Systematic Review of Periodontal Plastic Surgery in the Treatment of Multiple Recession-Type ...

7/27/2019 Systematic Review of Periodontal Plastic Surgery in the Treatment of Multiple Recession-Type Defects

http://slidepdf.com/reader/full/systematic-review-of-periodontal-plastic-surgery-in-the-treatment-of-multiple 1/8

ClinicalP R a c t i c e

ContactAuthor

Systematic Review of Periodontal Plastic Surgeryin the Treatment of Multiple Recession-TypeDefects

Leandro Chambrone, DDS, MSD; Luiz A. Lima, DDS, MSD, PhD;

Francisco E. Pustiglioni, DDS, MSD, PhD; Luiz Armando Chambrone, DDS, MSD, PhD

ABSTRACT

Objectives:The objectives o this systematic review were (1) to evaluate results obtained

with dierent periodontal plastic surgery procedures in the treatment o multiple reces-sion-type deects and (2) to assess dierences in results rom randomized controlled

trials and other types o studies (i.e., controlled clinical trials and case series).

MaterialsandMethods:The MEDLINE, EMBASE and CENTRAL databases were searched

up to June 2008 to identiy randomized controlled trials, controlled clinical trials and

case series with a ollow-up period o at least 6 months or patients with multiple reces-

sion-type deects who were treated with periodontal plastic surgery.

Results:O 632 articles initially retrieved, only 16 were deemed suitable or more detailed

analysis. O these, only 4 case series met the inclusion criteria. Mean recession and clin-

ical attachment level decreased substantially rom baseline to fnal examination, and

probing depth also declined. Mean width o keratinized tissue increased. Mean root

coverage ranged rom 94% to 98% over the 4 studies, and complete root coverage was

achieved or 68% to 90% o patients in the 3 trials or which this variable was reported.Conclusions:Analysis o the limited inormation available in the dental literature showed

improvements in clinical parameters with all o the periodontal plastic surgery proced-

ures. Randomized controlled trials are needed to identiy the indications or each sur-

gical technique and any prognostic actors.

Dr. L. Chambrone

Email: [email protected]

In most adults, the root suraces o one or

more teeth may become exposed through

displacement o the gingival margin apical

to the cementoenamel junction1 (i.e., gingival

recession).2 Tis problem has various causes:

• anatomic conditions, including lack o at-

tached gingiva, muscular inserts near the

gingival margin,3,4 poor tooth alignment5

or inadequate thickness o the alveolar

bone plate and root prominences6

• acquired pathological conditions, such as

periodontitis7 or viral inection8

• iatrogenic actors, such as improper res-

torations invading the biological space9

• mechanical trauma, including trauma

associated with toothbrushing10 or lip

piercing.11

Gingival recession is a matter o concern

or both patients and dental proessionals, es-

pecially when exposure o the root surace

For citation purposes, the electronic version is the definitive version of this article: www.cda-adc.ca/jcda/vol-75/issue-3/203.html

JCDA•www.cda-adc.ca/jcda • April 2009, Vol. 75, No. 3 • 203

mailto:[email protected]





––– Chambrone –––

is linked to deterioration in esthetic appearance and

increase in dental hypersensitivity.11 raditionally, the

primary goals o periodontal therapy are to eliminate any

etiologic agents associated with inammatory disease

and to improve clinical parameters, such as clinical at-

tachment level and probing depth. In treating gingival

recession, attempts should be made to improve all clinicalparameters, especially clinical attachment level and root

sensitivity, i present. In a recent cross-sectional survey o

specialists in periodontics and general dentists,12 the pre-

dominant indication or root-coverage procedures was

esthetics (90.7% o respondents). O the available peri-

odontal plastic surgery (PPS) techniques, ree gingival

graing was generally the most avoured option, ollowed

by subepithelial connective tissue graing (SCG), cor-

onally advanced ap (CAF) and guided tissue regenera-

tion (with only a small group o the dentists preerring

the regeneration procedure).

During the past ew years, the eectiveness o PPSprocedures in the treatment o localized or multiple re-

cession-type deects (MRD) has been reported in sev-

eral trials. Studies testing dierent techniques, such as

CAF alone,13–16 SCG alone or in combination with ro-

tated or advanced aps,17–23 and guided tissue regenera-

tion,24–26 have demonstrated that surgical treatment o

exposed root suraces improves clinical attachment levels

and reduces gingival recession in most patients. Other

recent studies have suggested that the choice o treatment

or MRD involving 2 or more adjacent teeth may be

based on a variety o actors, such as anatomic structure,

anticipated level o discomort during healing, cost andneed or more than one surgical procedure to treat the

entire recession site.22,23

Recent extensive systematic reviews have ocused on

the eect o PPS procedures in treating localized gingival

recession.27–33 Te authors o these reviews ound descrip-

tions o a variety o surgical techniques and ap designs

used to correct localized gingival recession, all o which

yielded statistically signicant improvements in gingival

recession and clinical attachment level. Te authors also

recommended that SCG, CAF or guided tissue regener-

ation be used or root coverage in clinical practice.

However, these previous reviews27–31

had some lim-itations. For example, they included only English-

language publications. Moreover, some o the

reviews27–29,31 pooled all sources o evidence available

(randomized controlled clinical trials [RCs], controlled

clinical trials and case series), regardless o methodologic

quality. Some reviews28–31 did not report specic inclu-

sion criteria or types o deect (according to Miller’s

classication34), and some28–30 did not report a specic

ollow-up period. Finally, several o the reviews27–30 did

not report the use o acellular dermal matrix gras or

enamel matrix protein.

O these systematic reviews,27–33 4 included data only up to 2002,27–30 and none ocused specically on PPS pro-cedures in the treatment o MRD. As such, there is nocompilation o evidence-based inormation or this typeo deect.

Given the common occurrence o recession areas in-

volving adjacent teeth and the lack o inormation link ingthe results achieved to dierent surgical techniques, theobjectives o this systematic review were to evaluate theresults obtained with dierent root-coverage proceduresin the treatment o MRDs and to assess dierences inresults rom RCs and other types o studies (i.e., degreeo concordance in treatment eects between randomizedand nonrandomized groups).

MaterialsandMethods

Study Selection and Type of Intervention

Te study protocol used or this review was based on

that used or previous publications.32,33 Studies eligibleor inclusion in this review were RCs, controlled clin-ical trials and case series involving at least 10 patientsper group, with a ollow-up period o at least 6 months.Studies had to be limited to patients with a clinicaldiagnosis o gingival recession aecting adjacent teeth(i.e., recession areas selected or treatment classied asMiller34 Class I or Class II) who underwent PPS proced-ures (e.g., ree gingival graing; laterally positioned ap;CAF; SCG, alone or in combination with lateral or advanced aps; guided tissue regeneration; enamel matrixprotein; or acellular dermal matrix graing). Data rom

nonrandomized trials were pooled. rials that reporteddata or both localized and multiple recession areas wereexcluded.

Outcomes Measures and Search Strategy

Te outcome measures assessed were changes in gin-gival recession, clinical attachment level and keratinizedtissue, as well as percentage o patients with completeroot coverage and mean root coverage.

Te MEDLINE, EMBASE and Cochrane CentralRegister o Controlled rials (CENRAL) databases weresearched up to June 2008 with the ollowing MeSH terms,key words and other ree terms: GINGIVAL RECESSION

[single MeSH term], ((recession NEAR gingiva*) OR (recession NEAR deect*)) OR “recession-type de-ect*”, ((exposure NEAR root*) OR (exposed NEAR root*)), (gingiva* NEAR deect*), denude* NEAR “rootsurace*”, GUIDED ISSUE REGENERAION[exploded MeSH term], “tissue NEAR regenerat*,((gingiva* NEAR esthetic*) OR (gingiva* NEAR aes-thetic*)), periodont* AND “plastic surgery,” “so tissuegra*” OR “coronally advanced ap*,” “laterally pos-itioned ap*” OR “lateral ly-positioned ap*,” “connectivetissue gra*” OR “connective-tissue gra*,” gingiva*NEAR transplant*, “dermal matrix” NEAR grat*,

203a JCDA•www.cda-adc.ca/jcda • April 2009, Vol. 75, No. 3 •



––– Periodontal Plastic Surgery –––

“enamel matrix protein.” Boolean operators (OR, AND)

were used to combine searches. Papers published in any

language and any journal were considered. Te ollowing

journa ls were also searched by hand to include any

possible trial not retrieved by electronic search: Journal

o Periodontology , Journal o Per iodontal Research ,

Jour nal o Clinical Periodontology and International Journal o Periodontics and Restorative Dentistry .

Assessment of Validity and Methodologic Quality

wo independent reviewers (L.C. and L.A.C.) screened

the titles, abstracts and ull texts o the articles identi-

ed by searching. Disagreement between the reviewers

was resolved by discussion and consensus. I data were

missing, the authors o the original reports were con-

tacted and asked to provide urther details.

Te methodologic quality o the included studies was

assessed by consideration o the ollowing points and

questions:• Method o randomizat ion: (a) adequate, i random

number tables, coin toss or shufed cards were used

to assign treatments; (b) inadequate, i any other

method was used to assign treatments; (c) unclear,

i method o randomization was not reported or ex-

plained; or (d) not applicable (i.e., or trials without

randomization).

• Allocation concealment: (a) adequate, i examiners

were kept unaware o randomization sequence; (b)

inadequate, i allocation was not concealed; (c) un-

clear, i the method o allocation concealment was not

reported or explained; or (d) not applicable (i.e., ortrials without randomization).

• Completeness o the ollow-up period (yes/no re-

sponses): (a) Were equal numbers o patients present

at baseline and ollow-up? (b) Were all o the pa-

tients who entered the trial properly accounted or at

completion? (c) Did the statistical analysis include the

total number o patients enrolled in the study?

• Blinding o examiners with regard to the treatment

procedures used in the study period (yes/no response):

Were the examiners blinded?

In addition, risk o bias was categorized accordingto the ollowing classication: (a) low risk o bias

(i.e., plausible bias that is unlikely to seriously alter the

results) i all criteria were met (i.e., adequate methods

o randomization and allocation concealment and “yes”

answers to all questions about completeness o ollow-up

questions and blinding o examiners); (b) moderate risk

o bias (i.e., plausible bias that raises some doubt about

the results) i one or more criteria were partly met; or

(c) high risk o bias (plausible bias that seriously weakens

condence in the results) i one or more criteria were

not met.

Results

Search Results

A total o 632 titles o potentially relevant publica-tions was retrieved rom the databases. O these, 616 arti-cles were excluded aer review o the title and abstract.Te ull texts o the remaining 16 papers were reviewedin more detail. O these, 4 were considered appropriateor analysis. Te other 12 were excluded or the ollowingreasons: ewer than 10 patients per group,35–37 inclusiono patients with Miller34 Class III recession areas,38,39 data or postsurgical clinical parameters not availableor ollow-up period less than 6 months,40,41 surgical sitesnot presenting contiguous recessions (i.e., sites with norecession interposed between teeth with recession),42 in-clusion o localized gingival recessions43–45 or duplicatereporting.15

Te search strategy was designed to include all typeso evidence (RCs, controlled clinical trials and case

series), and one o the study objectives was to comparethe results rom RCs with those obtained in nonran-domized trials. However, the search did not yield any RCs that ocused exclusively on the treatment o MRD.Tereore, only nonrandomized trials were included inthe analysis (Table 1). Besides, trials that had incorpor-ated both localized and multiple recession areas wereexcluded.

Quality Assessment

For the trials included in the analysis, the numberso patients at baseline and at nal examination were

equal, all patients who entered each study were prop-erly accounted or at completion, and the statistical an-alysis included the total number o patients enrolled. Teollow-up periods ranged rom 6 to 60 months. However,the studies were not blinded, and none o the publicationswere randomized or controlled clinical trials. Tereore,all 4 studies were considered to be at high risk o bias.

Description of Studies

Data regarding changes in probing depth, percentageo root coverage, gain in keratinized gingiva and numbero sites with complete coverage are reported in Table 2.Te 4 case series described 4 dierent surgical proced-

ures: 1 described the use o CAF alone and 3 involved theuse o SCG with CAF. A total o 70 patients were treatedin the 4 studies, with the patient being the preerred unito analysis.

Coronally Advanced Flap

Only 1 trial was ound in which CAF was used ortreatment o MRD. Zucchelli and De Sanctis47 evalu-ated the eectiveness o a modied CAF technique orthe treatment o MRD in 22 patients with esthetic de-mands. At the 12-month ollow-up examination, meanroot coverage was 97%. O the 73 maxillary recessions

JCDA•www.cda-adc.ca/jcda • April 2009, Vol. 75, No. 3 • 203b




present at baseline, 64 (88%) were completely covered,

and complete root coverage was achieved in 16 (73%) o

the 22 patients. At the 60-month ollow-up evaluation,

94% o the exposed root suraces were still covered with

so tissues, and 15 (68%) o the 22 patients had complete

root coverage.

SCG with Coronally Advanced Flap

Te other 3 studies analyzed in this review evaluated

the use o SCG in association with CAF.

Te rst o these studies46 assessed the eective-

ness o expanded-mesh SCG in association with CAF.

Complete root coverage was achieved or 12 (80%) o 15

treated areas (in a total o 10 patients), with mean root

coverage o 96%.

Te second publication22 evaluated clinical results ob-

tained with SCG placed under a CAF or the treatment

o MRD in a sample o 28 pat ients, 14 o whom had max-illary sites o recession and 14 o whom had mandibular

sites. Mean root coverage rom baseline to 6 months

aer surgery was 96%, and complete root coverage was

achieved in 20 (71%) o the patients. Tis study had one

distinct dierence rom the other case series included

in this review — it was the only study that considered

maxillary and mandibular recession deects separately:

improvements in gingival recession were signicantly

better or patients with maxillary MRDs than or those

with mandibular MRDs. Moreover, mean root coverage

was 94% or the mandibular sites and 98% or the maxil-

lary sites, and the percentage o sites with complete rootcoverage was 57% (8/14) and 85% (12/14), respectively.

Te third trial23 reported the eectiveness and predict-ability o root coverage at adjacent sites o multiple gin-gival recessions using a modied coronally advanced ap15

associated with an SCG in a sample o 10 nonsmokingpatients. Te authors observed that this combination o techniques was eective and produced predictable rootcoverage in shallow deects (mean root coverage o 98%and complete root coverage in 90% o patients).

Data Analysis and Clinical Outcomes

Given the small number o publications and theheterogeneity o procedures reported (i.e., dierencesin ap design and type o graing), the study charac-teristics were considered too variable to allow data to becombined or meta-analysis. Tereore, the data rom the4 studies22,23,46,47 were tabulated (Table 2), and the results

considered in terms o mean values.Overall, mean recession (± standard deviation) de-

clined rom 2.95 ± 0.36 mm at baseline to 0.13 ± 0.03 mmat nal examination. Complete root coverage was achievedin 44 (73%) o the 60 patients (rom 3 studies22,23,47) withmultiple gingival recessions. Overall mean root coverageat the nal examination was 96%. Clinical attachmentlevel decreased rom 4.37 ± 0.32 mm at baseline to 1.49± 0.18 mm at the nal examination, and probing depthdecreased rom 1.45 ± 0.16 mm to 1.31 ± 0.20 mm. Meanwidth o keratinized tissue increased rom 2.43 ± 0.52 mmat baseline to 3.94 ± 0.41 mm at the nal examination.

Table1 Characteristics of included studies

Study Methods

Participantsand

reasonsfortreatment Outcomes Unitofanalysis

Çetiner and

others46

12-month university-based

case series: CAF +

expanded mesh SCG

10 patients, 23–48 years old;

reasons not reported

RD, PD, CAL,

K, CRC, MRC (in-

dividual patientdata reported)

Recession

Zucchelli and

De Sanctis47


case series: modied CAF

22 patients, 18–34 years

old; esthetics

RD, PD, CAL,

K, CRC, MRC (in-

dividual patient

data reported)

Patient

Chambrone and

Chambrone22

6-month practice-based case

series: CAF + SCG

or maxillary versus

mandibular sites, with

tetracycline


old; esthetics and dental

hypersensitivity

RD, PD, CAL, K,

CRC, MRC (indi-

vidua l pat ient data

reported)

Patient

Carvalho and

others23


case series: modied CAF +

SCG


old; reasons not reported

RD, PD, CAL, K,

CRC, MRC (aggre-

gated patient data

reported)

Patient

Note: CAF = coronally advanced ap, SCG = subepithelial connective tissue graf, RD = recession depth, PD = probing depth, CAL = clinical attachment le vel,K = keratinized tissue, CRC = complete root coverage, MRC = mean root coverage.

203c JCDA•www.cda-adc.ca/jcda • April 2009, Vol. 75, No. 3 •




Discussion

Several surgical procedures to correct mucogingival

problems and improve the esthetics o the patient’s smile

have been described in the dental literature. Te 4 studies

included in this review 22,23,46,47 recorded statistically sig-

nicant improvements or all clinical parameters except

probing depth (Table 2). Te best results were achieved

by Carvalho and others,23 but that study (along with the

study by Çetiner and others46), involved the smallest

number o patients (n = 10).

Data rom a variety o PPS procedures reviewed

by other authors12 showed root coverage ranging rom

60% to 84% in the treatment o localized gingival reces-

sions. In the systematic review reported here, mean root

coverage ranged rom 94% to 98%, and complete root

coverage ranged rom 68% to 90% o patients. Reporting

o initial recession depth rom all treated sites has been

recommended by Bouchard and others48 but was available

in only 3 o the trials analyzed here. 22,46,47 Although 3 o

the studies were conducted in a university setting and the

ourth was conducted in a private periodontal practice,

electronic probes and probing acrylic stents were not

used in any o the trials.

All o the studies included in this analysis had a

small number o patients, and each tested only one PPS

procedure (i.e., no control group). Moreover, no 2 studies

used the same surgical procedure. Tese dierences

among the studies may be explained by the diculty

in recruiting patients with similar deects or bilateral

MRD sites. Because o the limited number o studies

and the lack o RCs comparing dierent techniques,

it is dicult to recommend a particular PPS procedureor the treatment o MRD, and it is impossible to draw

conclusions about the superiority o one PPS procedure

over the others.

Te secondary objective o this review was to compare

the results achieved in RCs with those obtained in con-

trolled clinical trials and case series, but no RCs were

identied and this comparison could not be perormed.

Case series have serious methodologic aws, and their in-

clusion in a systematic review leads to very weak evidence

and adds little to general knowledge o a problem. Te

act that none o the studies identied or this study used

Table2 Changes in various outcomes from baseline to final measurement

Meanmeasurement(SD)

StudyRecession

depth(mm)Probingdepth

(mm)

Clinicalattachmentlevel(mm)

Keratinizedtissue(mm)

Meanrootcoverage(%)

%ofpatientswithcompleterootcoveragea

Çetiner andothers46

96 Not reportedb

Baseline 3.11 (0.80) 1.38 (0.52) 4.40 (0.86) 3.93 (0.72)

Final 0.11 (0.27) 1.13 (0.35) 1.18 (0.35) 5.11 (0.76)

Zucchelli and

De Sanctis47

94 68 (15/22)

Baseline 2.78 (1.13) 1.06 (0.26) 3.84 (1.20) 1.80 (0.86)

Final 0.22 (0.56) 1.07 (0.26) 1.29 (0.59) 3.18 (0.53)

Chambrone andChambrone22

96 71 (20/28)

Baseline 3.84 (1.50) 1.52 (0.47) 5.29 (1.30) 1.66 (1.09)

Final 0.14 (0.23) 1.12 (0.43) 1.52 (0.47) 3.82 (0.91)

Carvalho and

others23

98 90 (9/10)

Baseline 2.10 (0.82) 1.86 (0.74) 3.97 (1.02) 2.34 (1.47)

Final 0.07 (0.26) 1.93 (0.37) 2.00 (0.46) 3.65 (0.94)

Overall 96 73 (44/60)

Baseline 2.95 (0.36) 1.45 (0.16) 4.37 (0.32) 2.43 (0.52)

Final 0.13 (0.03) 1.31 (0.20) 1.49 (0.18) 3.94 (0.41)

SD = standard deviation.aWith raw data in parenthesis.

bTis study described t reatment o 15 sites in 10 patients, and complete root coverage was achieved or 12 (80%) o these 15 sites.

JCDA•www.cda-adc.ca/jcda • April 2009, Vol. 75, No. 3 • 203d




blinded assessment urther undermines the strength o the evidence. As such, the greatest strength o the currentpaper is its role in calling attention to the paucity o well-designed studies that properly evaluate PPS proceduresor the treatment o MRD. Tese results also emphasizethat RCs are needed to identiy the indications or each

surgical technique and their prognostic actors.wo o the studies identied in this review did not in-

clude smokers.22,23 Although mean root coverage and per-cent o patients with complete root coverage were similaror trials with and without smokers (Table 2), cigarettesmoking has been reported to aect the short- and long-term outcome o PPS procedures.49 Te patient’s smokingstatus should thereore be careully evaluated i surgicalcorrection o gingival recession is being considered.49–51

In 1 study, all treated suraces were conditioned withtetracycline solution during preparation o the site, whichis a orm o root demineralization.22 Te results achieved

with such root demineralization have been controversial.Exposed root suraces have been treated with a solutiono citric acid and tetracycline HCl to enhance the degreeo attachment o new connective tissue to previously de-nuded root suraces through exposure o collagen brils o the cementum or dentin between the root surace and thetransplanted gra.52–55 In contrast, some RCs have sug-gested no signicant clinical benet o root conditioningin conjunction with root-coverage procedures.56–58

In all 4 trials, patient selection was based on estheticconsiderations or dental hypersensitivity (or both), andtreatment was intended to prevent continuing develop-ment o gingival recession, root abrasion or root cariesand to improve hygiene (Table 1). Tis inormation sug-gests that patients’ concerns should be careully evaluatedbeore any surgical correction is planned, with particularattention to whether it is possible to achieve the patient’sdesires with the proposed treatment modality.

Consequently, beore perorming any PPS procedure,the dental proessional should select the most appropriatetechnique or each deect, to ensure that patients’ individual needs and complaints are addressed and to achievethe best esthetic and unctional results. Te selection o one PPS procedure rather than another or the treatmento MRD depends on a variety o actors, such as size o

the deect (length and width), width o keratinized tissueadjacent to the deect, number o adjacent teeth to betreated, amount o connective tissue available rom thedonor site, location o the MRD (mandibular or maxil-lary), depth o the vestibular ornix and mucogingivalphenotypes.19,22 Insucient studies are available to allow evaluation o the dierent PPS procedures, and well-designed RCs are needed to address these questions.he Consolidated Standards o Reporting rials(CONSOR) guidelines59,60 provide guidance on the ap-propriate design and reporting o clinical trials, to ensurethat readers understand the design, conduct, analysis

and interpretation o trials and can assess the validity o their results. Te CONSOR guidelines improve thetransparency and quality o reporting o RCs.60

Conclusions

Only limited inormation about the use o PPS or

MRD is available in the dental literature. Systematic review o this inormation led to the ol lowing conclusions:

• All o the PPS procedures evaluated (i.e., CAF aloneor in combination with SCG) led to improvementsin recession depth, clinical attachment level and widtho keratinized tissue.

• RCs are needed to identiy the indications or eachsurgical technique and possible prognostic actors.Te design and reporting o uture studies shouldtake into account the requirements o the CONSORstatements.

• Patients’ individual needs should be careu lly evalu-

ated beore surgical correction o MRD is planned,to ensure that their chie complaints can be resolved.

his review also yielded some general recom-mendations:

• I MRDs involve 2 or more teeth, each surgical siteshould be considered as a single unit, in terms o de-termining the extent o complete root coverage (i.e.,100% root coverage is recorded only i all adjacentteeth have adequate root coverage).

• Multicentre studies may be required to increase thenumber o patients and to achieve adequate statisticalpower. a

THE AUTHORS

Dr. L. Chambrone is a graduate student, division o peri-odontics, department o stomatology, School o Dentistry,University o São Paulo, São Paulo, Brazil.

Dr. Lima is an associate proessor, division o periodontics, department o stomatology, School o Dentistry, University o São Paulo, São Paulo,Brazil.

Dr. Pustiglione is a proessor and chair o the division o periodontics,department o stomatology, School o Dentistry, University o São Paulo,São Paulo, Brazil.

Dr. L.A. Chambrone is a proessor and chair o the disciplineo periodontics, aculty o dentistry, Methodist University o São Paulo, São Bernardo do Campo, Brazil.

Acknowledgements: Tis paper was reviewed by members o the CochraneOral Health Group.

Correspondence to: Dr. Leandro Chambrone, Disciplina de Periodontia,Departamento de Estomatologia, Faculdade de Odontologia, Universidadede São Paulo Av. Pro. Lineu Prestes, 2227 Cidade Universitária, 05508-000 São Paulo SP.

Te authors have no declared nancial interests.

Tis article has been peer reviewed.

203e JCDA•www.cda-adc.ca/jcda • April 2009, Vol. 75, No. 3 •




References1. American Academy of Periodontology. Glossary of periodontal terms. 4thed. Chicago: American Academy of Periodontology; 2001.

2. Susin C, Haas AN, Oppermann RV, Haugejorden O, Albandar JM. Gingivalrecession: epidemiology and risk indicators in a representative urban Brazilianpopulation. J Periodontol 2004; 75(10):1377–86.

3. Bruno JF. Connective tissue graft technique assuring wide root coverage.Int J Periodontics Restorative Dent 1994; 14(2):126–37.

4. Camargo PM, Melnick PR, Kenney EB. The use of free gingival grafts foraesthetic purposes. Periodontol 2000 2001; 27:72–96.

5. Stoner J, Mazdyasna S. Gingival recession in the lower incisor region of15-year-old subjects. J Periodontol 1980; 51(2):74–6.

6. Wennström JL, Zucchelli G. Increased gingival dimensions. A significantfactor for successful outcome of root coverage procedures? A 2-year pro-spective clinical study. J Clin Periodontol 1996; 23(8):770–7.

7. Yoneyama T, Okamoto H, Lindhe J. Sockransky SS, Haffajee AD. Probingdepth, attachment loss and gingival recession. Finding from a clinicalexamination in Ushiku, Japan. J Clin Periodontol 1988; 15(1):581–91.

8. Prato GP, Rotundo R, Magnani C, Ficarra G. Viral etiology of gingivalrecession. A case report. J Periodontol 2002; 73(1):110–4.

9. Parma-Benfenali S, Fugazzoto PA, Ruben MP. The effect of restorativemargins on the postsurgical development and nature of the periodontium.Part I. Int J Periodontics Restorative Dent 1985; 5(6):30–51.

10. Khocht A, Simon G, Person P, Denepitiya JL. Gingival recession in relationto history of hard toothbrush use. J Periodontol 1993; 64(9):900–5.

11. Chambrone L, Chambrone LA. Gingival recessions caused by lip piercing:case report. J Can Dent Assoc 2003; 69(2):505–8.

12. Zaher CA, Hachem J, Puhan MA, Mombelli A. Interest in periodon-tology and preferences for treatment of localized gingival recessions.

J Clin Periodontol 2005; 32(4):375–82.

13. Trombelli L, Scabbia A, Wikesjö UM, Calura G. Fibrin glue applica-tion in conjunction with tetracycline root conditioning and coronally pos-itioned flap procedure in the treatment of human gingival recession defect s.

J Clin Periodontol 1996; 23(9):861–7.

14. Modica F, Del Pizzo M, Roccuzzo M, Romagnoli R. Coronally advancedflap for the treatment of buccal gingival recessions with and without enamelmatrix derivative. A split-mouth study. J Periodontol 2000; 71(11):1693–8 .

15. Zucchelli G, De Sanctis M. Treatment of multiple recession-type defectsin patients with esthetic demands. J Periodontol 2000; 71(9):1506–14.

16. Pini Prato GP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C,and others. Coronally advanced flap: the post-surgical position of the gin-gival margin is an important factor for achieving complete root coverage.

J Periodontol 2005; 76(5):713–22.

17. Harris HJ. The connective tissue with partial thickness double pediclegraft: the results of 100 consecutively-treated defects. J Periodontol 1994;65(5):448–61.

18. Bouchard P, Etienne D, Ouhayoun JP, Nilvéus R. Subepithelial connectivetissue grafts in the treatment of gingival recessions. A comparative study of2 procedures. J Per iodontol 1994; 65(10):929–36.

19. Caffesse RG, De LaRosa M, Garza M, Munne-Travers A, Mondragon JC,Weltman R. Citric acid demineralization and subepithelial connective tissuegrafts. J Periodontol 2000; 71(4):568–72.

20. Vergara JA, Caffesse RG. Localized gingival recessions treated withthe original envelope technique: a report of 50 consecutive patients.

J Periodontol 2004; 75(10):1397–403.

21. Lee YM, Kim JY, Seol YJ, Lee YK, Ku Y, Rhyu IC, and others. A 3-year

longitudinal evaluation of subpedicle free connective tissue graft for gingivalrecession coverage. J Periodontol 2002; 73(12):1412–8.

22. Chambrone LA, Chambrone L. Subepithelial connective tissue graftsin the treatment of multiple recession-type defects. J Periodontol 2006;77(5):909–16.

23. Carvalho PF, da Silva RC, Cury PR, Joly JC. Modified coronally advancedflap associated with a subepithelial connective tissue graft for the treatmentof adjacent multiple gingival recessions. J Periodontol 2006; 77(11):1901–6.

24. Prato GP, Clauser C, Magnani C, Cortellini P. Resorbable mem-branes in the treatment of human buccal recession: a nine-case report. Int J Periodontics Restorative Dent 1995; 15(3):258–67.

25. Tatakis DN, Trombelli L. Gingival recession treatment: guided tissueregeneration with bioabsorbable membrane versus connective tissue graft.

J Periodontol 2000; 71(2):299–307.

26. Leknes KN, Amarante ES, Price DE, Boe OE, Skavland RJ, Lie T. Coronallypositioned flap procedures with or without a biodegradable membrane

in the treatment of human gingival recession. A 6-year follow-up study. J Clin Periodontol 2005; 32(5):518–29.

27. Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plasticsurgery for treatment of localized gingival recessions: a systematic review.

J Clin Periodontol 2002; 29 Suppl 3:178–94.

28. Pagliaro U, Nieri M, Franceschi D, Clauser C, Pini-Prato G. Evidence-based mucogingival therapy. Part 1: A critical review of the literature on rootcoverage procedures. J Periodontol 2003; 74(5):709–40.

29. Clauser C, Nieri M, Franceschi D, Pagliaro U, Pini-Prato G. Evidence-basedmucogingival therapy. Part 2: Ordinary and individual patient data meta-an-alyses of surgical treatment of recession using complete root coverage as theoutcome variable. J Periodontol 2003; 74(5):741–56.

30. Oates TW, Robinson M, Gunsolley JC. Surgical therapies for the treat-ment of gingival recession. A systematic review. Ann Periodontol 2003;8(1):303–20.

31. Hwang D, Wang HL. Flap thickness as a predictor of root coverage:a systematic review. J Periodontol 2006; 77(10):1625–34.

32. Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA.Can subepithelial connective tissue grafts be considered the gold standardprocedure in the treatment of Miller Class I and II recession-type defects?

J Dent 2008; 36(9):659–71.

33. Chambrone L, Sukekava F, Araujo MG, Pustiglioni FE, Chambrone LA,Lima LA. Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database Syst Rev 2009; Issue 2. In press.

34. Miller PD Jr. A classification of marginal tissue recession. Int J PeriodonticsRestorative Dent 1985; 5(2):8–13.

35. Tözüm TF, Dini FM. Treatment of adjacent gingival recessions withsubepithelial connective tissue grafts and the modified tunnel technique.Quintessence Int 2003; 34(1):7–13.

36. Haghighat K. Modified semilunar coronally advanced flap. J Periodontol 2006; 77(7):1274–79.

37. Dembowska E, Drozdzik A. Subepithelial connective tissue graft in thetreatment of multiple gingival recession. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104(3):e1–7.

38. Zabalegui I, Sicilia A, Cambra J, Gil J, Sanz M. Treatment of multipleadjacent gingival recessions with the tunnel subepithelial connectivetissue graft: a clinical report. Int J Periodontics Restorative Dent 1999;19(12):199–206.

39. Blanes RJ, Allen EP. The bilateral pedicle flap-tunnel technique: a newapproach to cover connective tissue grafts. Int J Periodontics RestorativeDent 1999; 19(5):471–9.

40. Allen AL. Use of the supraperiosteal envelope in soft tissue grafting forroot coverage. I. Rationale and technique. Int J Periodontics Restorative Dent 1994; 14(3):216–27.

41. Harris RJ, Miller LH, Harris CR, Miller RJ. A comparison of three tech-niques to obtain root coverage on mandibular incisors. J Periodontol 2005;76(10):1758–67.

42. Henderson RD, Greenwell H, Drisko C, Regennitter FJ, Lamb JW,Mehlbauer MJ, and others. Predictable multiple site root coverage using anacellular dermal matrix allograft. J Periodontol 2001; 72(5):571–82.

43. Tözüm TF, Keçeli HG, Güncü GN, Hatipoglu H, Sengun D. Treatment ofgingival recession: comparison of two techniques of subepithelial connectivetissue graft. J Periodontol 2005; 76(11):1842–8 .

44. Santos A, Goumenos G, Pascual A. Management of gingival recession bythe use of an acellular dermal graft material: a 12-case series. J Pe riodontol 2005; 76(11):1982–90.

45. Gupta R, Pandit N, Sharma M. Clinical evaluation of a bioresorbablemembrane (polyglactin 910) in the treatment of Miller type II gingival reces-sion. Int J Periodontics Restorative Dent 2006; 26(3):271–7.

46. Çetiner D, Bodur A, Uraz A. Expanded mesh connective graft for the treat-ment of multiple gingival recessions. J Periodontol 2004; 75(8):1167–72.

47. Zucchelli G, De Sanctis M. Long-term outcome following treatment ofmultiple Miller class I and II recession defects in esthetic areas of the mouth.

J Periodontol 2005; 76(12):2286–92.

48. Bouchard P, Malet J, Borguetti A. Decision-making in aesthetics: rootcoverage revisited. Periodontol 2000 2001; 27:97–120.

49. Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA. Theinfluence of tobacco smoking on the outcomes achieved by root coverage-procedures: a systematic review. J Am Dent Assoc 2009; 140(3):294–306.

50. Trombelli L, Scabbia A. Healing response of gingival recession de-fects following guided tissue regeneration procedures in smokers and non-smokers. J Clin Periodontol 1997; 24(8):529–33.

JCDA•www.cda-adc.ca/jcda • April 2009, Vol. 75, No. 3 • 203f




51. Martins AG, Andia DC, Sallum AW, Sallum EA, Casati MZ, Nociti JùniorFH. Smoking may affect root coverage outcome: a prospective clinical studyin humans. J Periodontol 2004; 75(4):586–91.

52. Trombelli L, Scabbia A, Zangari F, Griselli A, Wikesjö UM, Calura G.Effect of tetracycline HCl on periodontally-affected human root surfaces.

J Periodontol 1995; 66(8):685–91.

53. Madison JG 3rd, Hokett SD. The effects of different tetracyclines on thedentin root surface of instrumented, periodontally involved human teeth:

a comparative scanning electron microscope study. J Periodontol 1997;68(8):739–45.

54. Bergenholtz A, Babay N. Scanning electron microscopy of the rootsurface texture of extracted periodontally diseased teeth following variousetching and chelating regimens. Int J Periodontics Restorative Dent 1998;18(2):171–9.

55. Isik AG, Tarim B, Hafez AA, Yalcin FS, Onan U, Cox CF. A comparativescanning electron microscopic study on the characteristics of demineral-ized dentin root surface using different tetracycline HCl concentrations andapplication times. J Periodontol 2000; 71(2):219–25.

56. Bouchard P, Etienne D, Ouhayoun JP, Nilvéus R. Subepithelial connectivetissue grafts in the treatment of gingival recessions. A comparative study of2 procedures. J Periodontol 1994; 65(10):929–36.

57. Bouchard P, Nilveus R, Etienne D. Clinical evaluation of tetracycline HClconditioning in the treatment of gingival recessions. A comparative study.

J Periodontol 1997; 68(3):262–9.

58. Caffesse RG, De LaRosa M, Garza M, Munne-Travers A, Mondragon, JC,

Weltman R. Citric acid demineralization and subepithelial connective tissuegrafts. J Periodontol 2000; 71(4):568–72.

59. Consolidated Standards of Reporting Trials (CONSORT). CONSORTStatement. 2007 Oct 22. Available: www.consort-statement.org/index.aspx?o=1011.

60. Needleman I, Worthington H, Moher D, Schulz D, Altman DG. Improvingthe completeness and transparency of reports of randomized trials in oralhealth: The CONSORT Statement. Am J Dent 2008; 21(1):7–12.

203g JCDA•www.cda-adc.ca/jcda • April 2009, Vol. 75, No. 3 •

Systematic Review of Periodontal Plastic Surgery in the Treatment of Multiple Recession-Type ...

Documents

Transcript of Systematic Review of Periodontal Plastic Surgery in the Treatment of Multiple Recession-Type ...