The comparison of modified semilunar technique in conjunction with connective tissue and subepithelial connective tissue graft for root coverage
A randomized controlled trial
Keywords:
Gingival recession, Autografting, Connective tissue, Subepithelial connective tissue graftAbstract
Background: Gingival recession may result in aesthetically unfavourable effects, difficulty in plaque control, increased susceptibility to root caries, and dentin hypersensitivity.
Objective: The aim of this study was to compare the use of modified semilunar techniques with connective tissue and subepithelial connective tissue grafts (Langer) for denuded root surface coverage.
Methods: In this randomized clinical trial, fourteen localized recessions of Miller class I to II were treated in 5 subjects. Recessions were randomly treated with modified semilunar techniques (test group) and a subepithelial connective tissue graft (control group). Clinical parameters such as clinical attachment level (CAL), keratinized tissue width (KTW), probing pocket depth (PPD), vertical recession depth (VRD) and recession width (RW)were recorded at base line, 1, 3 and 6 months after surgery and healing index and the subject's satisfaction was evaluated. The repeated measure test and paired-sample t-test were used for statistical analyses by SPSS.
Results: Both methods showed significant improvement in clinical parameters. The healing index (HI) in the test group was a slightly more than the control group in Day 10.Aesthetic VAS (Visual Analogue Scale) levels in the test group were more than the control group in 1, 3 and 6months (test group, in 1 month 6.57±1.13, in 3 month 7.86±1.07, in 6 month 8.00±0.81. control group in 1 month 5.57±1.13, in 3 month 7.00±1.00, in 6 month 7.14±0.90). The KTW, CAL, VRD and RW level’s difference in the test and control group was significant in 6 month compared to the base line (p=0.000).
Conclusions: The present study shows that treatment of Miller Class I and II gingival recession by the modified semilunar technique is acceptable.
Clinical trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT201512021760N43. Date registered: December 27, 2015.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
References
American Academy of Periodontology. Glossary of periodontal terms. 4th ed, American Academy of
Periodontology, Chicago, 44. 2001.
Henriques PS, Pelegrine AA, Nogueira AA, Borghi MM. Application of subepithelial connective tissue
graft with or without enamel matrix derivative for root coverage: a split-mouth randomized study. J Oral
Sci. 2010; 52(3): 463-71. doi: 10.2334/josnusd.52.463. PMID: 20881341.
Loe H, Anerud A, Boysen H. The natural history of periodontal disease in man: Prevalence, severity and
extent of gingival recession. J Periodontol. 1992; 63(6): 489-95. doi: 10.1902/jop.1992.63.6.489. PMID:
Edwards JG. The diastema, the frenum, the frenectemy: A clinical study. Am J Orthod. 1977; 71(5): 489- 508. doi: 10.1016/0002-9416(77)90001-X. PMID: 266363.
Coatoam GW, Behrents RG, Bissada NF. The width of keratinized gingiva during orthodontic treatment:
Its significance and impact on periodontal status. J Periodontol. 1981; 52(6): 307-13. doi:
1902/jop.1981.52.6.307. PMID: 6167704.
Boyd RL. Mucogingival considerations and their relationship to orthodontics. J Periodontol. 1978; 49(2):
-76. doi: 10.1902/jop.1978.49.2.67. PMID: 276594.
Lost C. Depth of alveolar dehiscences in relation to gingival recessions. J Clin Periodontol. 1984; 11(9):
-9. doi: 10.1111/j.1600-051X.1984.tb00911.x. PMID: 6593330.
Muller HP, Eqer T. Gingival phenotypes in young male adults. J Clin Periodontol. 1997; 24(1): 65-71. doi:
1111/j.1600-051X.1997.tb01186.x. PMID: 9049800.
Stetler KJ, Bissada NF. Significance of the width of keratinized gingiva on the periodontal status of teeth
with submarginal restorations. J Periodontol. 1987; 58(10): 696-700. doi: 10.1902/jop.1987.58.10.696.
PMID: 2444693.
American Academy of Periodontology. Glossary of Periodontal terms. 4th ed. Chicago: American
Academy of Periodontology. 2001; 49.
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(1): 30-43. doi:
1902/jop.1999.70.1.30. PMID: 10052768.
Lawrence HP, Hunt RJ, Beck JD. Three-year root caries incidence and risk modeling in older adults in
North Carolina. J Public Health Dent. 1995; 55(2): 69-78. doi: 10.1111/j.1752-7325.1995.tb02335.x.
PMID: 7643330.
Al-Wahadni A, Linden GJ. Dentine hypersensitivity in Jordanian dental attenders. A case control study. J
Clin Periodontol. 2002; 29(8): 688-93. doi: 10.1034/j.1600-051X.2002.290804.x. PMID: 12390564.
Tarnow DP. Semilunar Coronally Repositioned Flap. J Clin Periodontol. 1986; 13(3): 182-5. doi:
1111/j.1600-051X.1986.tb01456.x. PMID: 3457805.
Edel A. The use of free connective tissue graft to increase the width of attached gingiva. Oral Surg Oral
Med Oral Pathol. 1975; 39(3): 341-6. doi: 10.1016/0030-4220(75)90076-6. PMID: 1054133.
Nabers JM. Free gingival grafts. Periodontics. 1966; 4(5): 243-5. PMID: 5223124.
Sullivan HC, Atkins JH. Free autogenous gingival grafts. Principles of successful grafting. Periodontics.
; 6(3): 121-9. PMID: 5240496.
Bernimoulin JP, Luscher B, Muhlemann HR. Coronally repositioned periodontal flap. Clinical evaluation
after one year. J Clin Periodontol. 1975; 2(1): 1-13. doi: 10.1111/j.1600-051X.1975.tb01721.x. PMID:
Cohen DW, Ross SE. The double papillae repositioned flap in periodontal therapy. J Periodontol. 1968;
(2): 65-70. doi: 10.1902/jop.1968.39.2.65. PMID: 4870433.
Grupe HE. Modified technique for sliding flap operation. J Periodontol. 1966; 37(6): 491-5. doi:
1902/jop.1966.37.6.491. PMID: 5224017.
Grupe HE, Warren R. Repair of gingival defects by a sliding flap operation. J Periodontol. 1956; 27(2):
-5. doi: 10.1902/jop.1956.27.2.92.
Patur B. The rotation flap for covering denuded root surfaces: A closed wound technique. J Periodontol.
; 48(1): 41-4. doi: 10.1902/jop.1977.48.1.41. PMID: 264540.
Pennel BM, Higgason JD, Towner JD, King KO, Fritz BD, Salder JF. Oblique rotated flap. J Periodontol.
; 36: 305-9. doi: 10.1902/jop.1965.36.4.305. PMID: 14326697.
Restrepo OJ. Coronally repositioned flap: Report of 4 cases. J Periodontol. 1973; 44: 564-7. doi:
1902/jop.1973.44.9.564. PMID: 4518844.
Miller PD Jr. A classification of marginal tissue recession. Int J Periodont Rest Dent. 1985; 5(2): 8-13.
PMID: 3858267.
Newman MG, Takei HH, Klokkevold PR, Carranza FA. Carranza’s clinical periodontology. Elsevier.
; 11: 598.
Pandit N, Pandit IK, Bali D, Jindal S. Semilunar vestibular technique: A novel procedure for multiple
recession coverage (a report of two cases). J Indian Soc Periodontol. 2015; 19(6): 694-7. doi:
4103/0972-124X.162204. PMID: 26941524, PMCID: PMC4753718.
Landry RG TR, Howley T. Effectiveness of Benzydamine HCL in the treatment of periodontal post- surgical patients. Res Clinic Forums. 1988; 10: 105-18.
Haghighat K. Modified Semilunar Coronally Advanced Flap. J Periodontol. 2006; 77(7): 1274-9. doi:
1902/jop.2006.050426. PMID: 16805693.
Pai BS, Rajan SA, Padma R, Suragimath G, Annaji S, Kamath KV. Modified semilunar coronally advanced
flap: A case series. J Indian Soc Periodontol. 2013; 17(1): 124-7. doi: 10.4103/0972-124X.107488. PMID:
, PMCID: PMC3636932.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
