Root-Coverage Procedures for the Treatment of Localized Recession-Type Defects: A Cochrane Systematic Review

Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil.
Journal of Periodontology (Impact Factor: 2.71). 04/2010; 81(4):452-78. DOI: 10.1902/jop.2010.090540
Source: PubMed


The purpose of this review is to evaluate the effectiveness of different root-coverage procedures in the treatment of recession-type defects.
The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for entries up to October 2008. There were no restrictions regarding publication status or the language of publication. Only clinical randomized controlled trials (RCTs) with a duration > or = 6 months that evaluated recession areas (Miller Class I or II > or = 3 mm) that were treated by means of periodontal plastic surgery procedures were included.
Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significantly greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTGs) compared to guided tissue regeneration (GTR) with bioabsorbable membranes (GTR bms). A significantly greater gain in keratinized tissue was found for enamel matrix protein compared to a coronally advanced flap (0.40 mm) and for SCTGs compared to GTR bms plus bone substitutes. Limited data exist on the changes of esthetic conditions as related to the opinions and preferences of patients for specific procedures.
SCTGs, coronally advanced flaps alone or associated with other biomaterial, and GTR may be used as root-coverage procedures for the treatment of localized recession-type defects. In cases where root coverage and gain in keratinized tissue are expected, the use of SCTGs seems to be more adequate.

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Available from: Leandro Chambrone
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    • "This goal can be predictably achieved by the proper use of surgical techniques, basically pedicle flaps (laterally or coronally positioned ) that cover the denuded root surface, with or without the concomitant use of an autograft (AG). Sev- eral systematic reviews have evaluated the efficacy of these procedures reporting percentages of complete root coverage ranging from between 35% and 97%, being the subepithelial connective tissue graft (SCTG) harvested from the patient's palatal mucosa, the surgical approach that provided the best outcomes (Chambrone et al. 2010). To avoid this second surgical site, pedicle flaps, mainly the coronally advanced flap (CAF) has been advocated . "
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    ABSTRACT: To review the biological processes of wound healing following periodontal and periimplant plastic surgery when different technologies are used in a) the coverage of root and implant dehiscences, b) the augmentation of keratinized tissue (KT) and c) the augmentation of soft tissue volume. An electronic search from The National Library of Medicine (MEDLINE-PubMed) was performed: English articles with research focus in oral soft tissue regeneration, providing histological outcomes, either from animal experimental studies or human biopsy material were included. Barrier membranes, enamel matrix derivatives, growth factors, allogeneic and xenogeneic soft tissue substitutes have been used in soft tissue regeneration demonstrating different degrees of regeneration. In root coverage, these technologies were able to improve new attachment, although none has shown complete regeneration. In KT augmentation, tissue-engineered allogenic products and xenogeneic collagen matrixes demonstrated integration within the host connective tissue and promotion of keratinization. In soft tissue augmentation and peri-implant plastic surgery there are no histological data currently available. Soft tissue substitues, growth differentiation factors demonstrated promising histological results in terms of soft tissue regeneration and keratinization, whereas there is a need for further studies to prove their added value in soft tissue augmentation.
    Full-text · Article · Apr 2014 · Journal Of Clinical Periodontology
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    • "Bilaminar procedure was demonstrated the most predictable root coverage surgical technique (Cairo et al. 2008, Chambrone et al. 2010) but very few studies have measured the size of the CTG used in combination with the CAF. Efforts have been made to improve palatal healing and to decrease patient morbidity by making first (Edel 1974) and then modifying (Bruno 1994, Hurzeler & Weng 1999, Lorenzana & Allen 2000) CTG harvesting techniques characterized by primary intention palatal wound healing. "
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    ABSTRACT: Aim: Primary aim of this study was to evaluate if patient morbidity was improved by diminishing graft thickness and height; secondary objective was to evaluate if such graft modifications influence root coverage and aesthetic outcomes. Methods: 60 Miller class I and II gingival recessions (GR) (≥ 3 mm in depth) were treated with the coronally advanced flap plus extraoral de-epithelialized free gingival graft (FGG). In 30 randomly selected control GRs ("big graft group"), the FGG thickness was ≥ 2 mm and the height was equal to bone dehiscence (BD); in the other 30 test defects ("small graft group"), the thickness of the FGG was <2 mm and the height was 4 mm. The post-operative patient morbidity was assessed 1 week after the surgery. The clinical and aesthetic evaluations were performed 1 year after the surgery. Results: Lower analgesic assumption, better post-operative course evaluations, better patient colour match scores and better periodontist aesthetic assessments were reported in the "small graft" group. No statistically significant differences were demonstrated between the two groups in terms of recession reduction, CRC and increase in KTH. Greater GT increase was obtained in the control-treated sites. Conclusions: Coronally advanced flap plus CTG of reduced thickness and height was associated with less patient morbidity, better aesthetic evaluations with no difference in RC outcomes.
    Full-text · Article · Apr 2014 · Journal Of Clinical Periodontology
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    • "The main indications for surgical root coverage to correct recession defects include the need to improve localized soft tissue esthetics, reduce hypersensitivity, improve plaque control, and prevent further progression of the recession defect (Saha and Bateman, 2008). Multiple surgical procedures such as coronally advanced flaps (CAFs), laterally positioned flaps (LPFs), free gingival grafts (FGGs), and subepithelial connective tissue grafts (SCTGs) appeared as novel approaches to achieve improvements in recession depth, clinical attachment level, and width of keratinized tissue (Chambrone et al., 2010). CAFs and LPFs are recommended if adequate keratinized tissue exists close to the recession defect (Patel et al., 2011). "
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    ABSTRACT: Complete root coverage is considered the true goal of treatment of gingival recession defects because only complete coverage assures recovery from the hypersensitivity and esthetic defects associated with recession areas. Previous studies have shown that the laterally positioned flap (LPF) technique or root surface biomodification yield a higher percentage of complete root coverage upon gingival recession treatment. This article highlights the use of the laterally positioned pedicle flap-revised technique (LPFRT) as a modification of the LPF technique, along with 24% EDTA gel as a root surface biomodification agent, in the management of localized gingival recession defects. Clinical examination revealed a Miller class II recession defect on the buccal aspect of the lower right central incisor, as well as the presence of aberrant frenum pull adjacent to the recession defect. The LPFRT, together with 24% EDTA gel, was speculated to cover the gingival recession defect. The frenectomy, along with periosteal fenestration, was planned simultaneously with LPFRT. After 6 months of therapy, the clinical condition was stable with complete root coverage and satisfactory healing of the gingival tissues at both the donor and recipient sites with no signs of inflammation.
    Preview · Article · Jan 2014 · Saudi Dental Journal
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