Journal of Periodontal and Implant Science

Korean Academy of Periodontology (대한치주과학회)
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Clinical and patient-reported outcomes after recession coverage using modified vestibular incision subperiosteal tunnel access with a volume-stable collagen matrix as compared to a coronally advanced flap with a subepithelial connective tissue graft

  • Chun-Teh Lee (Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry) ;
  • Marlena Lange (Section of Geriodontics, Department of Conservative Dentistry and Periodontology, Center of Dental Medicine, University Hospital Jena, Friedrich Schiller University) ;
  • Alain Jureidini (Columbia University College of Dental Medicine) ;
  • Nurit Bittner (Columbia University College of Dental Medicine) ;
  • Ulrike Schulze-Spate (Columbia University College of Dental Medicine)
  • Received : 2021.11.04
  • Accepted : 2022.06.02
  • Published : 2022.12.31
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Abstract

Purpose: Coronally advanced split-or full-thickness (CAST or CAFT) flaps in combination with subepithelial connective tissue grafts (SCTGs) are commonly used in root-coverage procedures despite postoperative pain and bleeding from the graft donor site. Therefore, the modified vestibular incision subperiosteal tunnel access procedure (VISTAX) uses a novel collagen matrix (VCMX) instead of autogenous tissue to address the limitations associated with autogenous tissue grafting. This retrospective study compared the clinical outcomes of VISTAX to the results obtained after using a CAST or CAFT flap in combination with SCTG for root coverage. Methods: Patients with single or multiple adjacent recession I/II defects were included, with 10 subjects each in the VISTAX, CAFT, and CAST groups. Defect coverage, keratinized tissue width, esthetic scores, and patients' perceived pain and dentinal hypersensitivity (visual analogue scale [VAS]) were assessed at baseline, 3 months, and 6 months. Results: All surgical techniques significantly reduced gingival recession (P<0.0001). Defect coverage, esthetic appearance, and the reduction in dentinal hypersensitivity were comparable. However, the VAS scores for pain were significantly lower in the VISTAX group than in the CAFT and CAST groups, which had similar scores (P<0.05). Furthermore, the clinical results of VISTAX and CAFT/CAST generally remained stable at 6 months. Conclusions: The clinical outcomes of VISTAX, CAFT, and CAST were comparable. However, patients perceived significantly less pain after VISTAX, indicating a potentially higher patient acceptance of the procedure. A prospective trial with a longer follow-up period and a larger sample size should therefore evaluate VISTAX further.

Keywords

Acknowledgement

This study was supported by Geistlich Pharma AG, Wolhusen, Switzerland, the Interdisciplinary Center of Clinical Research of the Medical Faculty Jena (IZKF UKJ FF02) and the German Federal Ministry of Education and Research (BMBF: 01EC1901B).

References

  1. Albandar JM, Kingman A. Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999;70:30-43. https://doi.org/10.1902/jop.1999.70.1.30
  2. Sarfati A, Bourgeois D, Katsahian S, Mora F, Bouchard P. Risk assessment for buccal gingival recession defects in an adult population. J Periodontol 2010;81:1419-25. https://doi.org/10.1902/jop.2010.100102
  3. Serino G, Wennstrom JL, Lindhe J, Eneroth L. The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene. J Clin Periodontol 1994;21:57-63. https://doi.org/10.1111/j.1600-051X.1994.tb00278.x
  4. Chambrone L, Tatakis DN. Long-term outcomes of untreated buccal gingival recessions: a systematic review and meta-analysis. J Periodontol 2016;87:796-808. https://doi.org/10.1902/jop.2016.150625
  5. Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2018;89 Suppl 1:S237-48. https://doi.org/10.1002/JPER.17-0733
  6. Ker AJ, Chan R, Fields HW, Beck M, Rosenstiel S. Esthetics and smile characteristics from the layperson's perspective: a computer-based survey study. J Am Dent Assoc 2008;139:1318-27. https://doi.org/10.14219/jada.archive.2008.0043
  7. McLeod C, Fields HW, Hechter F, Wiltshire W, Rody W Jr, Christensen J. Esthetics and smile characteristics evaluated by laypersons. Angle Orthod 2011;81:198-205. https://doi.org/10.2319/060510-309.1
  8. Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 2014;41 Suppl 15:S44-62. https://doi.org/10.1111/jcpe.12182
  9. Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 2015;86 Suppl:S8-51. https://doi.org/10.1902/jop.2015.130674
  10. Harris RJ, Miller R, Miller LH, Harris C. Complications with surgical procedures utilizing connective tissue grafts: a follow-up of 500 consecutively treated cases. Int J Periodontics Restorative Dent 2005;25:449-59.
  11. Harris RJ. A comparative study of root coverage obtained with an acellular dermal matrix versus a connective tissue graft: results of 107 recession defects in 50 consecutively treated patients. Int J Periodontics Restorative Dent 2000;20:51-9.
  12. McGuire MK, Scheyer ET. Long-term results comparing xenogeneic collagen matrix and autogenous connective tissue grafts with coronally advanced flaps for treatment of dehiscence-type recession defects. J Periodontol 2016;87:221-7. https://doi.org/10.1902/jop.2015.150386
  13. Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique. Int J Periodontics Restorative Dent 1994;14:216-27.
  14. Zadeh HH. Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet-derived growth factor BB. Int J Periodontics Restorative Dent 2011;31:653-60.
  15. Chao JC. A novel approach to root coverage: the pinhole surgical technique. Int J Periodontics Restorative Dent 2012;32:521-31.
  16. Mathes SH, Wohlwend L, Uebersax L, von Mentlen R, Thoma DS, Jung RE, et al. A bioreactor test system to mimic the biological and mechanical environment of oral soft tissues and to evaluate substitutes for connective tissue grafts. Biotechnol Bioeng 2010;107:1029-39. https://doi.org/10.1002/bit.22893
  17. Caballe-Serrano J, Zhang S, Sculean A, Staehli A, Bosshardt DD. Tissue integration and degradation of a porous collagen-based scaffold used for soft tissue augmentation. Materials (Basel) 2020;13:E2420.
  18. Thoma DS, Hammerle CH, Cochran DL, Jones AA, Gorlach C, Uebersax L, et al. Soft tissue volume augmentation by the use of collagen-based matrices in the dog mandible -- a histological analysis. J Clin Periodontol 2011;38:1063-70. https://doi.org/10.1111/j.1600-051X.2011.01786.x
  19. Thoma DS, Jung RE, Schneider D, Cochran DL, Ender A, Jones AA, et al. Soft tissue volume augmentation by the use of collagen-based matrices: a volumetric analysis. J Clin Periodontol 2010;37:659-66. https://doi.org/10.1111/j.1600-051X.2010.01581.x
  20. Stefanini M, Mounssif I, Barootchi S, Tavelli L, Wang HL, Zucchelli G. An exploratory clinical study evaluating safety and performance of a volume-stable collagen matrix with coronally advanced flap for single gingival recession treatment. Clin Oral Investig 2020;24:3181-91. https://doi.org/10.1007/s00784-019-03192-5
  21. Schulze-Spate U, Lee CT. Modified vestibular incision subperiosteal tunnel access procedure with volume-stable collagen matrix for root coverage: report of three cases. Int J Periodontics Restorative Dent 2019;39:e181-7. https://doi.org/10.11607/prd.4014
  22. Nelson SW. The subpedicle connective tissue graft. A bilaminar reconstructive procedure for the coverage of denuded root surfaces. J Periodontol 1987;58:95-102. https://doi.org/10.1902/jop.1987.58.2.95
  23. Harris RJ. The connective tissue and partial thickness double pedicle graft: a predictable method of obtaining root coverage. J Periodontol 1992;63:477-86. https://doi.org/10.1902/jop.1992.63.5.477
  24. Chambrone L, Ortega MA, Sukekava F, Rotundo R, Kalemaj Z, Buti J, et al. Root coverage procedures for treating single and multiple recession-type defects: an updated Cochrane systematic review. J Periodontol 2019;90:1399-422. https://doi.org/10.1002/JPER.19-0079
  25. Tavelli L, Barootchi S, Nguyen TV, Tattan M, Ravida A, Wang HL. Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: a systematic review and meta-analysis. J Periodontol 2018;89:1075-90. https://doi.org/10.1002/JPER.18-0066
  26. Dai A, Huang JP, Ding PH, Chen LL. Long-term stability of root coverage procedures for single gingival recessions: a systematic review and meta-analysis. J Clin Periodontol 2019;46:572-85. https://doi.org/10.1111/jcpe.13106
  27. Thombre V, Koudale SB, Bhongade ML. Comparative evaluation of the effectiveness of coronally positioned flap with or without acellular dermal matrix allograft in the treatment of multiple marginal gingival recession defects. Int J Periodontics Restorative Dent 2013;33:e88-94. https://doi.org/10.11607/prd.1371
  28. Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 2011;38:661-6. https://doi.org/10.1111/j.1600-051X.2011.01732.x
  29. Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13.
  30. Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963;21:533-51. https://doi.org/10.3109/00016356309011240
  31. O'Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol 1972;43:38.
  32. Bruno JF. Connective tissue graft technique assuring wide root coverage. Int J Periodontics Restorative Dent 1994;14:126-37.
  33. Lorenzana ER, Allen EP. The single-incision palatal harvest technique: a strategy for esthetics and patient comfort. Int J Periodontics Restorative Dent 2000;20:297-305.
  34. Kan JY, Morimoto T, Rungcharassaeng K, Roe P, Smith DH. Gingival biotype assessment in the esthetic zone: visual versus direct measurement. Int J Periodontics Restorative Dent 2010;30:237-43.
  35. Cairo F, Rotundo R, Miller PD Jr, Pini Prato GP. Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol 2009;80:705-10. https://doi.org/10.1902/jop.2009.080565
  36. Jensen MP, Karoly P. Self-report scales and procedures for assessing pain in adults. In Turk DC, Melzack R, editors. Handbook of pain assessment. New York (NY): The Guilford Press; 2011. p.19-44. 
  37. Griffin TJ, Cheung WS, Zavras AI, Damoulis PD. Postoperative complications following gingival augmentation procedures. J Periodontol 2006;77:2070-9. https://doi.org/10.1902/jop.2006.050296
  38. Gargallo-Albiol J, Barootchi S, Tavelli L, Wang HL. Efficacy of xenogeneic collagen matrix to augment peri-implant soft tissue thickness compared to autogenous connective tissue graft: a systematic review and meta-analysis. Int J Oral Maxillofac Implants 2019;34:1059-69. https://doi.org/10.11607/jomi.7497
  39. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol 1985;56:715-20. https://doi.org/10.1902/jop.1985.56.12.715
  40. Mazzocco F, Comuzzi L, Stefani R, Milan Y, Favero G, Stellini E. Coronally advanced flap combined with a subepithelial connective tissue graft using full- or partial-thickness flap reflection. J Periodontol 2011;82:1524-9. https://doi.org/10.1902/jop.2011.100586
  41. Tavelli L, Barootchi S, Di Gianfilippo R, Kneifati A, Majzoub J, Stefanini M, et al. Patient experience of autogenous soft tissue grafting has an implication for future treatment: a 10- to 15-year cross-sectional study. J Periodontol 2021;92:637-47. https://doi.org/10.1002/JPER.20-0350
  42. Douglas de Oliveira DW, Oliveira-Ferreira F, Flecha OD, Goncalves PF. Is surgical root coverage effective for the treatment of cervical dentin hypersensitivity? A systematic review. J Periodontol 2013;84:295-306. https://doi.org/10.1902/jop.2012.120143
  43. Zeltner M, Jung RE, Hammerle CH, Husler J, Thoma DS. Randomized controlled clinical study comparing a volume-stable collagen matrix to autogenous connective tissue grafts for soft tissue augmentation at implant sites: linear volumetric soft tissue changes up to 3 months. J Clin Periodontol 2017;44:446-53. https://doi.org/10.1111/jcpe.12697
  44. Roman A, Balazsi R, Campian RS, Soanca A, Moldovan R, Sculean A, et al. Patient-centered outcomes after subepithelial connective tissue grafts and coronally advanced flaps. Quintessence Int 2012;43:841-51.
  45. Zucchelli G, Mele M, Stefanini M, Mazzotti C, Mounssif I, Marzadori M, et al. Predetermination of root coverage. J Periodontol 2010;81:1019-26. https://doi.org/10.1902/jop.2010.090701
  46. Cortellini P, Tonetti M, Baldi C, Francetti L, Rasperini G, Rotundo R, et al. Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? A multi-centre, randomized, double-blind, clinical trial. J Clin Periodontol 2009;36:68-79. https://doi.org/10.1111/j.1600-051X.2008.01346.x
  47. Pini Prato GP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C, et al. Coronally advanced flap: the post-surgical position of the gingival margin is an important factor for achieving complete root coverage. J Periodontol 2005;76:713-22. https://doi.org/10.1902/jop.2005.76.5.713