A Clinical Results of Subepithelial Connective Tissue Graft for Root Coverage

상피하 결합조직 이식술을 이용한 치근피개 술식의 임상적 평가

  • Choi, Kyung-Hee (Department of Periodontology, College of Dentistry, Yonsei University Oral Science Research Center) ;
  • Paik, Jeong-Won (Department of Periodontology, College of Dentistry, Yonsei University Oral Science Research Center) ;
  • Kim, Chang-Sung (Department of Periodontology, College of Dentistry, Yonsei University Oral Science Research Center) ;
  • Choi, Seong-Ho (Department of Periodontology, College of Dentistry, Yonsei University Oral Science Research Center) ;
  • Cho, Kyoo-Sung (Department of Periodontology, College of Dentistry, Yonsei University Oral Science Research Center) ;
  • Kim, Chong-Kwan (Department of Periodontology, College of Dentistry, Yonsei University Oral Science Research Center) ;
  • Chai, Jung-Kiu (Department of Periodontology, College of Dentistry, Yonsei University Oral Science Research Center)
  • 최경희 (연세대학교 치과대학 치주과학교실, 구강과학연구소) ;
  • 백정원 (연세대학교 치과대학 치주과학교실, 구강과학연구소) ;
  • 김창성 (연세대학교 치과대학 치주과학교실, 구강과학연구소) ;
  • 최성호 (연세대학교 치과대학 치주과학교실, 구강과학연구소) ;
  • 조규성 (연세대학교 치과대학 치주과학교실, 구강과학연구소) ;
  • 김종관 (연세대학교 치과대학 치주과학교실, 구강과학연구소) ;
  • 채중규 (연세대학교 치과대학 치주과학교실, 구강과학연구소)
  • Published : 2002.09.30

Abstract

Exposed root surfaces can cause esthetic problems, hypersensitivity, and root caries. Numerous efforts have been tried to cover the recessed root surfaces, and various techniques have been developed and introduced. Among these, subepithelial connective tissue graft which shows high coverage rate in various researches, has the advantage of good color match, less discomfort to the donor site, rich vascularity, and high predictability. Following results were obtained after investigating 6 and 18 months post operatively, 98 cases of subepithelial connective tissue graft from 48 patients who underwent subepithelial connective tissue graft procedure in the department of periodontology, college of dentistry, Yonsei university. 1. The total average root coverage of Miller class I, II & III were 76.2?24% at 6 months follow-up and 75?25.2% at 18 months follow-up with no statistically significant difference between the follow-up periods.(p<0.05) 2. The percentage of teeth showing complete coverage were 41.9% at 6 months follow-up and 39.2% at 18 months follow-up. 3. At 6 months follow-up, Miller classification I showed 84.9?20.7%, class II showed 82.5?17.7%, and class III showed 62.3?24.5% of coverage. In class III recession, statistically significantly less root coverage was observed compared to class I & II. (p(0.05) 4. At 18 months follow-up, Miller classification I showed 92.2?13.5%, class II showed 84.3?17.4%, and class III showed 59.5?24.5% of coverage. In class III recession, statistically significantly less root coverage was observed compared to class I & II. (p<0.05) In conclusion, subepithelial connective tissue graft for class I and II recession can be used as a clinically predictable treatment modality for root coverage.

Keywords

References

  1. American Academy of Periodontology. Glossary of periodontal terms. 3rd edn, Chicago: American Academy of Periodontology, 1992
  2. Khocht A, Simon G, Person P, Denepitiya JL. Gingival recession in relation to relation to history of hard toothbrush use. J Periodontol 1993; 64: 900-905 https://doi.org/10.1902/jop.1993.64.9.900
  3. Serino G, Wennstrom JL, Lindhe J, Ennerath L. The prevalence and distribution of gingival recession in subjects with high standard of oral hygiene. J Clin Periodontol 1994; 21: 57-63 https://doi.org/10.1111/j.1600-051X.1994.tb00278.x
  4. Loe H, Anerud A, Boysen H. The natural history of periodontal disease in man; prevalence, severity, and extent of gingival recession. J Periodontol 1992 ;63: 489-495
  5. Joshipura KJ, Kent RL, Depaola PF. Gingival recession: intraoral distribution and associated factors. J Periodontol, 1994; 65: 864-871 https://doi.org/10.1902/jop.1994.65.9.864
  6. Lost C. Depth of alveolar bone dehiscences in relation to gingival recession. J Clin Periodontol 1984; 11: 583-589 https://doi.org/10.1111/j.1600-051X.1984.tb00911.x
  7. Kallestal C, Uhlin S. Buccal attachment loss in Swedish adolescents. J Clin Periodontol 1992; 19: 458-491
  8. Foushee DG, Moriarty JD, Simpson DM. Effects of mandibular orthognathic treatment on mucogingival tissues. J Periodontol 1985; 56: 727-733 https://doi.org/10.1902/jop.1985.56.12.727
  9. Muller HP, Eger T. Gingival phenotypes in young male adults. J Clin Periodontol 1992; 19: 458-491
  10. Trott JR, Love B. An analysis of localized recession in 766 Winnipeg high school students. Dental Practice 1966; 16: 209-213
  11. Gorman WJ. Prevalence and etiology of gingival recessions. J Periodontol 1967; 38: 316-322 https://doi.org/10.1902/jop.1967.38.4.316
  12. Sullivan HC, Atkins JH. Free autogenous gingival Wafts m. Utilization of grafts in the treatment of gingival recession. Periodontics 1968; 6: 152-159
  13. Holbrook T, Ochsenbein C. Complete coverage of the denuded root surface with a one stage gingival graft. Int J Periodont Rest Dent 1983; 3:9
  14. Pini Prato G, Tinti C, Vincenzi G, Magnani C, Cortellini P, Clauser C. Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession. J Periodontol 1992; 53: 919-928
  15. Miller PD, A classification of marginal tissue recession. Int J Periodont Rest Dent 1985; 5: 9-13
  16. Grupe H, Warren R. Repair of gingival defects by an sliding flap operation. J Periodontol 1956; 27:92 https://doi.org/10.1902/jop.1956.27.2.92
  17. Guinard EA, Caffesse RG. Treatment of localized gingival recessions III, Comparison of results obtained with lateral sliding and coronally repositioned flaps. J Periodontal 1978; 49: 351-356 https://doi.org/10.1902/jop.1978.49.7.351
  18. Harris RJ, Harris AW, The coronally positioned pedicle graft with inlaid margins: A predictable method of obtaining root coverage of shallow defects. lnt J Periodont Rest Dent 1982; 25: 229-241
  19. Miller PD. Root coverage using a free soft tissue autograft following citric acid application. part I . Technique. lnt J Periodont Rest Dent 1982; 2: 65-7
  20. Miller PD. Root coverage using a free soft tissue autograft following citric acid application, part III. A successful and predictable procedure in areas of deep-wide recession, Int J Periodont Rest Dent 1985; 5: 14-37
  21. Borghetti A, Gardella J. Thick gingival autograft for the coverage of gingival recession: A Clinical evaluation. lnt J Periodont Rest Dent 1990; 10: 217-229
  22. Tolmie PN, Rubins RP, Buck GS, Vagianos V, Lanz JC. The predictability of root coverage by way of free gingival autograft and citric acid application: An evaluation by multiple clinicians. Int J Periodont Rest Dent 1991; 11: 261-277
  23. Paul L, Michaelides, Suzan G, Wilson. An autogenous gingival graft technique, lnt J Periodont Rest Dent 1994; 14: 113-125
  24. Langer B, Calagna LJ. The subepithelial connective tissue graft. A new approach to the enhancement of anterior cosmetics. lnt J Periodont Rest Dent 1982; 2: 22-34
  25. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontal. 1985; 56: 715-720 https://doi.org/10.1902/jop.1985.56.12.715
  26. Nelson SW. The subpedicle connective tissue graft: A bilaminar reconstructive procedure for the coverage of denuded root surfaces, J Periodontal 1987; 58: 95-102 https://doi.org/10.1902/jop.1987.58.2.95
  27. Harris RJ. The connective tissue and partial thickness double pedicle graft: A predictable method of obtaining root coverage. J Periodontal 1992; 63: 477-486 https://doi.org/10.1902/jop.1992.63.5.477
  28. Jahnke PV, Sandifer JB, Gher ME, Gray JL, Richardson CA. Thick free gingival and connective tissue autografts for root coverage. J Periodotol 1993; 64: 315-322 https://doi.org/10.1902/jop.1993.64.4.315
  29. Tinti C, Vincenzi G, Cortellini P, Pini Prato GP, Clauser C. Guided tissue regeneration in the treatment of human facial recession. A 12 case report. J Periodontal 1992; 63: 554-560 https://doi.org/10.1902/jop.1992.63.6.554
  30. Trombelli L, Schincaglia G, Scapoli C, Calura G. Healing response of human buccal gingival recessions treated with expended polytetrafluomethylene membranes: A retrospective report, J Periodontal 1995; 66: 14-22 https://doi.org/10.1902/jop.1995.66.1.14
  31. Edel A. Clinical evaluation of connective tissue grafts used to increase the width of keratinized gingiva, J Clin Periodontal 1974; 1: 185-196 https://doi.org/10.1111/j.1600-051X.1974.tb01257.x
  32. Raetzke PB, Covering localized areas of root exposure employing the 'Envelope' Technique. J PeriodontoI 1985; 56: 397-402 https://doi.org/10.1902/jop.1985.56.7.397
  33. Allen AL: Use of the supraperiosteal envelope in the soft tissue grafting for root coverage II . Clinical results. Int J Periodont Rest Dent 1994; 14: 302-315
  34. Wilderman M, Wentz F. Repair of dentogingival defect with a pedicle flap, J Periodontal 1965; 36: 218-226 https://doi.org/10.1902/jop.1965.36.3.218
  35. Caffesse RG, Kon S, Castelli WA, Nasjleti C. Revascularization following the lateral sliding flap procedure. J PeriodontoI 1984; 55: 352-358 https://doi.org/10.1902/jop.1984.55.6.352
  36. Cortellini P, DeSanctis M, Pini Prato GP, Baldi C, Clauser C. Guided tissue regeneration procedure using a fibrin-fibronectin system in surgically induced recessions in dogs. Int J Periodont Rest Dent 1991; 11: 151-163
  37. 정현철, 최성호, 조규성, 채중규, 김종관. 성견의 실험적 상피하 결합조직 이식시의 치주조직의 치유. 대한치주과학회지, 1997; 27: 379-394
  38. Magnusson I, Runstad L, Nyman S, Lindhe J. A long junctional epithelium- A locus minoris resistentiae in plaque infection. J Clin Periodontol 1983; 10: 333-340 https://doi.org/10.1111/j.1600-051X.1983.tb01282.x
  39. Beaumont R, O'Leary T, Kafrawy A. Relative resistance of long junctional epithelial adhesions and connective tissue attachments to plaqueinduced inflammation. J Periodontol 1984; 55: 213-223 https://doi.org/10.1902/jop.1984.55.4.213
  40. Borghetti, A., Gardella, J.: Thick gingival autograft for the coverage of gingival recession: A clinical evaluation. Int J Periodont Rest Dent, 10: 217, 1990
  41. Jahnke PV, Sandifer JB, Gher ME, Gray JL, Richardson AC. Thick free gingival and connective tissue autografts for root coverage. J Periodontol 1993; 64: 315-322 https://doi.org/10.1902/jop.1993.64.4.315
  42. Paolantonio M, Di Murro C, Cattabriga A, Cattabriga M. Subpedicle connective tissue graft versus free gingival in the coverage of exposed root surfaces. A 5-year clinical study. J Clin PeriodontoI 1997; 24: 51-56 https://doi.org/10.1111/j.1600-051X.1997.tb01184.x
  43. Pini Prato G, Clauser C, Magnani C, Cortellini P, Resorbable membranes in the treatment of human buccal recession. A 9 case report. Int J Periodont Rest Dent 1995; 15: 258-267
  44. Ricci G, Silvestri M, Tinti C, Rasperini G. A clinical/statistical comparison between the subpedide connective tissue graft method and guided tissue regeneration technique in root coverage. Int J Periodont Rest Dent 1996; 16: 539-545
  45. 박철, 임성빈, 정진형. 독립된 결합조직 이식술로 치은퇴축 치료시 치근 피개에 관한 임상적 연구. 대한치주과학회지, 2000 ; 30 : 651-660