ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Comparison Of Surgical Techniques In Treating Gingival Recession
Clinical Question In patients with gingival recession, does connective tissue graft provide better coverage of exposed root surfaces compared to free gingival graft?
Clinical Bottom Line In patients with gingival recession, subpedicle graft (bilaminar) technique offers better results in comparison to free gingival grafts in Miller class I and class II categories. (See Comments on the CAT below)
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) 9049798Paolantonio/1997Patients were 32 Male and 38 Females aged between 25 and 48 years attending a private practice who had requested an esthetic reasons. All of the participants showed probing depths less than or equal to 2 mm, with insignificant gingival inflammation. None of the patients used abrasive toothpaste, and showed plaque index of less than 20% and bleeding on probing in less than 10% of the sites. All patients selected, had at least one gingival recession classified in I or II Miller class. The more pronounced gingival recession was chosen if more than one site existed with gingival recession. Each patient was randomly assigned to one of two groups, Group A containing patients getting treatment done by free gingival graft, and Group B containing patients getting treatment by connective tissue graft. Randomized Controlled Trial
Key resultsThe exposed root surface was significantly reduced in groups getting gingival graft treatment and subpedicle connective tissue graft treatment. However, the exposed root surface after treatment was significantly smaller in subpedicle connective tissue graft group (mean coverage of 53.19% in free gingival graft patients versus 85.23% in subpedicle connective tissue graft treated patients) p < 0.0001.
Evidence Search Treatment Outcome"[Mesh], Connective Tissue/surgery"[Mesh] "Gingival Recession/surgery"[Mesh]"Gingiva/transplantation"[Mesh]
Comments on
The Evidence
The study design in the article was randomized controlled trial. The groups were similar at the start, displaying plaque in less than 20% of the sites and bleeding on probing on less than 10% of the sites. With patients with more than one gingival recession, the more pronounced was chosen. The study had more than 90% completion rate. The groups were not treated the same due to difference in procedures, and were provided an adequate follow-up. The study was not double-blind as the operator knew the kind of treatment that was provided to the group. The compliance was adequate, with no likely recall bias, and no competing interests.
Applicability The subjects in this study would be representative of patients who present with gingival recession and are looking for treatment. The treatment would have to be done in a periodontist clinic due to the equipment and surgical technique. Some of the harms included in these procedures were post-operative oral hygiene to prevent inflammation or other damage to the tissue. For patients receiving free gingival graft treatment, the exposed donor site would require extra care when eating and drinking. Benefits included in this study are getting good root coverage which may prevent hypersensitivity of tooth and correct gingival height. Patients’ expectations might not be met in case where full coverage of roots was not obtained.
Specialty/Discipline (Periodontics)
Keywords Subpedicle graft, Free gingival graft, Root coverage.
ID# 552
Date of submission: 03/30/2010spacer
E-mail charolias@livemail.uthscsa.edu
Author Sahegin Charolia
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author e-mail finlaysonr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Ross Pickei (San Antonio, Texas) on 04/20/2012
I conducted a PubMed search on this topic April 2012 and found a more recent publication: PubMed ID 22048593. While the publication listed in the CAT is the most recent and highest level of evidence, the case report I found concludes that a two-stage procedure utilizing a FGG and SECTG was successful for root coverage in the case of deep recession and lack of attached gingiva in the mandibular anterior region.
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