A novel approach to minimizing gingival recession in the treatment of vertical bony defects.
BACKGROUND
In ideal conditions, the gain in clinical attachment following regenerative therapy of infrabony defects should be equal to probing depth reduction; thus, gingival recession should not increase as a consequence of the treatment procedures. The goal of the study was to evaluate the effectiveness of a surgical technique for the treatment of intrabony defects aimed at minimizing gingival recession and increasing the potential for clinical periodontal regeneration.


METHODS
Fifteen deep intrabony defects were treated with cause-related therapy aimed at eliminating bleeding on probing in the surgical area with minimal mechanical trauma to the root and the soft tissues. Four weeks later, a surgical technique combining the simplified papilla preservation approach at the level of the defect and the coronally advanced buccal flap at the adjacent teeth was performed. Enamel matrix protein was used in the intrabony defect. Soft tissue measurements were made before cause-related therapy, before and after surgery, and at the 1-, 6-, and 12-month follow-up visits. The clinical reevaluation was made 1 year after the surgery.


RESULTS
No changes in the position of the buccal and interproximal soft tissues next to the defect area were observed before and after cause-related therapy or when comparing the baseline (before surgery) and 1-year follow-up visits. The clinical attachment gain (5.9 +/- 1.4 mm), probing depth reduction (6.0 +/- 0.8 mm), and radiographic bone level gain (5.0 +/- 0.5 mm) were statistically and clinically significant, whereas no statistically significant increase in gingival recession (0.1 +/- 1.0 mm) was noted during the observation period.


CONCLUSIONS
It is possible to avoid statistically and clinically significant changes in the position of the soft tissues when treating vertical bony defects. This can be accomplished by minimizing soft tissue trauma during cause-related therapy and by advancing the buccal flap coronally during the surgery.
Zucchelli
Giovanni
G
Department of Odontostomatology, Bologna University, Via S. Vitale 59, Bologna, Italy. zucchell@alma.unibo.it
De Sanctis
Massimo
M
D000328:Adult; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000704:Analysis of Variance; D001861:Bone Regeneration; D003773:Dental Plaque / Q000628:therapy; D012534:Dental Scaling; D005260:Female; D005889:Gingival Recession / Q000517:prevention & control*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D010512:Periodontal Index; D010518:Periodontitis / Q000150:complications; D011859:Radiography; D013524:Surgical Flaps