Journal of Periodontal and Implant Science

Korean Academy of Periodontology (대한치주과학회)
권호 표지
DOI QR코드

DOI QR Code

Root coverage with a modified laterally positioned flap combined with a subepithelial connective tissue graft in advanced recession

  • Lee, Chun-Teh (Division of Periodontology, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine) ;
  • Chang, Po-Chun (Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University) ;
  • Touchan, Nawar (Private Practice) ;
  • Royzman, Daniel (Division of Periodontics, Section of Oral and Diagnostic Sciences, College of Dental Medicine, Columbia University)
  • Received : 2014.10.18
  • Accepted : 2014.12.24
  • Published : 2014.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: A laterally positioned flap (LPF) combined with a subepithelial connective tissue graft (SCTG) is one of the conventional approaches for resolving gingival recession defects, with the advantages of flap flexibility and extended coverage of the tissue graft. However, thus far, evidence is lacking for the use of this technique for the treatment of advanced gingival recession defects. This report discusses three Miller class III cases with interproximal bone loss and wide and deep defects treated with a combination procedure of a modified laterally positioned flap (mLPF) and SCTG. Methods: mLPF combined with SCTG was performed for each case. The defect size and the degree of hypersensitivity at baseline and the final appointment in each case were documented. Results: The three cases had a mean initial defect of $7.7{\pm}1.5mm$ and a mean residual defect of $1.7{\pm}1mm$ at the 6-, 3-, and 36-month follow-up, respectively, after the root coverage surgery. The symptom of hypersensitivity was improved, and the patients were satisfied with the clinical outcomes. Conclusions: The results demonstrated that the combination of mLPF with SCTG is promising for treating these advanced cases with respect to obtaining the expected root coverage with the gingival tissue.

Keywords

References

  1. Albandar JM, Kingman A. Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999;70:30-43. https://doi.org/10.1902/jop.1999.70.1.30
  2. Wennstrom JL. Mucogingival therapy. Ann Periodontol 1996;1: 671-701. https://doi.org/10.1902/annals.1996.1.1.671
  3. Oates TW, Robinson M, Gunsolley JC. Surgical therapies for the treatment of gingival recession: a systematic review. Ann Periodontol 2003;8:303-20. https://doi.org/10.1902/annals.2003.8.1.303
  4. Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions: a systematic review. J Clin Periodontol 2014;41 Suppl 15: S44-62. https://doi.org/10.1111/jcpe.12182
  5. Harvey PM. Management of advanced periodontitis. I. Preliminary report of a method of surgical reconstruction. N Z Dent J 1965; 61:180-7.
  6. Grupe HE, Warren RF Jr. Repair of gingival defects by a sliding flap operation. J Periodontol 1956;27:92-5. https://doi.org/10.1902/jop.1956.27.2.92
  7. Nelson SW. The subpedicle connective tissue graft: a bilaminar reconstructive procedure for the coverage of denuded root surfaces. J Periodontol 1987;58:95-102. https://doi.org/10.1902/jop.1987.58.2.95
  8. Borghetti A, Louise F. Controlled clinical evaluation of the subpedicle connective tissue graft for the coverage of gingival recession. J Periodontol 1994;65:1107-12. https://doi.org/10.1902/jop.1994.65.12.1107
  9. Smukler H. Laterally positioned mucoperiosteal pedicle grafts in the treatment of denuded roots: a clinical and statistical study. J Periodontol 1976;47:590-5. https://doi.org/10.1902/jop.1976.47.10.590
  10. Caffesse RG, Guinard EA. Treatment of localized gingival recessions. Part IV. Results after three years. J Periodontol 1980;51: 167-70. https://doi.org/10.1902/jop.1980.51.3.167
  11. Caffesse RG, Alspach SR, Morrison EC, Burgett FG. Lateral sliding flaps with and without citric acid. Int J Periodontics Restorative Dent 1987;7:42-57.
  12. Zucchelli G, Cesari C, Amore C, Montebugnoli L, De Sanctis M. Laterally moved, coronally advanced flap: a modified surgical approach for isolated recession-type defects. J Periodontol 2004;75: 1734-41. https://doi.org/10.1902/jop.2004.75.12.1734
  13. Santana RB, Furtado MB, Mattos CM, de Mello Fonseca E, Dibart S. Clinical evaluation of single-stage advanced versus rotated flaps in the treatment of gingival recessions. J Periodontol 2010;81: 485-92. https://doi.org/10.1902/jop.2010.090237
  14. Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13.
  15. Cairo F, Cortellini P, Tonetti M, Nieri M, Mervelt J, Cincinelli S, et al. Coronally advanced flap with and without connective tissue graft for the treatment of single maxillary gingival recession with loss of inter-dental attachment. A randomized controlled clinical trial. J Clin Periodontol 2012;39:760-8. https://doi.org/10.1111/j.1600-051X.2012.01903.x
  16. Miller SC. Textbook of periodontia. Philadelphia: Blakiston Co.; 1938.
  17. Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. II. Clinical results. Int J Periodontics Restorative Dent 1994;14:302-15.
  18. Ricci G, Silvestri M, Rasperini G, Cattaneo V. Root coverage: a clinical/statistical comparison between subpedicle connective tissue graft and laterally positioned full thickness flaps. J Esthet Dent 1996;8:66-73. https://doi.org/10.1111/j.1708-8240.1996.tb00887.x
  19. Han JS, John V, Blanchard SB, Kowolik MJ, Eckert GJ. Changes in gingival dimensions following connective tissue grafts for root coverage: comparison of two procedures. J Periodontol 2008;79: 1346-54. https://doi.org/10.1902/jop.2008.070472
  20. Bouchard P, Malet J, Borghetti A. Decision-making in aesthetics: root coverage revisited. Periodontol 2000 2001;27:97-120. https://doi.org/10.1034/j.1600-0757.2001.027001097.x
  21. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol 1985;56:715-20. https://doi.org/10.1902/jop.1985.56.12.715
  22. Gordon HP, Sullivan HC, Atkins JH. Free autogenous gingival grafts. II. Supplemental findings: histology of the graft site. Periodontics 1968;6:130-3.
  23. Esteibar JR, Zorzano LA, Cundin EE, Blanco JD, Medina JR. Complete root coverage of Miller Class III recessions. Int J Periodontics Restorative Dent 2011;31:e1-7.
  24. Chambrone LA, Chambrone L. Treatment of Miller class I and II localized recession defects using laterally positioned flaps: a 24-month study. Am J Dent 2009;22:339-44.
  25. Zucchelli G, Marzadori M, Mele M, Stefanini M, Montebugnoli L. Root coverage in molar teeth: a comparative controlled randomized clinical trial. J Clin Periodontol 2012;39:1082-8. https://doi.org/10.1111/jcpe.12002
  26. Yilmaz E, Ozcelik O, Comert M, Ozturan S, Seydaoglu G, Teughels W, et al. Laser-assisted laterally positioned flap operation: a randomized controlled clinical trial. Photomed Laser Surg 2014;32: 67-74. https://doi.org/10.1089/pho.2013.3602

Cited by

  1. 상피하결합조직 이식을 동반한 측방변위 판막술을 통한 의원성 치은퇴축 치료 증례보고 vol.32, pp.4, 2014, https://doi.org/10.14368/jdras.2016.32.4.330
  2. Laterally positioned flap along with acellular dermal matrix graft in the management of maxillary localized recessions vol.23, pp.2, 2014, https://doi.org/10.1007/s00784-018-2475-1
  3. Lateral osteoperiosteal flap versus lateral pedicle flap in the treatment of class III gingival recession: A single-center, open-label trial vol.24, pp.5, 2020, https://doi.org/10.4103/jisp.jisp_489_19