Patients’ morbidity and root coverage outcomes by means of coronally advanced flap and the application of sub-eptithelial connective tissue graft with different surgical procedures.

Abstract

Numerous surgical periodontal techniques have been introduced, over the years, to correct labial, gingival recessions defects. Aesthetic concerns are usually the reason to perform these procedures. The aim of this project was to evaluate by means of an image analysis system the efficacy of two different surgical procedures with and without the use of a subepithelial connective tissue graft for the treatment of miller class one and two maxillary gingival recession. Therefore the aim of the first study was to compare the effectiveness of root coverage with coronally advanced flap alone versus a connective tissue graft used in combination with a coronally advanced flap in the treatment of single gingival recessions by analyzing the data with an open source image-processing program. The result of this study showed better outcomes in terms of recession reduction after 12 months when the coronally advanced flap was combined with the connective tissue graft. Adjunctive application of a connective tissue graft under a coronally advanced flap increased the probability of achieving complete root coverage in maxillary Miller Class I and II defects (61.5% vs. 83.3%, p=0.38). The second article is a case demonstration of the benefit attained using the CAF+CTG in order to meet the patient’s needs and fulfilling the clinical outcomes. More recently, several authors have proposed the application of a connective tissue graft using a tunneling technique, which has recently gained popularity in periodontal mucogingival therapy. However, there is scarce data available regarding postoperative patient-centered outcomes after tunneling technique as compared to other surgical procedures for the treatment of gingival recession. The aim of the second randomizedcontrolled clinical trial was to compare the patient morbidity and root coverage outcomes 6 of a connective tissue graft used in combination with a coronally advanced flap or tunneling technique. Fifty patients completed the study. Healing was uneventful for all test and control patients. The connective tissue graft used in combination with a coronally advanced flap group reported less pain or discomfort in all four sections of the questionnaire: Pain experienced within the mouth as a whole, pain experienced throughout the day, pain experienced at night and edema experienced after the surgery (p=0.002, p=0.001, p=0.001 and p=0,001, respectively). Both treatments showed clinical efficacy in terms of root coverage as no differences per groups were observed in percentage of root coverage (87% vs. 85%, p=704) or patients with complete root coverage (60% vs. 52%, p=0.569). The tunneling technique is associated with a greater incidence of pain and discomfort compared to the connective tissue graft used in combination with a coronally advanced flap in early postoperative periods, as well as longer chair time. Both treatments showed similar clinical efficacy in terms of root coverage. The results of this study may influence the surgeon’s choice on which root coverage procedure perform considering the need of more chair time and more pain killer assumption with the tunnel technique.