A Modified Surgical Technique for Root Coverage With an Allograft: A 12-Month Randomized Clinical Trial
- Autores: Lauro G. Ayub, Umberto D. Ramos, Danilo M. Reino, Márcio F.M. Grisi, Mário Taba Jr., Sérgio L.S. Souza, Daniela B. Palioto, Arthur B. Novaes Jr.
- Localización: Journal of periodontology, ISSN 0022-3492, Vol. 85, Nº. 11, 2014, págs. 1529-1536
- Idioma: inglés
- Enlaces
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Resumen
Background: The aim of this randomized controlled clinical study is to investigate whether a modified surgical technique could provide better results for root coverage and greater amounts of keratinized tissue (KT) with the acellular dermal matrix graft (ADMG).
Methods: Fifteen bilateral Miller Class I or II gingival recessions (GRs) were selected. The recessions were treated and assigned randomly to the test group (TG), and the contralateral recessions were assigned to the control group (CG). The ADMG was used in both groups with differences in the graft positioning between them. The following clinical parameters were measured before the surgeries and after 12 months: 1) probing depth; 2) relative clinical attachment level; 3) GR; 4) thickness of KT (TKT); and 5) KT width. A new parameter, the GR area (GRA), was measured in standardized photographs using a special device and software.
Results: There was no significant difference between groups in KT width and TKT parameters at the 12-month postoperative period. However, there was a significant difference between the gains in GR (ΔGR) and GRA (ΔGRA), favoring the TG after 12 months. The TG presented ΔGR = 3.04 ± 0.29 mm and ΔGRA= 38,919 ± 9,238 pixel square values (pix2), and the CG presented ΔGR= 2.61 ± 0.41 mm and ΔGRA= 22,245 ± 9,334 pix2 (P <0.05 and <0.001, respectively).
Conclusions: Both techniques were successful. The TG treatment was more effective in reducing GR and GRA. The flap and graft position may be of importance in root coverage procedures outcome.
Treatment of exposed root surfaces, caused by the apical migration of the gingival margin over the cemento-enamel junction (CEJ), became an important therapeutic issue as a result of its perception by patients as an esthetic problem and its association with dentinal hypersensitivity. The main etiologic factor of gingival recessions (GRs) is inflammation,1 which can be induced by the accumulation of biofilm or by traumatic brushing, i.e., because the epidemiologic aspect of GR showed that populations with high standards of oral hygiene2,3 and populations with poor oral hygiene4,5 exhibit prevalence of ≈51%.6 Coronally advanced flaps associated with subepithelial connective tissue (CT) grafts are an effective treatment for root coverage,7 although it demands a second surgical area, increasing postoperative discomfort, and provides a limited amount of available donor tissue, resulting in increased patient resistance for this surgical procedure.8 The use of acellular dermal matrix graft (ADMG) was described extensively as a substitute for a subepithelial CT graft in periodontal plastic surgery that presents similar results with less morbidity.9-11 One of the main concerns in periodontal plastic surgery is primary closure with a tensionless flap to reduce postoperative graft exposure12 and enhance root coverage outcome.12,13 Avoiding graft exposure is essential when an avascular graft, such as ADMG, is used and may be of great importance to the root coverage outcome when using this matrix.13 The aim of this controlled randomized clinical trial (RCT) is to investigate whether a modified surgical technique could provide better results for root coverage and greater amounts of keratinized tissue (KT) with the ADMG based on the principle of increasing the availability of cells and blood vessels through the use of a broader flap and compensation of flap contraction by positioning the graft more apically and the flap more coronally than the technique used in the control group (CG).
