Abstract
Objectives
This randomized controlled clinical trial with 1-year follow-up compared the clinical and aesthetic results of coronally advanced flap (CAF) + connective tissue graft (CTG) positioned apical to the cemento-enamel junction (CEJ) (CAF + CTG-ACEJ) with CAF + CTG positioned on the CEJ (CAF + CTG-CEJ) for treating isolated gingival recession defects.
Materials and methods
Thirty-eight patients with recession type 1 (RT 1) with a depth ≥ 3, gingival recessions were enrolled. Nineteen patients were randomly assigned to the CAF + CTG-ACEJ group or CAF + CTG-CEJ group. Clinical and aesthetical evaluations were made at 6 and 12 months.
Results
While the 6 months results showed that both surgical techniques were similar for clinical outcomes, the results achieved at the 6th month were more stable in the CAF + CTG-ACEJ group at the 12th month with significantly better recession depth, mean, and complete root coverage values and aesthetical results.
Conclusions
Isolated gingival recession defects can be clinically successfully treated by both CAF + CTG-ACEJ and CAF + CTG-CEJ techniques.
Clinical relevance
Limited studies have compared the clinical and aesthetical effects of positioning CTG apical to the CEJ for the treatment of gingival recessions. This randomized clinical study showed that CAF + CTG-ACEJ technique can provide additional benefit for the treatment. The described technique is effective in obtaining better long-term CRC stability and aesthetics.
Similar content being viewed by others
References
Cortellini P, Pini Prato G (2012) Coronally advanced flap and combination therapy for root coverage. Clinical strategies based on scientific evidence and clinical experience. Periodontology 2000 59:158–184
Cairo F, Pagliaro U, Nieri M (2008) Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol 35:136–162
Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA (2010) Root-coverage procedures for the treatment of localized recession-type defects: A Cochrane systematic review. J Periodontol 81:452–478
Cairo F, Nieri M, Pagliaro U (2014) Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 41:S44–S62
Zucchelli G, Tavelli L, McGuire MK, Rasperini G, Feinberg SE, Wang HL, Giannobile WV (2019) Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction. J Periodontol 91:9–16
Langer B, Langer L (1985) Subepithelial connective tissue graft technique for root coverage. J Periodontol 56:715–720
Prato GPP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C, Rotundo R, Muzzi L (2005) Coronally advanced flap: The post-surgical position of the gingival margin is an important factor for achieving complete root coverage. J Periodontol 76:713–722
Cairo F, Rotundo R, Miller PD Jr, Pini Prato GP (2009) Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol 80:705–710
Langer B (1982) The subepithelial connective tissue graft. A new approach to the enhancement of anterior cosmetics. Int J Periodontics Restorative Dent 2:22–33
Zucchelli G, Mounssif I, Mazzotti C, Montebugnoli L, Sangiorgi M, Mele M, Stefanini M (2014) Does the dimension of the graft influence patient morbidity and root coverage outcomes? A randomized controlled clinical trial. J Clin Periodontol 41:708–716
Zuhr O, Bäumer D, Hürzeler M (2014) The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 41:S123–S142
Bouchard P, Malet J, Borghetti AJP (2001) Decision-making in aesthetics: root coverage revisited 27:97–120
Cairo F, Nieri M, Pagliaro UJJocp, (2014) Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review 41:S44–S62
Bouchard P (2000) Malet J and Borghetti A (2001) Decision-making in aesthetics: root coverage revisited. Periodontol 27:97–120
Zucchelli G, Amore C, Sforza N, Montebugnoli L, De Sanctis M (2003) Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study. J Clin Periodontol 30:862–870
Raetzke PB (1985) Covering localized areas of root exposure employing the “envelope” technique. J Periodontol 56:397–402
Zucchelli G, Mounssif I (2015) Periodontal plastic surgery. Periodontol 2000(68):333–368
Allen AL (1994) Use of the supraperiosteal envelope in soft tissue grafting for root coverage. II. Clinical results. Int J Periodontics Restorative Dent 14:216–227
Nelson SW (1987) The subpedicle connective tissue graft. J Periodontol 58:95–102
Bruno JF (1994) Connective tissue graft technique assuring wide root coverage. Int J Periodontics Restorative Dent 14:126–137
Wennström JL, Zucchelli G (1996) Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study. J Clin Periodontol 23:770–777
Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U (2011) The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 38:661–666
Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M (2009) Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol 80:1083–1094
Zucchelli G, Mele M, Stefanini M, Mazzotti C, Mounssif I, Marzadori M, Montebugnoli L (2010) Predetermination of root coverage. J Periodontol 81:1019–1026
Ozcelik O, Seydaoglu G, Haytac CM (2016) Diode laser for harvesting de-epithelialized palatal graft in the treatment of gingival recession defects: a randomized clinical trial. J Clin Periodontol 43:63–71
Ucak Turer O, Ozcan M, Alkaya B, Surmeli S, Seydaoglu G, Haytac MC (2019) Clinical evaluation of injectable platelet-rich fibrin with connective tissue graft for the treatment of deep gingival recession defects: a controlled randomized clinical trial. J Clin Periodontol 47:72–80
Fernandes-Dias SB, de Marco AC, Santamaria M Jr, Kerbauy WD, Jardini MA, Santamaria MP (2015) Connective tissue graft associated or not with low laser therapy to treat gingival recession: randomized clinical trial. J Clin Periodontol 42:54–61
Kerner S, Sarfati A, Katsahian S, Jaumet V, Micheau C, Mora F, Monnet-Corti V, Bouchard P (2009) Qualitative cosmetic evaluation after root-coverage procedures. J Periodontol 80:41–47
Zucchelli G, Mounssif I, Mazzotti C, Montebugnoli L, Sangiorgi M, Mele M, Stefanini MJJocp (2014) Does the dimension of the graft influence patient morbidity and root coverage outcomes? A randomized controlled clinical trial. 41:708–716
Kisch J, Badersten A, Egelberg J (1986) Longitudinal observation of “unattached”, mobile gingival areas. J Clin Periodontol 13:131–134
Graziani F, Tsakos G (2000) (2020) Patient-based outcomes and quality of life. Periodontol 83:277–294
Funding
This research was conducted by the investigators who independently performed all phases of the study, including protocol development, clinical procedures, data analysis, result interpretation, and reporting. The study was self-funded.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Turer, O.U., Ozcan, M., Alkaya, B. et al. The effects of connective tissue graft position on clinical and aesthetical outcomes of gingival recession treatment: a controlled randomized clinical trial. Clin Oral Invest 26, 2751–2759 (2022). https://doi.org/10.1007/s00784-021-04250-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-021-04250-7