Coverage of localized gingival recessions: comparison of micro- and macrosurgical techniques.
BACKGROUND
In the presence of a thin and narrow zone of gingival tissue root recessions caused by trauma or inflammatory reactions seem to be a common feature of the buccal tissue morphology. The surgical coverage is mainly indicated for aesthetic reasons and may be accomplished with pedicled flaps in conjunction with or without the use of connective tissue grafts.


OBJECTIVE
The purpose of the present study was to evaluate the degree of vascularization of connective tissue grafts by applying a microsurgical approach. In addition, the clinical outcome was followed for 1 year.


METHODS
The study population consisted of 10 patients with bilateral Class I and II recessions at maxillary canines. In split-mouth design, the defects were randomly selected for recession coverage either by a microsurgical (test) or macrosurgical (control) approach. Immediately after the surgical procedures, and after 3 and 7 days of healing, fluorescent angiograms were performed to evaluate graft vascularization. In addition, the clinical parameters were assessed before the surgical intervention, and 1, 3, 6 and 12 months postoperatively.


RESULTS
The results of the angiographic evaluation at test sites revealed a vascularization of 8.9+/-1.9% immediately after the procedure. After 3 days and after 7 days, the vascularization rose to 53.3+/-10.5% and 84.8+/-13.5%, respectively. The corresponding vascularization at control sites were 7.95+/-1.8%/44.5+/-5.7% and 64.0+/-12.3%, respectively. All the differences between test and control sites were statistically significant. The clinical measurements revealed a mean recession coverage of 99.4+/-1.7% for the test and 90.8+/-12.1% for the control sites after the first month of healing. Again, this difference was statistically significant. The percentage of root coverage both test and control sites remained stable during the first year at 98% and 90%, respectively.


CONCLUSIONS
The present controlled clinical study has demonstrated that in root surface coverage, a microsurgical approach substantially improved the vascularization of the grafts and the percentages of root coverage compared with applying a conventional macroscopic approach.
Burkhardt
Rino
R
School of Dental Medicine, University of Berne, Berne, Switzerland. rino.burkhardt@bluewin.ch
Lang
Niklaus P
NP
D000328:Adult; D003238:Connective Tissue / Q000098:blood supply / Q000637:transplantation; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005881:Gingiva / Q000098:blood supply / Q000637:transplantation; D005889:Gingival Recession / Q000473:pathology / Q000601:surgery*; D005893:Gingivoplasty / Q000379:methods; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D018919:Neovascularization, Physiologic / Q000502:physiology; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology