title: Comparative Evaluation of Coronally Advanced Flap with and without Bioactive Glass Putty in the Management of Gingival Recession Defects: A Randomized Controlled Clinical Trial.
abstract: BACKGROUND
  The need-of-the-hour is a material that can support coronally advanced flap (CAF) procedures in treatment of gingival recession. Recent literature shows that various bone substitutes are being used for this procedure. This study clinically evaluates the outcomes of CAF with and without bioactive glass putty (NovaBone®) in terms of root coverage, gains in keratinized tissue height, and root coverage esthetic score in multiple gingival recession defects.
  
  
  METHODS
  Ten healthy patients (age range 18-45 years) with multiple bilateral (n = 40 test 20; control 20) and comparable Miller's Class I or Class II gingival recession defects were selected. The defects were randomly assigned by a computer-generated list to either test (CAF + bioactive glass putty) or control (CAF alone) groups. Clinical parameters included gingival recession (GR), probing pocket depth (PPD), clinical attachment level (CAL), keratinized tissue height (KTH), root coverage esthetic score (RES) evaluated at baseline and at 6 months post-surgery CAF with or without bioactive glass putty.
  
  
  RESULTS
  Six months post-surgery all clinical parameters showed significant reductions. Gingival recession showed significant reduction both in test and control groups (2.0 ± 0.47 mm and 2.3 ± 0.48 mm, respectively; p < 0.05) with no intergroup difference. The exposed root was covered by 72% (test) and 79% (control). CAL gain was also significant in both groups (test: 2.7 ± 0.67 mm; control: 2.8 ± 0.78 mm; p < 0.05) with no intergroup difference. Keratinized tissue height gain was significant in both the groups (test group: 1.2 ± 0.42 mm; control group: 0.9 ± 0.57 mm) with no intergroup difference. Also, the RES was significant for both the test and control groups (7.2 ± 2.78 and 7.7 ± 1.41 respectively) with no intergroup differences.
  
  
  CONCLUSIONS
  In isolated Class I/II GR defects, CAF associated with bioactive glass putty provided no significant difference in root coverage, CAL, KTH or RES compared to CAF alone. However, statistically significant gains were seen in all the parameters in both groups as compared to baseline. We refute the claims of the recent studies using a bone substitute for root coverage. Further long-term clinical trials are warranted to substantiate our results.
authors.affiliation: Department of Periodontics and Oral Implantology, Dr. D.Y Patil Dental College and Hospital, Dr. D. Y Patil Vidyapeeth, Pune-411018, India.
authors.forename: Amrita
authors.initials: A
authors.lastname: Bansal
authors.affiliation: Department of Periodontics and Oral Implantology, Dr. D.Y Patil Dental College and Hospital, Dr. D. Y Patil Vidyapeeth, Pune-411018, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Kulloli
authors.affiliation: Department of Periodontics and Oral Implantology, Dr. D.Y Patil Dental College and Hospital, Dr. D. Y Patil Vidyapeeth, Pune-411018, India.rkathariya@gmail.com.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kathariya
authors.affiliation: Department of Periodontics and Oral Implantology, Dr. D.Y Patil Dental College and Hospital, Dr. D. Y Patil Vidyapeeth, Pune-411018, India.
authors.forename: Sharath
authors.initials: S
authors.lastname: Shetty
authors.affiliation: University of Edinburgh, Edinburgh, UK.
authors.forename: Hansa
authors.initials: H
authors.lastname: Jain
authors.affiliation: Dr. D Y Patil Dental School, Lohegaon, Pune-412105, India.
authors.forename: Sonal
authors.initials: S
authors.lastname: Raikar
mesh_terms: D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D005881:Gingiva; D005889:Gingival Recession / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000601:surgery; D013524:Surgical Flaps; D014092:Tooth Root / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: alveolar bone grafting; bioactive glass putty; coronally advanced flap; gingival recession; periodontal flap; root coverage