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PubMed1995

Effects of tetracycline HCl conditioning and fibrin-fibronectin system application in the treatment of buccal gingival recession with guided tissue regeneration.

A split-mouth clinical trial was designed to evaluate the effect of treating deep wide buccal gingival recession with guided tissue regeneration using expanded polytetrafluoroethylene membrane combined with tetracycline HCl (TTC) root conditioning and fibrin-fibronectin sealing system (FFSS) application. Eight patients, aged 25 to 57 years, each presenting two similar mucogingival defects, were selected. The two bilateral recessions were randomly assigned in each patient to either test or control treatment procedure. After initial therapy, each patient was examined for assessment of plaque, gingivitis, recession depth (RD), probing depth (PD), probing attachment level (PAL), and keratinized tissue width (KT). The test procedure included the elevation of mucoperiosteal flap at the buccal aspect of the alveolar process. The root was debrided and demineralized with 100 mg/ml TTC solution for 4 minutes using a burnishing technique with cotton pellets. A teflon membrane was secured and a film of FFSS was applied between the membrane and the root surface. The buccal flap was sutured to completely submerge the membrane. Control treatment included gingival flap surgery with barrier membrane alone. After 6 weeks, the membrane was removed. Healing was evaluated 6 months after surgery. Both test and control procedures resulted in highly significant recession reduction (3.0 mm +/- 1.1 and 2.6 mm +/- 1.2, respectively) and attachment gain (3.6 mm +/- 1.7 and 2.6 mm +/- 1.1, respectively). Mean root coverage was of 67% in the TTC + FFSS treated sites and 60% in membrane-only treated sites. However, only treatment with TTC + FFSS significantly reduced PD and increased KT (P < 0.05). When treatments were compared, changes in PD and PAL were significantly greater in TTC + FFSS treated sites (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Treatment of localized gingival recessions with coronally displaced flaps and citric acid. An experimental study in the dog.

The present study was designed to examine the effect of citric acid conditioning on the result of healing following treatment of localized gingival recessions with coronally displaced flaps. In 3 beagle dogs, localized gingival recessions were surgically created at the buccal surfaces of canines, premolars and molars. All experimental sites were allowed to accumulate plaque for a period of 6 months. Following preparation of notches in the buccal root surfaces at the level of the gingival margin, buccal and lingual mucoperiosteal flaps were raised. The exposed portion of the root surfaces was scaled and the cementum layer was removed. Another notch was prepared in the root surfaces at the level of the crest of the alveolar bone. Half the number of the roots were treated by topical application of citric acid while the remaining roots were used as non-acid treated controls. The flaps were sutured in a coronally displaced position. After 3 months of healing, the dogs were sacrificed and the jaws removed and placed in fixative. After decalcification, histological sections of the experimental roots and their periodontal tissues were produced. The 2 notches described above were used as reference points in the histological examination. The histological analysis disclosed that new attachment had formed on all test and control roots and extended in some specimens of both groups to a position coronal to the presurgical level of the gingival margin. The amount of new attachment was similar in the 2 categories of roots, demonstrating that citric acid conditioning did not produce additional new attachment.

Animals↗
PubMed2005

The influence of anatomical features on the outcome of gingival recessions treated with coronally advanced flap and enamel matrix derivative: a 1-year prospective study.

BACKGROUND: Coronally advanced flap (CAF) is one of the most effective treatments of Miller Class I and II recessions. Even if excellent outcomes are reported in the literature, complete root coverage is not always predictable, since many surgical and host-related factors may affect the percentage of root coverage obtained. The aim of this clinical study was to evaluate if some anatomical features such as tissue thickness, papillae height and width, recession depth, and vestibular bone height may influence defect coverage of Miller Class I and II gingival recessions treated with CAF in combination with enamel matrix derivative (EMD). METHODS: Thirty healthy, non-smoking patients (13 men and 17 women; mean age 32.8 +/- 6.2 years) were enrolled. Each patient was treated for one single recession using a CAF with the adjunct of EMD. Clinical parameters at baseline and 6 and 12 months were recorded and compared by using paired Student t test. Data were subdivided in two groups according to the baseline recession depth (REC): REC < 4 mm (group 1) and REC > or = 4 mm (group 2). The relation between the anatomical parameters (papilla height, papilla width, crestal bone height, and flap thickness) and percent of root coverage was evaluated by multiple linear regression analysis. RESULTS: At 12 months, 91.7% of root coverage was obtained with a mean attachment gain of 3.23 mm. Better results in terms of percentage of root coverage were obtained when the baseline REC was < 4 mm compared to defects > or = 4 mm (96.5% versus 83.5%). Flap thickness was positively correlated to the percentage of root coverage. For gingival recessions > or = 4 mm, 100% root coverage was achieved only when tissue thickness was > or = 1 mm. Root coverage percentage was slightly related to papilla width in both groups, while it was associated with papilla height only in group 1 (P = 0.004). Only in patients in group 1 was the height of bone on the vestibular side related to the percentage of root coverage obtained (P = 0.003). CONCLUSIONS: The results of the present study suggest that baseline recession depth and flap thickness may influence the outcome of marginal tissue recession therapy with CAF plus EMD at 12 months. There is not a clear relation between root coverage and other anatomical features as papilla width, papilla height, and the amount of bone on the vestibular side.

Adult↗
PubMed2001

A bioresorbable barrier in the treatment of gingival recession: description of a new resorbable dome device.

The biologic principle of guided tissue regeneration has been expanded to mucogingival surgery, using resorbable barrier membranes for the treatment of gingival recessions. Space provision is one of the main problems in non-space making defects, considering the softness of resorbable membranes. In this study, we tested the possibility to create and maintain a secluded space using a slow, long-lasting resorbable suture so that a resorbable dome device could support the barrier and immediately become a space-making device. Ten purely mucogingival recessions in ten patients were treated. At 12 months, the results were evaluated. In five subjects the gingival margin was within 1 mm of the cementoenamel junction, in four patients it was within 2 mm, and in one case a residual gingival recession was present (where the membrane became exposed). The mean root coverage obtained was 70.4%, while the mean gain of clinical attachment was 3.3 mm.

Absorbable Implants↗
PubMed2005

Interest in periodontology and preferences for treatment of localized gingival recessions.

OBJECTIVES: The purpose of this study was to evaluate the views, knowledge and preferences of a large sample of practising dentists in periodontics, focusing specifically on the treatment of gingival recessions, and to compare the findings with the current evidence available in the dental literature. METHODS: We conducted a cross-sectional postal survey of 3780 dentists, representing the majority of all dentists working in Switzerland. The questionnaire consisted of 17 questions, most of them giving the possibility of multiple choices of answers. The demographic profile, interests and satisfaction in periodontics were associated with the choice of treatment options offered for the management of six clinical situations. RESULTS: One thousand two hundred and one dentists sent back the questionnaire within three months and were thus included in the analysis. In general, the interest and the satisfaction in periodontics were moderate to high (6-7 on an analogue scale from 1 to 10). Specialists in periodontics indicated a significantly higher interest and satisfaction in periodontics than the general dentists (p<0.001), and practitioners working in urban areas indicated a slightly higher interest (p=0.027) and satisfaction (0.047) than their colleagues established in a rural setting. The predominant indication of root coverage procedures was aesthetics (90.7%). The region in which dentists worked was the only significant predictor for choosing "no treatment" of buccal recessions: dentists from the German-speaking part were significantly less inclined to surgically treat gingival recessions than their colleagues from the French or Italian part. For those who opted for therapy, a free tissue graft was generally the favourite option, followed by a connective tissue graft and a coronally advanced flap. Throughout, only a small fraction of the dentists considered using a guided tissue regeneration procedure. The relative odds for not extracting teeth with severe periodontal disease were higher if the dentist was a specialist than a generalist. Satisfaction in practicing periodontics also positively strengthened the inclination towards keeping severely compromised teeth. CONCLUSIONS: Aesthetic concerns were the predominant indication for root coverage procedures. Further research should therefore include aesthetic aspects as primary clinical outcome variables. Specific training of dentists and their satisfaction in periodontics influenced treatment decisions. Specialists involved in continuing education should inform practicing dentists more efficiently on the potential and usefulness of periodontal therapy for saving and maintaining periodontally compromised teeth.

Adult↗
PubMed1994

[Progressive gingival recession: a 2-stage surgical technic].

A technique for treating gingival recession which provides a means of achieving two objectives, interrupting the disease process and aesthetic covering of the exposed root, are described. A two step procedure is used: 1) a free submarginal gingival graft is positioned high enough to attach the gum, 2) the exposed root is covered with a bipediculated crown flap. A biological glue was used instead of suture after preparing the root surface with citric acid.

Adult↗
PubMed2005

Non-surgical periodontal therapy of shallow gingival recession defects: evaluation of the restorative capacity of marginal gingiva after 12 months.

BACKGROUND: There is a large amount of data on surgical root coverage procedures for the treatment of gingival recessions but no controlled clinical trials on the behavior of marginal gingiva following non-surgical therapy. The aim of our study was to compare in terms of root coverage two different modalities of root surface treatment, root planing and polishing versus polishing alone, over a 12-month period. METHODS: The study was conducted in a split-mouth design. Twenty-four non-smoking patients (14 females and 10 males, mean age 25.17 4.03 years) with high levels of oral hygiene (full-mouth plaque score <20%) and with two bilateral Class I buccal recessions up to 2 mm deep were selected for the study. In each patient one recession was randomly assigned to the test group and the contra-lateral one to the control group. In the test group the exposed root surface was gently debrided and polished with mini curets and mini rubber cups, while the control group was polished only. The root surface instrumentation was repeated twice a month during the first 2 months and at 2-month intervals over the next 10 months. Clinical measurements were taken at baseline and 12 months post-therapy. RESULTS: At baseline the mean recession depth in the test group was 1.64 +/- 0.37 mm and in the control sites 1.43 +/- 0.42 mm, which decreased at 12 months to 0.78 +/- 0.60 mm and to 1.34 +/- 0.45 mm, respectively. The difference between the two groups was significant (P <0.0001). No significant differences were observed in keratinized tissue width and probing depth improvements. CONCLUSIONS: The removal of microbial toxins from the exposed root surfaces by polishing prevents further progression of gingival recession; the reduction of root convexity by scaling and root planing promotes the coronal shift of the gingival margin.

Adult↗
PubMed1989

[Etiology of gingival recessions].

About every third patient of our department suffers from gingival recessions (g. r.): 1980, 1985, 1986, 1987 altogether 1039 patients from 4022. People at the age of 20-25 years are mainly affected: 44.4% of these patients in the age-group of 20-25 years suffer from g. r., 28.3% of patients suffering from l.P.a. are 20-25 years old. Patients diseased with g. r. (N = 60) show functional disturbances (79% at the 1st bicuspid, 72% at the 2nd bicuspid) during their occlusion movements to a great extent. Patients afflected by g.r. (N = 20) show in comparison to healthy people a smaller diameter of the canin's apical basis both in upper and lower jaw, a smaller circumference of the alveolar crest as well as an upper canin-crown which is turned out from the teeth arcus in a more labial direction. Prevention of g. r. involves individual oral health education to protect the vestibular gingiva from chronic brushing-trauma, an early follow-up, and a functional adjustment.

Adolescent↗
PubMed2005

Guided tissue regeneration in human gingival recessions. A 10-year follow-up study.

OBJECTIVE: The aim of the present study was to evaluate the changes of the mucogingival complex of guided tissue regeneration (GTR)-treated gingival recession defects over a 10-year follow-up. METHODS: The study population consisted of 20 patients, 11 males and nine females, mean age: 44.3+/-10.4 years, each contributing one recession defect treated with a polytetrafluoroethylene membrane. Eight patients were smokers at the time of surgery and at 10 years post-surgery. Recession depth (RD), probing depth clinical attachment level (CAL), and width of keratinized gingiva (KG) were assessed immediately before surgery, at 6 months, 4 years and 10 years post-surgery. RESULTS: RD was 0.9+/-0.6 mm at 6 months, 1.0+/-1.3 mm at 4 years and 1.3+/-1.6 mm at 10 years. CAL amounted to 1.9+/-1.0 mm at 6 months and shifted to 2.2+/-1.4 and 2.6+/-1.6 mm at 4 years and 10 years, respectively. KG significantly increased following surgery and remained stable thereafter. At 10-year examination, no significant changes from 4-year evaluation were observed. Differences in periodontal parameters between smokers and non-smokers were not statistically significant. CONCLUSION: In conclusion, the results of the present study failed to demonstrate changes over time in the clinical outcome achieved following GTR procedure in gingival recession defects over a period between 4 and 10 years post-surgery.

Adult↗
PubMed1995

Gingival recession related to removable partial dentures in older patients.

One hundred forty-six patients, living in the community and attending a general dental practice, were examined on two occasions separated by 3 years to determine relationships among removable partial dentures, their design, and gingival recession. This study confirmed the relationship between the presence of a partial denture and an increase of gingival recession, but was unable to demonstrate any predictable relationship to the lack of tooth support, the material used for the dentures, or covering the gingival margins with lingual plates. These design factors may be less important than the maintenance of good oral hygiene for the prevention of periodontal disease in patients wearing removable partial dentures.

Age Factors↗
PubMed2001

Clinical evaluation of acellular allograft dermis for the treatment of human gingival recession.

BACKGROUND: Periodontal root coverage procedures to treat recession areas are indicated for unesthetic, exposed, and/or painful root surfaces. Many methods, most using autogenous soft tissue grafts, have been utilized, but with associated morbidity at the donor sites. An alternative donor material would reduce the morbidity and provide for sufficient available donor tissue. METHODS: An acellular allogeneic dermal connective tissue matrix (AD) and autogenous palatal connective tissue (CT) were compared as subepithelial grafts for the treatment of gingival recession. Twenty-two patients with similar isolated gingival recession of > or = 2 mm on 2 separate teeth were treated with the subepithelial graft technique. Exposed roots were hand root planed only and, by random allocation, either a fitted AD or fitted CT graft was secured in place and covered by coronally positioned flaps. RESULTS: Mann Whitney U test analysis found the following changes at 6 months for AD and CT, respectively, compared to presurgical conditions: root coverage of 1.7 +/- 1.2 (65.9%) and 2.2 +/- 1.1 mm (74.1%) (both P<0.01), increase in keratinized tissue (KT) of 1.2 +/- 1.3 and 1.6 +/- 1.9 (both P<0.01), and an increase in gingival thickness with both; 83.2% of expected root coverage was obtained with AD and 88.6% with CT (P= 0.43). There were no significant differences between treatments for any parameter. Global assessments by clinicians and patients suggested a more esthetic clinical result with AD. CONCLUSIONS: These results suggest that acellular allogeneic dermal matrix may be a useful substitute for autogenous connective tissue grafts in root coverage procedures.

Adult↗
PubMed1998

Gingival recessions and noncarious cervical lesions: a soft and hard tissue challenge.

Gingival recessions and noncarious cervical lesions are frequent and closely related defects which can be successfully treated by mucogingival surgery and restorative therapy techniques either used alone or in combination depending on the defect characteristics. Proper treatment planning is guided by careful clinical diagnosis. A selection of treatment modalities are presented and useful hints proposed: the long term success is always strictly bound to the identification and elimination of the etiologic factors, to a correct treatment and a meticulous maintenance program.

Gingival Recession↗
PubMed2001

Long term results in the treatment of multiple gingival recessions.

Exposed root surfaces cause esthetic problems and hypersensitivity to thermal and tactile stimuli. Plastic surgical treatment solves these problems and yields good permanent results. The authors share their experience of the treatment of 30 patients with 186 gingival recessions localized in the lower and upper jaws, frontally and premolarly. The clinico-biometrical studies conducted over a period of 3 to 15 years showed a mean root coverage of 88.48% and in 17 patients the root coverage is 100%. The applied method can successfully deal with multiple gingival recessions in only two visits preserving the periodontium of the adjacent teeth. The surgical technique and the results of its application are illustrated by the results of well-documented cases.

Adolescent↗
PubMed2003

Comparative clinical study of connective tissue graft and two types of bioabsorbable barriers in the treatment of localized gingival recessions.

BACKGROUND: Localized buccal recessions occur in more than 60% of individuals; therefore, there is a need for predictable root coverage techniques. The objective of the present study was to evaluate the clinical effectiveness of the guided tissue regeneration (GTR) procedure versus connective tissue graft (CTG) in the treatment of localized gingival recessions over a 12-month postoperative period. METHODS: Thirty bilateral matched pairs of localized buccal recessions in 22 patients were treated with CTG and GTR in this study. For the GTR procedure, two types of bioabsorbable barriers, polylactide/polyglycolide acid (PLGA) and solvent dehydrated duramater allograft (SDDA) membranes, were used and CTG was obtained from the palatal mucosa. The selected pairs of teeth were randomly assigned to one of three groups (10 pairs per group): group 1, PLGA (10 recessions) or CTG (10 recessions); group 2, SDDA (10 recessions) or CTG (10 recessions); or group 3, PLGA (10 recessions) or SDDA (10 recessions). Statistical analysis evaluated both intra- and intergroup measurements. The height of gingival recession (GR), width of keratinized tissue (KT), clinical attachment level (CAL), and probing depth (PD) were assessed at baseline and at 6, 9, and 12 months following surgery. RESULTS: The amount of root coverage was 74.3%, 69.6%, and 86.3% with PLGA, SDDA, and CTG, respectively. The gain in KT was significant in the CTG group (P<0.05). No significant differences were observed among the three groups with respect to PD and CAL. CONCLUSIONS: Results of this study indicate that all techniques led to an improvement of all clinical parameters except PD from baseline. However, CTG increased KT considerably compared to GTR. The final esthetic results were similar for the two membranes and connective tissue graft.

Absorbable Implants↗
PubMed2002

Tongue piercing: impact of time and barbell stem length on lingual gingival recession and tooth chipping.

BACKGROUND: The increasing popularity of tongue piercing has prompted several case reports documenting oral complications of this practice. However, there are no studies assessing potentially significant parameters. The purpose of this study was to evaluate the effect of time (years of wear) and tongue barbell size (stem length) on gingival recession and tooth chipping. METHODS: Fifty-two adults (mean age 22) with tongue piercings were examined for gingival recession on the lingual aspect of the 12 anterior teeth and for tooth chipping anywhere in the mouth. Subjects were grouped according to years of wear (0 to 2, 2 to 4, and 4+ years) and barbell stem length (long > or =1.59 cm, or short <1.59 cm). Data analysis was based on binomial test and non-parametric tests. RESULTS: No subject with a tongue piercing <2 years (group 0-2) exhibited lingual recession or tooth chipping. Lingual recession was found on mandibular central incisors in 50% of subjects wearing long barbells for 2 or more years. Tooth chipping was found on molars and premolars in 47% of subjects with a tongue piercing for 4+ years. CONCLUSIONS: Tongue piercing is associated with lingual recession of mandibular anterior teeth and chipping of posterior teeth. Long-term use of a tongue barbell increases the prevalence of these complications. Barbell stem length appears to differentially affect prevalence of recession and chipping. Since the overwhelming majority of subjects with tongue piercings are young adults, cessation efforts are needed to target this population.

Adolescent↗
PubMed2002

Labial piercing resulting in gingival recession. A case series.

Several complications of oral piercing have been recently reported in the medical and dental literature. Even though few people have had problems related to oral piercing, dentists should familiarise themselves with the potential associated oral and dental problems. We present three cases of young people with gingival recession in the mandibular incisor area related to labial piercing. The clinical examination and the dental history of the three cases revealed the relationship between the gingival recession and the presence of labial piercing. In particular, a stud in the lower lip was held in place by a metal disk on the inner labial mucosa in each case. The metal disk was in close proximity to the mandibular front teeth and it would appear that it was responsible for local trauma and recession. This case series reinforces previously reported concerns regarding the practice of piercing and the role of the dentist, both in advising patients with oral or facial piercing and in the treatment of related oral, gingival and dental problems.

Adult↗