Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M
Department of Odontostomatology, Bologna University, Bologna, Italy.
J Periodontol. 2009 Jul;80(7):1083-94. doi: 10.1902/jop.2009.090041.
Vertical releasing incisions might damage the blood supply to the flap and result in unesthetic visible white scars. The aim of the present study was to compare root coverage and esthetic outcomes of the coronally advanced flap (CAF) with and without vertical releasing incisions in the treatment of multiple gingival recessions.
Thirty-two systemically and periodontally healthy subjects with esthetic complaints due to the exposure of Miller Class I and II multiple (at least two) gingival recession defects (> or =1 mm) affecting adjacent teeth of the same quadrant of the upper jaw were enrolled in the study. Sixteen patients (with 45 gingival recessions) were randomly assigned to the control group, and the other 16 patients (with 47 recession defects) were assigned to the test group. All recessions were treated with a CAF; vertical releasing incisions were performed in the control group, whereas an envelope-type flap was used in the test group. The patient's postoperative morbidity was assessed 1 week after the surgery, whereas the esthetic evaluation, made by the patient and independent periodontist, and the clinical evaluation were made 1 year later.
Surgical time was significantly shorter in the envelope-type CAF group. No statistically significant difference was demonstrated between the two groups in terms of recession reduction and clinical attachment level gain. A statistically greater probability of complete root coverage (adjusted odds ratio, 3.76; 95% confidence interval: 0.92 to 15.33; P <0.05) and a greater increase in buccal keratinized tissue height were observed with the envelope type of CAF. Patient satisfaction with esthetics was very high in both treatment groups, with no statistically significant differences between them. A better postoperative course and better results in the esthetic evaluation made by an independent periodontist were demonstrated in patients treated with the envelope type of CAF.
Both CAF techniques were effective in reducing recession depth. The envelope type of CAF was associated with an increased probability of achieving complete root coverage and with a better postoperative course. Keloid formation along the vertical releasing incisions was responsible for the worst esthetic evaluation made by an independent expert periodontist.
垂直松弛切口可能会破坏瓣的血供，并导致出现不美观的明显白色瘢痕。本研究的目的是比较在治疗多处牙龈退缩时，采用与不采用垂直松弛切口的冠向推进瓣（CAF）的牙根覆盖情况和美学效果。
32名全身和牙周健康、因上颌同一象限相邻牙齿出现Miller I类和II类多处（至少两处）牙龈退缩缺损（≥1mm）而有美学诉求的受试者纳入本研究。16例患者（共45处牙龈退缩）被随机分配至对照组，另外16例患者（共47处退缩缺损）被分配至试验组。所有退缩均采用CAF治疗；对照组进行垂直松弛切口，而试验组采用信封式瓣。术后1周评估患者的发病率，而患者和独立牙周医生进行的美学评估以及临床评估在1年后进行。
信封式CAF组的手术时间明显更短。两组在退缩减少和临床附着水平增加方面无统计学显著差异。采用信封式CAF观察到完全牙根覆盖的概率在统计学上更高（调整优势比，3.76；95%置信区间：0.92至15.33；P<0.05），颊侧角化组织高度增加更多。两个治疗组患者对美学的满意度都很高，两组之间无统计学显著差异。采用信封式CAF治疗的患者术后病程更好，独立牙周医生进行的美学评估结果更好。
两种CAF技术在减少退缩深度方面均有效。信封式CAF与实现完全牙根覆盖的概率增加以及更好的术后病程相关。垂直松弛切口处的瘢痕疙瘩形成是独立专家牙周医生做出最差美学评估的原因。
