The Effects of Vertically Coronally Advanced Flap and Free Gingival Graft Techniques on Shallow Vestibule: a Randomized Comparative Prospective Trial

Overview

Journal Clin Oral Investig

Specialty Dentistry

Date 2023 Oct 19

PMID 37855920

Authors

Hanife Merva Parlak

Birtan Tolga Yilmaz

Murat Haktan Durmaz

Havanur Toz

H Gencay Keceli

Affiliations

Soon will be listed here.

Abstract

Objectives: The present study aimed to compare the influence of vertically coronally advanced flap (V-CAF) and free gingival graft (FGG) techniques on shallow vestibule depth (VD).

Materials And Methods: Parallel-arm randomized clinical trial was conducted on 38 sites treated with either FGG or V-CAF. Periodontal variables (VD, recession depth and width, probing depth, clinical attachment level, keratinized tissue height (KTH), and tissue thickness (TT)), clinician- and patient-based subjective variables were assessed.

Results: All periodontal variables showed significant improvements in both groups at all follow-up intervals compared to baseline (p < 0.05). Both groups increased VD compared to baseline. RC and CRC were similar after treatment for both techniques. FGG provided a greater increase in KTH (p < 0.001) and VD (VD1, p = 0.02 and VD2, p < 0.001) while V-CAF exhibited more TT gain (p = 0.002). Except overall tissue appearance that was better in V-CAF (p < 0.001), no inter-group significant difference existed in patient-based variables.

Conclusions: Both techniques were significantly effective in VD increasing. While both techniques were equally successful in RC, V-CAF provided higher TT gain and better tissue appearance. V-CAF can be chosen instead of FGG in the treatment of recessions with shallow VD.

Clinical Relevance: It can be recommended to prefer V-CAF instead of FGG in the treatment of shallow vestibule.

Trial Registration Number: NCT05777811 (clinicaltrials.gov).

References

Cairo F . Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontol 2000. 2017; 75(1):296-316. DOI: 10.1111/prd.12186. View

Chambrone L, Tatakis D . Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol. 2015; 86(2 Suppl):S8-51. DOI: 10.1902/jop.2015.130674. View

Keceli H, Sengun D, Berberoglu A, Karabulut E . Use of platelet gel with connective tissue grafts for root coverage: a randomized-controlled trial. J Clin Periodontol. 2008; 35(3):255-62. DOI: 10.1111/j.1600-051X.2007.01181.x. View

Tozum T, Keceli H, Guncu G, Hatipoglu H, Sengun D . Treatment of gingival recession: comparison of two techniques of subepithelial connective tissue graft. J Periodontol. 2005; 76(11):1842-8. DOI: 10.1902/jop.2005.76.11.1842. View

Zucchelli G, Marzadori M, Mounssif I, Mazzotti C, Stefanini M . Coronally advanced flap + connective tissue graft techniques for the treatment of deep gingival recession in the lower incisors. A controlled randomized clinical trial. J Clin Periodontol. 2014; 41(8):806-13. DOI: 10.1111/jcpe.12269. View

Wennstrom J . Mucogingival therapy. Ann Periodontol. 1996; 1(1):671-701. DOI: 10.1902/annals.1996.1.1.671. View

Chambrone L, Botelho J, Machado V, Mascarenhas P, Mendes J, Avila-Ortiz G . Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? A systematic review and network meta-analysis. J Periodontol. 2022; 93(9):1336-1352. DOI: 10.1002/JPER.22-0167. View

Blasi G, Monje A, Munoz-Penalver J, Oates T, Avila-Ortiz G, Nart J . Influence of vestibular depth on the outcomes of root coverage therapy: A prospective case series study. J Periodontol. 2022; 93(12):1857-1866. DOI: 10.1002/JPER.21-0638. View

Bethaz N, Romano F, Ferrarotti F, Mariani G, Aimetti M . A mucogingival technique for the treatment of multiple recession defects in the mandibular anterior region: a case series with a 2-year follow-up. Int J Periodontics Restorative Dent. 2014; 34(3):345-52. DOI: 10.11607/prd.1920. View

10.

Stefanini M, Mounssif I, Marzadori M, Mazzotti C, Mele M, Zucchelli G . Vertically Coronally Advanced Flap (V-CAF) to Increase Vestibule Depth in Mandibular Incisors. Int J Periodontics Restorative Dent. 2021; 41(3):325-333. DOI: 10.11607/prd.4925. View

11.

Pini Prato G, Pagliaro U, Baldi C, Nieri M, Saletta D, Cairo F . Coronally advanced flap procedure for root coverage. Flap with tension versus flap without tension: a randomized controlled clinical study. J Periodontol. 2000; 71(2):188-201. DOI: 10.1902/jop.2000.71.2.188. View

12.

Schmitt C, Tudor C, Kiener K, Wehrhan F, Schmitt J, Eitner S . Vestibuloplasty: porcine collagen matrix versus free gingival graft: a clinical and histologic study. J Periodontol. 2012; 84(7):914-23. DOI: 10.1902/jop.2012.120084. View

13.

Melo L, Almeida A, Scarelli Lopes J, Rezende M, Neto J, Ciporkin F . A modified approach for vestibuloplasty in severely resorbed mandible using an implant-retained postoperative stent: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106(4):e7-14. DOI: 10.1016/j.tripleo.2008.05.029. View

14.

Schulz K, Altman D, Moher D . CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2011; 1(2):100-7. PMC: 3043330. DOI: 10.4103/0976-500X.72352. View

15.

Zuhr O, Rebele S, Vach K, Petsos H, Hurzeler M . Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 2-year results of an RCT using 3D digital measuring for volumetric comparison of gingival dimensions. J Clin Periodontol. 2020; 47(9):1144-1158. DOI: 10.1111/jcpe.13328. View

16.

Santamaria M, Neves F, Silveira C, Mathias I, Fernandes-Dias S, Jardini M . Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions: a randomized clinical trial. J Clin Periodontol. 2017; 44(5):540-547. DOI: 10.1111/jcpe.12714. View

17.

Halperin-Sternfeld M, Zigdon-Giladi H, Machtei E . The association between shallow vestibular depth and peri-implant parameters: a retrospective 6 years longitudinal study. J Clin Periodontol. 2016; 43(3):305-10. DOI: 10.1111/jcpe.12504. View

18.

Joly J, Carvalho A, da Silva R, Ciotti D, Cury P . Root coverage in isolated gingival recessions using autograft versus allograft: a pilot study. J Periodontol. 2007; 78(6):1017-22. DOI: 10.1902/jop.2007.060428. View

19.

Huang L, Neiva R, Soehren S, Giannobile W, Wang H . The effect of platelet-rich plasma on the coronally advanced flap root coverage procedure: a pilot human trial. J Periodontol. 2005; 76(10):1768-77. DOI: 10.1902/jop.2005.76.10.1768. View

20.

Yukna R, Evans G, Nasr H, Mayer E . Clinical evaluation of acellular allograft dermis for the treatment of human gingival recession. J Periodontol. 2001; 72(8):998-1005. DOI: 10.1902/jop.2001.72.8.998. View