The treatment of gingival recessions - Our experience

Chenchev, Ivan Lulchev; Atanasov, Dimitar Todorov; Vicheva, Dilyana

doi:10.1515/rjr-2016-0010

Abstract

OBJECTIVE. The purpose of this study was to compare the options for treatment of Miller’s Class I and Class II gingival recessions using coronally advanced flap (CAF) and platelet-rich fibrin membrane (PRFm) with CAF and connective tissue graft (CTG).

MATERIAL AND METHODS. A surgical treatment was carried out on 30 subjects (23 women and 7 men), with a total of 118 symmetrical recessions of Class I and Class II by Miller on different places of the jaws, using two different methods. On one side of the jaw was held a plastic covering of the recessions with CAF in combination with PRFm (test group), and on the other side – CAF in combination with connective tissue graft (control group). The clinical evaluation includes: gingival recession depth (GRD), probing pocket depth (PPD), clinical attachment level (CAL), keratinized gingival width (KGW), gingival thickness (GTH), mean percent of root coverage (RC %). The results were observed six months postoperatively.

RESULTS. The average values for the GRD measured six months postoperatively for the control group were 0.37±0.36 mm and 0.70±0.41 mm for the test group. The results for CAL for the control group were 2.01±0.44 mm and 2.28±0.50 mm for the test group, while the mean percentage of root coverage (RC %) was 90.29±9.05% for the control group and 80.48±10.19% for the test group. The values for GTH were 1.04±0.16mm for the control group and 0.92±0.09 mm for the test group.

CONCLUSION. Both compared methods show good results in terms of all evaluated parameters. The group treated with CAF + CTG showed better results with a statistically significant difference for the RC% and the average values for GRD, GTH and CAL. The results of our study demonstrate a good potential for PRFm used in the treatment of Miller’s Class I and Class II gingival recessions.

References

1. Baccini M., et al. - Advanced Flap (CAF) Plus Connective Tissue Graft (CTG) Is Gold Standard for Treatment of Miller Class I and Class II Gingival Defects. J Clin Periodontol., 2013;40(4):372-386.
Search in Google Scholar
2. Rotundo R., Pini-Prato G. - Use of New Collagen Matrix (Mucograft) for the Treatment of Multiple Gingival Recessins: Case Reports. Int J Periodontics Restorative Dent., 2012;32(4):413-419.
Search in Google Scholar
3. Anilkumar K., Geetha A., Umasudhakar, Ramakrishnan T., Vijayalakshmi R., Pameela E. - Platelet-rich-fibrin: A novel root coverage approach. J Indian Soc Periodontol., 2009;13(1):50-54.
Search in Google Scholar
4. Jankovic S., Aleksic Z., Milinkovic I., Dimitrijevic B. - The coronally advanced flap in combination with platelet-rich fibrin (PRF) and enamel matrix derivative in the treatment of gingival recession: a comparative study. Eur J Esthet Dent., 2010;5(3):260-273.
Search in Google Scholar
5. Aleksic Z., Jankovic S., Dimitrijevic B., Divnic-Resnik T., Milinkovic I., Lekovic V. - The use of platelet-rich fibrin membrane in gingival recession treatment. Srp Arh Celok Lek., 2010;138(1-2):11-18.10.2298/SARH1002011A
Search in Google Scholar
6. Del Corso M., Sammartino G., Dohan Ehrenfest D.M. - Re: „Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: a 6-month study“. J Periodontol., 2009;80(11):1694-1697;author reply 1697-9. doi: 10.1902/jop.2009.090253.10.1902/jop.2009.09025319905939
Search in Google Scholar
7. Gupta G., Puri K., Bansal M., Khatri M., Kumar A. - Platelet Rich Fibrin-Reinforced Vestibular Incision Subperiosteal Tunnel Access Technique for Recession Coverage. Clinical Advances in Periodontics, 2015;5(4):248-253. doi: 10.1902/cap.2014.140027.10.1902/cap.2014.140027
Search in Google Scholar
8. Uraz A., Sezgin Y., Yalim M., Taner I.L., Cetiner D. - Comparative evaluation of platelet-rich fibrin membrane and connective tissue graft in the treatment of multiple adjacent recession defects: A clinical study. Journal of Dental Sciences, 2013;10(1):36-45.10.1016/j.jds.2012.10.010
Search in Google Scholar
9. Dohan D.M., Choukroun J., Diss A., Dohan S.L., Mouhyi J., Gogly B. - Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part III: leucocyte activation: a new feature for platelet concentrates? Oral Surg Oral Med Oral Pathol Oral Radiol Endod., 2006;101(3):e51-55.
Search in Google Scholar
10. Dohan Ehrenfest D.M., Rasmusson L., Albrektsson T. - Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte-and platelet-rich fibrin (L-PRF). Trends Biotechnol., 2009;27(3):158-167. doi: 10.1016/j.tibtech.2008.11.009. Epub 2009 Jan.10.1016/j.tibtech.2008.11.00919187989
Search in Google Scholar
11. Dohan Ehrenfest D.M., de Peppo G.M., Doglioli P., Sammartino G. - Slow release of growth factors and thrombospondin-1 in Choukroun’s platelet-rich fibrin (PRF): a gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors, 2009;27(1):63-69. doi: 10.1080/08977190802636713.10.1080/0897719080263671319089687
Search in Google Scholar
12. Dohan Ehrenfest D.M. - How to optimize the preparation of leukocyte- and platelet-rich fibrin (L-PRF, Choukroun’s technique) clots and membranes: introducing the PRF Box. Oral Surg Oral Med Oral Pathol Oral Radiol Endod., 2010;110(3):275-278. author reply 278-280. doi: 10.1016/j.tripleo.2010.05.048.10.1016/j.tripleo.2010.05.04820727495
Search in Google Scholar
13. Saluja H., Dehane V., Mahindra U. - Platelet –rich fibrin: A second generation platelet concentrate and new friend of oral and maxillofacial surgeons. Ann Maxillofac Surg., 2011;1(1):53-57.
Search in Google Scholar
14. Zhao J.H., Tsai C.H., Chang Y.C. - Clinical and histologic evaluations of healing in an extraction socket filled with platelet-rich fibrin. J Dent Sci., 2011;6(2):116-122.
Search in Google Scholar
15. Chang Y.C., Wu K.C., Zhao J.H. - Clinical application of platelet-rich fibrin as the sole grafting material in periodontal intrabony defects. J Dent Sci., 2011;6(3):181-188.
Search in Google Scholar
16. Zhao J.H., Tsai C.H., Chang Y.C. - Management of radicular cysts using platelet-rich fibrin and bioactive glass: a report of two cases. J Formos Med Assoc., 2014;113(7):470-476.
Search in Google Scholar
17. Kim J.W., Kim S.L., Kim M.R. - Leucocyte-rich and platelet-rich fibrin for the treatment of bisphosphonate-related osteonecrosis of the jaw: a prospective feasibility study. Br J Oral Maxillofacial Surg., 2014;52(9):854-859.
Search in Google Scholar
18. Paolantonio M. - Treatment of gingival recessions by combined periodontal regenerative technique, guided tissue regeneration, and subpedicle connective tissue graft. A comparative clinical study. J Periodontol., 2002;73(1):53-62.10.1902/jop.2002.73.1.5311846201
Search in Google Scholar
19. Choukroun J., Adda F., Schoeffer C., Vervelle A. - PRF: an opportunity in perio-implantology (in French). Implantodontie., 2000;42:55-62.
Search in Google Scholar
20. Dohan D.M., Choukroun J., Diss A., Dohan S.L., Dohan A.J., Mouhyi J., Gogly B. - Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod., 2006;101(3):e37-44.
Search in Google Scholar
21. Hürzeler M.B., Weng D. - A single-incision technique to harvest subepithelial connective tissue grafts from the palate. Int J Periodontics Restorative Dent., 1999;19(3):279–287.
Search in Google Scholar
22. Liu C.L., Weisgold A.S. - Connective tissue graft: a classification for incision design from the palatal site and clinical case reports. Int J Periodontics Restorative Dent., 2002;22(4):373-379.
Search in Google Scholar
23. Pini-Prato G.P., Mieri M., Pagliaro U. Giorgi T.S., La Marca M., et al. - Surgical treatment of single gingival recessions: clinical guidelines. Eur J Oral Implantol., 2014;7(1):9-43.
Search in Google Scholar
24. Dridi S.M., Chousterman M., Danan M., Gaudy J.F. - Haemorrhagic risk when harvesting palatal connective tissue grafts: a reality? J Perio., 2008;5(4):231-240.
Search in Google Scholar
25. Aroca S., Keglevich T., Barbieri B. Gera I. Etienne D. - Clinical Evaluation of a Modified Coronally Advanced Flap Alone or in Combination With a Platelet-Rich Fibrin Membrane for the Treatment of Adjacent Multiple Gingival Recessions: A 6-Month Study. J Periodontol., 2009;80(2):244-252.
Search in Google Scholar
26. Padma R., Shilpa A., Kumar P.A., Nagasri M., Kumar C., Sreedhar A. - A split mouth randomized controlled study to evaluate the adjunctive effect of platelet-rich fibrin to coronally advanced flap in Miller’s class-I and II recession defect. J Indian Soc of Periodontol., 2013;17(5);631-636.10.4103/0972-124X.119281380801924174758
Search in Google Scholar
27. Thamaraiselvan M., Elavarasu S., Thangakumaran S., Gadagi J.S., Arthie T. - Comparative clinical evaluation of coronally advanced flap with or without platelet rich fibrin membrane in the treatment of gingival recession. J Indian Soc Periodontol. 2015;19(1):66-71.10.4103/0972-124X.145790436516125810596
Search in Google Scholar
28. Dohan D.M., Choukroun J., Diss A., Dohan S.L., Dohan A.J., Mouhyi J., Gogly B. - Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod., 2006;101(3):e45-50.
Search in Google Scholar
29. Dohan Ehrenfest D.M., Lemo N., Jimbo R., Sammartino G. - Selecting a relevant animal model for testing the in vivo effects of Choukroun’s platelet-rich fibrin (PRF): rabbit tricks and traps. Oral Surg Oral Med Oral Pathol Oral Radio Endod., 2010;110(4):413-416.
Search in Google Scholar
30. Jankovic S., Aleksic Z., Klokkevold P., Lekovic V., Dimitrijevic B., Kenney E.B., Camargo P. - Use of Platelet-Rich Fibrin Membrane Following Treatment of Gingival Recession: A Randomized Clinical Trial. Int J of Periodontics Restorative Dent., 2012;32(2):e41-e50.
Search in Google Scholar
31. Girouard M.E. - Root coverage comparing acellular dermal matrix to connective tissue graft using the coronally positioned tunnel technique. Canada, Qb, Montreal, 2011.
Search in Google Scholar
32. Harris R.J. - A comparison of 2 root coverage techniques: guided tissue regeneration with a bioabsorbable matrix style membrane versus a connective tissue graft combined with a coronally positioned pedicle graft without vertical incisions. Results of a series of consecutive cases. J Periodontol., 1998;69(12):1426-1434.10.1902/jop.1998.69.12.14269926774
Search in Google Scholar
33. Harris R.J., Miller L.H., Harris C.R., Miller R.J. - A comparison of three techniques to obtain root coverage on mandibular incisors. J Periodontol., 2005;76(10):1758-1767.
Search in Google Scholar

The treatment of gingival recessions - Our experience

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