Berlucchi Ignazio, Francetti Luca, Del Fabbro Massimo, Basso Matteo, Weinstein Roberto L
Department of Odontology, Galeazzi Orthopedic Institute, University of Milan, Milan, Italy.
J Periodontol. 2005 Jun;76(6):899-907. doi: 10.1902/jop.2005.76.6.899.
Coronally advanced flap (CAF) is one of the most effective treatments of Miller Class I and II recessions. Even if excellent outcomes are reported in the literature, complete root coverage is not always predictable, since many surgical and host-related factors may affect the percentage of root coverage obtained. The aim of this clinical study was to evaluate if some anatomical features such as tissue thickness, papillae height and width, recession depth, and vestibular bone height may influence defect coverage of Miller Class I and II gingival recessions treated with CAF in combination with enamel matrix derivative (EMD).
Thirty healthy, non-smoking patients (13 men and 17 women; mean age 32.8 +/- 6.2 years) were enrolled. Each patient was treated for one single recession using a CAF with the adjunct of EMD. Clinical parameters at baseline and 6 and 12 months were recorded and compared by using paired Student t test. Data were subdivided in two groups according to the baseline recession depth (REC): REC < 4 mm (group 1) and REC > or = 4 mm (group 2). The relation between the anatomical parameters (papilla height, papilla width, crestal bone height, and flap thickness) and percent of root coverage was evaluated by multiple linear regression analysis.
At 12 months, 91.7% of root coverage was obtained with a mean attachment gain of 3.23 mm. Better results in terms of percentage of root coverage were obtained when the baseline REC was < 4 mm compared to defects > or = 4 mm (96.5% versus 83.5%). Flap thickness was positively correlated to the percentage of root coverage. For gingival recessions > or = 4 mm, 100% root coverage was achieved only when tissue thickness was > or = 1 mm. Root coverage percentage was slightly related to papilla width in both groups, while it was associated with papilla height only in group 1 (P = 0.004). Only in patients in group 1 was the height of bone on the vestibular side related to the percentage of root coverage obtained (P = 0.003).
The results of the present study suggest that baseline recession depth and flap thickness may influence the outcome of marginal tissue recession therapy with CAF plus EMD at 12 months. There is not a clear relation between root coverage and other anatomical features as papilla width, papilla height, and the amount of bone on the vestibular side.
冠向复位瓣（CAF）是治疗Miller I类和II类牙龈退缩最有效的方法之一。尽管文献报道了良好的治疗效果，但由于许多手术和宿主相关因素可能影响牙根覆盖的百分比，完全的牙根覆盖并不总是可预测的。本临床研究的目的是评估一些解剖学特征，如组织厚度、龈乳头高度和宽度、退缩深度以及前庭骨高度，是否会影响采用CAF联合釉基质衍生物（EMD）治疗的Miller I类和II类牙龈退缩的缺损覆盖情况。
纳入30例健康、不吸烟的患者（13例男性和17例女性；平均年龄32.8±6.2岁）。每位患者使用CAF联合EMD治疗单个牙龈退缩。记录基线、6个月和12个月时的临床参数，并采用配对t检验进行比较。根据基线退缩深度（REC）将数据分为两组：REC<4mm（第1组）和REC≥4mm（第2组）。通过多元线性回归分析评估解剖学参数（龈乳头高度、龈乳头宽度、牙槽嵴顶高度和瓣厚度）与牙根覆盖百分比之间的关系。
12个月时，牙根覆盖率达到91.7%，平均附着获得量为3.23mm。与REC≥4mm的缺损相比，基线REC<4mm时在牙根覆盖百分比方面获得了更好的结果（96.5%对83.5%）。瓣厚度与牙根覆盖百分比呈正相关。对于牙龈退缩≥4mm的情况，仅当组织厚度≥1mm时才能实现100%的牙根覆盖。两组中牙根覆盖百分比与龈乳头宽度均有轻微关联，而仅在第1组中与龈乳头高度相关（P=0.004）。仅在第1组患者中，前庭侧骨高度与获得的牙根覆盖百分比相关（P=0.003）。
本研究结果表明，基线退缩深度和瓣厚度可能会影响12个月时CAF联合EMD治疗边缘组织退缩的效果。牙根覆盖与其他解剖学特征如龈乳头宽度、龈乳头高度和前庭侧骨量之间没有明确的关系。
