Surgical Treatment for Gingival Recessions After Orthodontic Treatment

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• Gingival Recession 426

Gingival Recession

426 studies on the registry are indexed under Gingival Recession; 106 are open to participants now.

This study's planned enrollment of 75 is above the median of 30 across 390 interventional studies indexed under Gingival Recession.

Lead sponsor

Aziz Aliyev Azerbaijan State Advanced Training Institute for Doctors is the lead sponsor of 2 studies on the registry; 1 is open to participants now.

Study arms

• Active comparator
  Group I: Coronally advanced flap and a de-epithelialized soft tissue graft.

  Patients in Group I who have completed orthodontic treatment will receive a coronally advanced flap and a de-epithelialized soft tissue graft to modify the periodontal soft tissue phenotype and cover exposed root surfaces caused by gingival recession.Evaluation of the effectiveness of coronally advanced flap combined with a de-epithelialized soft tissue graft in the management of multiple gingival recessions (Cairo classification RT1 and RT2 ≥ 2 mm).

  Procedure: Coronally advanced flap and a de-epithelialized soft tissue graft

• Active comparator
  Coronally advanced flap and a subepithelial connective tissue graft.

  Patients in Group II will receive a coronally advanced flap and a subepithelial connective tissue graft for the same purpose. Evaluation of the effectiveness of coronally advanced flap combined with a subepithelial connective tissue graft in the management of multiple gingival recessions (Cairo classification RT1 and RT2 ≥ 2 mm).

  Procedure: Coronally advanced flap and a subepithelial connective tissue graft

• Experimental
  Coronally advanced flap and Mucoderm soft tissue collagen graft.

  Patients in Group III will receive a coronally advanced flap and a Mucoderm soft tissue collagen graft. Evaluation of the effectiveness of coronally advanced flap combined with a Mucoderm soft tissue collagen graft in the management of multiple gingival recessions (Cairo classification RT1 and RT2 ≥ 2 mm). In all three groups, surgical interventions will be performed after completion of orthodontic treatment. Gingival thickness will be evaluated before treatment and at 6 and 12 months postoperatively. Root coverage, esthetic parameters, and patient satisfaction will be assessed 12 months after treatment.

  Procedure: Coronally advanced flap and Mucoderm soft tissue collagen graft

Interventions

• ProcedureCoronally advanced flap and a de-epithelialized soft tissue graft

  Evaluation of the effectiveness of coronally advanced flap combined with a de-epithelialized soft tissue graft in the management of multiple gingival recessions (Cairo classification RT1 and RT2 ≥ 2 mm).

• ProcedureCoronally advanced flap and a subepithelial connective tissue graft

  Evaluation of the effectiveness of coronally advanced flap combined with a subepithelial connective tissue graft in the management of multiple gingival recessions (Cairo classification RT1 and RT2 ≥ 2 mm).

• ProcedureCoronally advanced flap and Mucoderm soft tissue collagen graft

  Evaluation of the effectiveness of coronally advanced flap combined with a Mucoderm soft tissue collagen graft in the management of multiple gingival recessions (Cairo classification RT1 and RT2 ≥ 2 mm).

Primary outcomes

1. Complete root coverage (CRC)

   Complete defect coverage was calculated as the percentage of patients with defects having complete coverage achieved as the gingival margin at cemento-enamel junction or coronal level.

   Time frame: 12 months

2. Root coverage esthetic score (RES)

   Root coverage esthetic score (RES) was used as a scoring system to assess the esthetic outcomes following root coverage procedures on Miller Class I \& II gingival recession defects through the evaluation of clinical cases. Gingival margin level, marginal tissue contour, soft tissue texture, mucogingival junction alignment and gingival color were evaluated without magnification. Zero, 3 and 6 points were used for the evaluation of the position of the gingival margin, whereas a score 0 or 1 point was used for each of the other variables.

   Time frame: 12 months

3. Mean root coverage

   Mean root coverage refers to the average amount of exposed tooth root that becomes covered again by gum tissue after periodontal treatment for gum recession, calculated as a percentage or millimeters. It is used to evaluate how successful the treatment is in restoring gum coverage, improving aesthetics, and protecting the root surface.

   Time frame: 12 months

4. Patient satisfaction score

   Each patient was questioned about his/her satisfaction with regard to the following patient-centered criteria: Root coverage attained, relief from dentinal hypersensitivity, color of gums, shape and contour of gums, surgical procedure in terms of pain during surgery and the discomfort experienced related to the duration of the procedure and handling by the operator, post surgical phase in terms of the pain, swelling, and postoperative complications; and cost effectiveness in terms of the time and money spent for the treatment. Patient satisfaction was assessed using a three-point rating scale: fully satisfied (3 points); satisfied (2 points); and unsatisfied (1 point).

   Time frame: 12 months

Secondary outcomes

1. Plaque Index

   Teeth were isolated by cotton rolls and after drying by air syringe, the microbial dental plaque was evaluated by the explorer from 4 tooth surfaces (mesio-buccal, mid-buccal, disto-buccal and mid-palatinal) and scores between 0- 3 were given for each point. Scoring was made as follows: 0 - No microbial dental plaque in the gingival area 1. \- A film of microbial dental plaque adhering to the free gingival margin and adjacent area of the tooth, recognized only by running a probe across the tooth surfaces. 2. \- Moderate accumulation of soft deposits within the gingival pocket and on the gingival margin and/or adjacent tooth surfaces that can be seen by the naked eye. 3. \- Abundance of soft matter within the gingival pocket and/or on the gingival margin and adjacent tooth surface.

   Time frame: 12 months

2. Gingival Index

   The periodontal probe was used to assess the bleeding potential of the tissues from 4 tooth surfaces (mesio-buccal papilla, mid-buccal margin, disto- buccal papilla and mid-palatinal margin) and scores between 0 - 3 were given for each point. Scoring was made as follows: 0 - Normal gingiva 1. \- Mild inflammation, slight change in color, slight edema; no bleeding on probing (BoP) 2. \- Moderate inflammation, redness, edema, and glazing; bleeding on probing 3. \- Severe inflammation, marked redness and edema, ulcerations; tendency to spontaneous bleeding.

   Time frame: 12 months

3. Bleeding on Probing

   The periodontal probe was used to assess the percentage of bleeding after probing from 4 tooth surfaces (mesio-buccal papilla, mid-buccal margin, disto-buccal papilla and mid-palatinal margin) and scored as positive (+) or negative (-) bleeding for each point.

   Time frame: 12 months

4. Probing Depth

   Probing Depth of the recession defect was measured in mm by the periodontal probe at the mid buccal surface of the related tooth as the distance between the gingival margin and the bottom of the gingival sulcus.

   Time frame: 12 months

5. Clinical Attachment Level

   Clinical Attachment Level of the recession defect was measured in mm by the periodontal probe at the mid-buccal surface of the related tooth and it was defined as the distance between the cemento-enamel junction and the bottom of the gingival sulcus

   Time frame: 12 months

6. Recession Depth

   Recession Depth was measured in mm by the periodontal probe at the mid-buccal surface of the related tooth as the distance between the cemento-enamel junction and the most apical point of the gingival margin

   Time frame: 12 months

7. Recession Width

   Recession Width of the defect was measured in mm by the periodontal probe as the horizontal distance from one border of the recession to another in mesio-distal direction at the level of the cemento-enamel junction

   Time frame: 12 months

8. Gingival Thickness

   Gingival Thickness was measured in mm at the mid-point location between the gingival margin and mucogingival junction, using an #25 endodontic spreader. Under the local anesthesia, the spreader was pierced perpendicularly to the mucosal surface, through the soft tissue with light pressure until hard surface was felt. The silicone disk stop was placed in tight contact with the external soft tissue surface. After carefully removing the spreader, penetration depth was measured with a digital caliper5 with 0.05 resolution.

   Time frame: 12 months

9. Keratinized Tissue Width

   Keratinized Tissue Width of the recession defect was measured in mm by the periodontal probe at the same point as the probing depth, clinical attachment level and recession depth.

   Time frame: 12 months

10. Oral Health Impact Profile-14 (OHIP-14)

    Each patient was questioned about his/her satisfaction with regard to the following patient-centered criteria: Functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, handicap Each question is usually scored on a 5-point Likert scale: 0 - Never 1. \- Hardly ever 2. \- Occasionally 3. \- Fairly often 4. \- Very often Sum all 14 item scores. Total range: 0-56 Higher scores = poorer oral health-related quality of life 0-14: little or no impact 15-28: moderate impact 29-42: substantial impact 43-56: severe impact

    Time frame: 12 months