Treatment of human mucogingival defects utilizing a bioabsorbable membrane with and without a demineralized freeze-dried bone allograft.

BACKGROUND: The use of guided tissue regeneration (GTR) has become an effective procedure for the treatment of gingival recession. No reports exist on the use of a bioabsorbable membrane in combination with a demineralized freeze-dried bone allograft (DFDBA) for the treatment of these defects. METHODS: Fourteen (14) patients with 17 recession defects were included in this clinical study. Each patient had at least 1 tooth with 3 mm or greater marginal tissue recession on the facial surface as measured from the cemento-enamel junction (CEJ). Each patient was treated by GTR using a bioabsorbable membrane. When the first patient presented for inclusion in the study, a coin was flipped to determine if the tooth being treated would be a test tooth (DFDBA) or a control tooth (no DFDBA). Each subsequent patient was alternated between test and control. Immediately prior to the surgical procedure, measurements were made which included recession depth, recession width at the widest point, probing depth, amount of keratinized tissue, and marginal tissue thickness. Local anesthesia was administered, and a measurement from the CEJ to the bone crest was made by sounding through the attachment. RESULTS: The mean initial recession for all defects was 3.35 mm (SD +/- 0.49) and at 6 months postsurgery, mean recession was 0.47 mm (SD +/0.62). This correlated to 86% root coverage for both treatments. For all defects treated, there was a statistically significant increase in keratinized tissue (mean 0.88 mm) and tissue thickness (mean 0.47 mm) and a significant decrease in probing bone level (mean 0.76 mm). No statistically significant differences were observed between groups for any parameter. CONCLUSIONS: Although only 14 subjects with 17 defects were included in this study, the results suggest that the treatment of human gingival recession with a bioabsorbable membrane with or without the use of DFDBA results in significant root coverage, and slight, but significant improvements in keratinized tissue, tissue thickness, and bone level. The greatest limitation of the study was its lack of statistical power. Twenty-two (22) subjects would have been required for the results of the study to show equivalence between groups.

Physiologic dimensions of the periodontium significant to the restorative dentist.

When treating patients, the objectives of restorative therapy must be clear. The first and most basic objective is preservation of the teeth. The attainment of this objective would be far less complex if it could be considered independent of restoration of function, comfort and esthetics, but such is not the case. The latter objectives usually require sophisticated restorative dentistry and often include restorations with intracrevicular margins. Although it is widely accepted that the best restorative margin is one that is placed coronal to marginal tissue, most restorations have margins in the gingival crevice, and permanent tissue damage is common. In attempting to reach his objective, the restorative dentist must remember the fundamental precept of the health professions, which is: Do no harm. Daily observation of the three physiologic dimensions permits the therapist to restore teeth with minimal injury to the periodontium.

Coronal positioning of a previously placed autogenous gingival graft.

A procedure has been presented, with indications and necessary precautions, for predictably covering the denuded root surfaces of canines and premolars. The results of treating other areas with this technique have been less predictable. An alternate technique for covering denude root surfaces of the same teeth has been described. The alternate technique is more difficult to carry out and the results achieved are not as favorable.

Mucogingival problems, prevalence and therapy in children.

The clinical impressions of the authors and a survey of mucogingival problems in children lead to the following conclusions: 1. Mucogingival problems occur in children. 2. The prevalence of such problems is 12 to 19% in sample of 100 patients examined. 3. Insufficient keratinized tissue is developmentally related to: a. eruption pattern of the permanent incisors. b. buccolingual width of the alveolar process. 4. The autogenous free gingival graft is recommended as an acceptable procedure to prevent incipient mucogingival problems from progressing. 5. Where orthodontic therapy is anticipated and coincidentally insufficient keratinized tissue exists, a free gingival graft should be performed prior to tooth movement. 6. Grafts would be recommended in children with 1 mm or less of keratinized tissue. 7. Grafts would not be recommended in children when there is over 2 mm of keratinized tissue. 8. Grafts would not be recommended in children with greater than 1 mm of attached gingiva.