the rate of bone and tooth loss in non-smoking periodontally treated patients during maintenance. METHODS: Sixty consecutive non-smoking patients (mean age 46.8 +/- 5.0) with moderate to severe periodontitis, treated and maintained for over 10 years were selected. At baseline (T0), radiographic evaluation (cemento-enamel junction [CEJ]-root apex, CEJ-bottom of defect mesial and distal, CEJ-bone crest mesial and distal, crown-root ratio) was performed. All patients received scaling and root planing; 36 patients then underwent surgical therapy. Subsequently, all patients were enrolled in a periodontal maintenance program with recall visits every 3.4 +/- 1.0 months for at least 10 years. At the latest recall visit (T2) the same radiographic measurements evaluated at baseline were taken and a DNA sample for IL-1 genetic susceptibility testing was collected and sent for analysis. RESULTS: Twenty-three of the 60 patients (38.3%) were IL-1 genotype positive. A total of 52 teeth (3.3%) out of 1,566 were lost due to periodontitis between T0 and T2; 28 of 957 (2.9%) in the IL-1 genotype negative group and 24 of 609 (3.9%) in IL-1 genotype positive group. The mean variation in bone defect level (DeltaBD) averaged -0.04 mm in IL-1 genotype negative patients and 0.01 mm in IL-1 genotype positive patients. The mean variation in bone crest level (DeltaBC) averaged -0.24 mm in IL-1 genotype negative patients and -0.28 mm in IL-1 genotype positive patients. However, a few patients showed significant differences in response to therapy based on initial bone levels and genotype. IL-1 negative patients who showed minimal initial bone loss responded to the therapy better than the IL-1 positive patients. IL-1 positive patients with severe initial bone loss showed a better response to the therapy than IL-1 negative patients. CONCLUSIONS: On average, there were no significant differences related to IL-1 genotype in tooth loss after 10 years in a non-smoking, well-maintained periodontal population. On an individual patient basis, the IL-1 genotype, in combination with the initial bone level, seems useful at the beginning of therapy for predicting bone level variation.

Coronally advanced flap procedure for root coverage. Flap with tension versus flap without tension: a randomized controlled clinical study.

BACKGROUND: This clinical controlled study was designed to measure the tension of coronally advanced flaps (CAF) performed to treat shallow gingival recessions and to compare the recession reduction (Rec Red) achieved in a test group (flaps with tension) and in a control group (flaps without tension) 3 months after surgery. METHODS: Eleven patients, aged 22 to 41 years, with high levels of oral hygiene (full mouth plaque score <20%) were selected for the study. Each patient showed 2 bilateral Miller Class I maxillary or mandibular gingival recessions located on homologous teeth. A total of 22 recessions were treated. The recession depth at the right site was similar to that at the left site (difference < or =1 mm). For each patient, the 2 recessions underwent CAF procedure in the same surgical session. Before suturing, the residual tension (FTens) of both right and left flaps was measured with a dynamometer. Then, one site was randomly assigned to the test group and the contralateral site to the control group. In the test site the flap was sutured. In the control site the flap was further relaxed, the tension was measured again, and the flap was sutured. RESULTS: In the test group (with tension) the initial mean recession depth was 2.82 +/- 0.64 mm and mean FTens was 6.5 g, while in the control group (without tension) the initial mean recession depth was 2.68 +/- 0.81 mm and mean FTens was 0.4 g. Three months later, the test group showed a mean recession reduction of 2.18 +/- 0.60 mm, a mean percent root coverage of 78 +/- 15%, and complete root coverage was achieved on 2 teeth (18%). In the control group the mean recession reduction was 2.32 +/- 0.81 mm and mean percent root coverage was 87 +/- 13%. Complete root coverage was obtained on 5 teeth (45%). The difference of recession reduction between the test and control group was not statistically significant (P = 0.3911). In the test group, linear regression analysis showed a statistically significant association between recession reduction and both recession depth at baseline (P= 0.0001) and mean of the 3 tensions recorded on the test side (MFTens) (P = 0.0009). CONCLUSIONS: This study shows that minimal flap tension does not influence recession reduction after 3 months when shallow recessions are treated by means of CAF. In the test group (with tension), the statistical analysis suggests that the higher the flap tension, the lower the recession reduction.

Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal recessions. A 4-year follow-up study.

The 4-year follow-up results of a clinical trial are reported. The clinical results of the treatment of buccal recession were analyzed comparing the outcomes of a guided tissue regeneration (GTR) procedure with nonresorbable membranes and a 2-step mucogingival procedure consisting of a coronally-positioned free gingival graft in two groups of 25 patients each. The final root coverage was 73.07% in the test group (GTR) and 72.3% in the control group (mucogingival surgery). In the test group, statistically significant recession reduction, probing depth reduction, clinical attachment level gain, and increase of keratinized tissue width were observed. In the control group the results were similar except for probing depth, which did not vary significantly. At the end of the 4-year follow-up period, the average periodontal conditions did not differ between the 2 groups, with the exception of the keratinized tissue width. This was obviously greater in the control group, where a free gingival graft had been carried out. Recessions > or = 5 mm had a greater root coverage after GTR treatment. In both groups, the periodontal parameters remained stable between 18 months and 4 years after surgery, indicating remarkable stability; the only exception was a significant increase in the keratinized tissue width in the test group. When the changes between the baseline and the 4-year follow-up were compared, the average reduction in the recession was similar in the two groups while probing depth reduction and clinical attachment level were greater in the GTR group.

Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series.

This clinical study was designed to determine whether the thickness of the flap can influence root coverage when gingival recessions associated with traumatic toothbrushing are treated using a coronally advanced flap (CAF). Nineteen patients, aged from 25 to 57 years, with high levels of oral hygiene (full-mouth plaque scores <20%) were selected for the study. Each patient contributed with one Miller Class I or II maxillary or mandibular recession. A total of 19 recessions > or =2 mm were treated. After local anesthesia and before flap elevation, the exposed root surface was planed with a sharp curet. A trapezoidal full- and partial-thickness flap was then elevated, displaced coronally, and sutured to cover the treated root surface. Before suturing, flap thickness was measured in the alveolar mucosa with a gauge. After surgery, all patients were recalled for control and professional prophylaxis once a week during the first month and monthly up to the third month. The mean initial recession depth was 3.0+/-0.9 mm. Mean flap thickness (FT) was 0.7+/-0.2 mm. Three months later, mean recession depth was 0.6+/-0.6 (P <0.0001) and mean recession reduction was 2.4+/-0.7 mm. Mean root coverage was 82+/-17%. Flap thickness >0.8 mm was associated with 100% of root coverage. The results of this study indicate that there is a direct relation between flap thickness and recession reduction (P <0.0001).

Coronally advanced flap procedure for root coverage. Treatment of root surface: root planning versus polishing.

This clinical study was designed to determine if mechanical instrumentation (root planing) of the exposed root is useful in treating gingival recession caused by traumatic toothbrushing following a coronally advanced flap (CAF). Ten patients with high levels of oral hygiene (full-mouth plaque score <20%), from 25 to 57 years of age, were selected for the study. Each patient showed 2 bilateral Class I or II maxillary recessions. A total of 20 recessions were treated. The difference in the recessions was < or =1 mm. In each patient, one recession was randomly assigned to the test group and the contralateral one to the control group. In the test group, the exposed root surface was polished at slow speed with a rubber cup and prophylaxis paste for 60 seconds. In the control group, the exposed root surface was planed with a sharp curet. In both test and control groups, a trapezoidal full- and partial-thickness flap was elevated, coronally displaced, and sutured to cover the treated root surface. Before treatment, the mean recession depth in the test group (polishing) was 3.1+/-1.1 mm; and in the control group (root planing), 2.9+/-1.0 mm. Three months after the described procedures, the test group (polishing) showed a mean recession reduction of 2.6+/-0.6 mm; mean percent root coverage was 89+/-14%. In the control group (root planing), the mean recession reduction was 2.3+/-0.7 mm and mean percent root coverage was 83+/-16%. The difference of recession reduction between the test and control group was not statistically significant (P = 0.1405), even though the test group showed slightly better clinical results in terms of root coverage. This prospective clinical, controlled, randomized study shows that mechanical instrumentation (root planing) of the exposed root surfaces is not necessary when shallow recessions caused by traumatic toothbrushing are treated using a coronally advanced flap (CAF) in patients with high levels of oral hygiene.