title: Guided tissue regeneration using a bioabsorbable membrane in the treatment of human buccal recession. A re-entry study.
abstract: A surgical technique involving a bioabsorbable membrane was used to treat localized buccal recession defects of between 2 and 5 mm on 17 sites in 13 patients. A conventional flap for coronal repositioning was raised consisting of a trapezoid flap with de-epithelialization of papillae, and the root surface planed back to reduce its convexity. The polylactate membrane with internal spacer bars was placed over the root surface with its coronal edge as near to the cemento-enamel junction (CEJ) as possible. This was held in place by a bioabsorbable retaining suture around the root, and the flap was coronally repositioned to cover the membrane. The patients were prescribed tetracycline for 2 weeks postsurgically, the sutures removed after 4 weeks, and cleaning procedures in the area reinstated after 6 weeks. Measurements were made using a custom made stent, and subjected to a Wilcoxon signed ranked analysis. These were clinical recession, clinical attachment level, probing depth, width of attached gingiva and the level of the buccal alveolar crest. The healing was monitored for a minimum of 1 year, and a surgical re-entry procedure was performed on 11 sites. The new buccal alveolar crest position was measured. This procedure resulted in a clinical and statistically significant reduction in clinical recession of 2.4 +/- 0.2 mm, a gain in attachment level of 2.7 +/- 0.2 mm, a gain in root coverage of 76 +/- 6% (P < 0.002), and a regeneration of buccal bone in all cases, with an average of 2.0 +/- 0.1 mm (P < 0.0023). This study shows that the use of a bioabsorbable membrane will predictably and significantly increase root coverage and regenerate buccal bone when used to treat localized buccal recession defects.
authors.affiliation: Department of Periodontology, King's College Hospital School of Medicine and Dentistry, London, UK.
authors.forename: C A
authors.initials: CA
authors.lastname: Waterman
mesh_terms: D000042:Absorption; D016301:Alveolar Bone Loss / Q000473:pathology / Q000601:surgery; D000539:Alveolar Process / Q000473:pathology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001673:Biodegradation, Environmental; D001861:Bone Regeneration; D004846:Epithelial Attachment / Q000473:pathology; D004867:Equipment Design; D005500:Follow-Up Studies; D005544:Forecasting; D005881:Gingiva / Q000473:pathology; D005889:Gingival Recession / Q000473:pathology / Q000601:surgery*; D016557:Guided Tissue Regeneration, Periodontal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D019344:Lactic Acid / Q000737:chemistry; D008567:Membranes, Artificial; D011091:Polyesters; D011108:Polymers / Q000737:chemistry; D012086:Reoperation; D016745:Root Planing; D015607:Stents; D013524:Surgical Flaps / Q000473:pathology; D013536:Suture Techniques; D013537:Sutures; D013752:Tetracycline / Q000627:therapeutic use; D019237:Tooth Cervix / Q000473:pathology; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents; D008567:Membranes, Artificial; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide); D013752:Tetracycline