Mucogingival versus guided tissue regeneration procedures in the treatment of deep recession type defects.
The objective of the study was to compare the clinical efficacy of 3 surgical approaches in the treatment of deep recession type defects. Fifty-four (54) gingival recessions > or = 5 mm were randomly assigned to 1 of the 3 treatment groups by blocking the prognostic variables. The first group was treated with a guided tissue regeneration (GTR) procedure using a bioabsorbable membrane, the second with non-resorbable membrane, and the third with a mucogingival surgical approach consisting of a connective tissue graft combined with a coronally advanced flap (bilaminar technique). No differences, in terms of baseline oral hygiene and defect characteristics, were observed among the 3 groups showing an effective blocking approach. The 1-year results indicated that 1) all treatment approaches resulted in clinically significant root coverage and attachment gain; 2) a statistically significant treatment effect (P = 0.012, ANOVA) was observed comparing the bioabsorbable (4.9+/-0.3 mm), the non-resorbable (4.5+/-0.8 mm), and the bilaminar (5.3+/-0.7 mm) groups, in terms of root coverage; 3) the difference in terms of root coverage between the bilaminar and the non-resorbable membrane groups was statistically significant while differences between the 2 GTR groups or between the bilaminar and the bioabsorbable membrane groups did not reach statistical value; 4) the 95% confidence intervals for the proportions of complete successes showed a similar pattern; 5) no statistical difference was demonstrated in the amount of attachment gain among the 3 groups (P=0.73, ANOVA). A regression model showed that the amount of root coverage was significantly affected by the initial recession depth, the procedure and smoking habits: a poorer root coverage result is expected in case of shallow recession type defects, when either bioabsorbable (P < 0.05) or non-resorbable (P < 0.001) membranes are used instead of a bilaminar technique and if the patient smokes (P < 0.01). It was concluded that the mucogingival bilaminar technique is at least as effective as GTR procedures in the treatment of gingival recession > or = 4 mm and thus recession depth is not the parameter which influences the selection of the surgical procedure.
Zucchelli
G
G
Department of Periodontology, Faculty of Odontology, Bologna University, Italy.
Clauser
C
C
De Sanctis
M
M
Calandriello
M
M
D000042:Absorption; D000328:Adult; D000704:Analysis of Variance; D016001:Confidence Intervals; D003238:Connective Tissue / Q000637:transplantation; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology; D005888:Gingival Pocket / Q000473:pathology / Q000601:surgery; D005889:Gingival Recession / Q000473:pathology / Q000601:surgery*; D005893:Gingivoplasty / Q000379:methods*; D016557:Guided Tissue Regeneration, Periodontal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D009061:Mouth Mucosa / Q000601:surgery*; D009910:Oral Hygiene; D011379:Prognosis; D012044:Regression Analysis; D012907:Smoking / Q000009:adverse effects; D013524:Surgical Flaps; D014092:Tooth Root / Q000473:pathology; D016896:Treatment Outcome
D008567:Membranes, Artificial