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Title Connective Tissue Grafting and Guided Tissue Regeneration Procedures Restore Root Coverage with Long Term Stability
Clinical Question In patients presenting with gingival recession, is connective tissue graft (CTG) more effective than guided tissue regeneration (GTR) in restoring root coverage (RC) 1 year post surgery?
Clinical Bottom Line Both connective tissue grafting and guided tissue regeneration exhibited similar levels of root coverage restoration 18 months post surgery. However, connective tissue grafting resulted in better root coverage stability 10 years post surgery. Both treatments are well within the realm of routine periodontal surgery and may be acceptable to patients presenting with gingival recession.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 11022773Rosetti/200024 defects in 12 patients presenting with canine or premolar bilateral gingival recessionRandomized Controlled Trial
Key resultsWhen comparing the two procedures, CTG and GTR (with a bioabsorbable collagen membrane and a bone graft material) exhibited various results in terms of gingival recession height, probing depth, keratinized tissue width, and esthetics. However at 18 months post surgery, both procedures were statistically similar in root coverage (CTG = 95.6%, GTR = 84.2%, P= 0.073).
#2) 20450359Nickles/20109 patients (24 recession defects) 10 years post CTG or GTR surgeryRandomized Controlled Trial
Key resultsFrom the patients who were available for re-examination 10 years post CTG or GTR (with bioabsorbable polylactide acetyltributyl citrate barriers) procedures, the stability of root coverage was significantly better post CTG surgery than post GTR surgery (P = 0.002).
Evidence Search (("guided tissue regeneration"[MeSH Terms] OR ("guided"[All Fields] AND "tissue"[All Fields] AND "regeneration"[All Fields]) OR "guided tissue regeneration"[All Fields]) AND ("connective tissue"[MeSH Terms] OR ("connective"[All Fields] AND "tissue"[All Fields]) OR "connective tissue"[All Fields]) AND ("transplants"[MeSH Terms] OR "transplants"[All Fields] OR "graft"[All Fields]) AND ("plant roots"[MeSH Terms] OR ("plant"[All Fields] AND "roots"[All Fields]) OR "plant roots"[All Fields] OR "root"[All Fields]) AND ("AHIP Cover"[Journal] OR "coverage"[All Fields])) AND Clinical Trial[ptyp]
Comments on
The Evidence
The study conducted by Rosetti et al was a randomized controlled trial. The patients were all non-smokers and presented with good general and periodontal health. Each patient had canines and premolars presenting with Miller Class I and II bilateral recessions of at least 3 mm. Recession that does not extend to the mucogingival junction with no periodontal bone loss in the interdental areas is known as Miller Class I recession. On the other hand, recession that extends to or beyond the mucovgingival junction with no interdental bone loss is known as Miller Class II recession. In this study, there was only one patient group. Each patient acted as his or her own control (split mouth design). There was one blinded examiner who did not know the treatment modality and was calibrated. This particular study had an 18-month adequate follow-up so moderate conclusions were made concerning the long-term effects on root coverage of these treatments. The study conducted by Nickles et al was a randomized control trial with 15 patients presenting with Miller I and II recessions as well. Similar to the other study, the examiner was blinded to the treatment and calibrated. After 10 years, the scientists reexamined available patients. Only 9 of the 15 patients were reexamined so they had less than 80% completion rate. However, a 10-year follow up is very long, so even though the sample numbers are low, it is a great study design. They did have adequate follow-up allowing them to make solid conclusions about the long-term effects of these two procedures. The issue of compliance for both studies was not directly addressed. It is also important to note that each study used a different barrier material for GTR but both were bioabsorbable.
Applicability These findings are clinically relevant for periodontists and general dentists who are treatment planning and performing surgeries for patients presenting with gingival recession. However, these studies were performed on canines and premolars for Miller Class I and II recessions. Therefore, application of results may be limited when treating gingival recession associated with central incisors, lateral incisors and molars.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Gingival recession; connective tissue graft (CTG); guided tissue regeneration (GTR); root coverage
ID# 3012
Date of submission: 03/18/2016spacer
E-mail Vipulanandan@livemail.uthscsa.edu
Author Geethanjali Vipulanandan
Co-author(s) e-mail
Faculty mentor/Co-author Yong-Hee Patricia Chun, DDS, MS, PhD
Faculty mentor/Co-author e-mail chuny@uthscsa.edu
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