Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
J Periodontol. 2012 Jun;83(6):721-30. doi: 10.1902/jop.2011.110202. Epub 2011 Aug 26.
Minimally invasive techniques have broadened the horizons of periodontal plastic surgery to improve treatment outcomes. Thus, the purpose of this clinical trial was to compare root coverage, postoperative morbidity, and esthetic outcomes of subepithelial connective tissue graft (SCTG) technique with or without the use of a surgical microscope in the treatment of gingival recessions.
In this split-mouth study, twenty-four patients with bilateral Miller's Class I or II buccal gingival recessions ≥2.0 mm in canines or premolars were selected. Gingival recessions were randomly designated to receive treatment with SCTG with or without the assistance of the surgical microscope (test and control groups, respectively). Clinical parameters evaluated included the following: depth (RH) and width (RW) of the gingival defect, width (WKT) and thickness (TKT) of keratinized tissue, probing depth (PD), and clinical attachment level (CAL). Postoperative morbidity was evaluated by means of an analog visual scale and questionnaire. Patient satisfaction was also evaluated with a questionnaire. Descriptive statistics were expressed as mean ± SD. Repeated-measures analysis of variance was used for examination of differences regarding PD, CAL, and TKT. The Wilcoxon test was used to detect differences between groups and the Friedman test to detect differences within group regarding WKT, RH, and RW.
The average percentages of root coverage for test and control treatments, after 12 months, were 98.0% and 88.3%, respectively (P <0.05). Complete root coverage was achieved in 87.5% and 58.3% of teeth treated in test and control groups, respectively. For all parameters except recession height, there was an improvement in the final examination but without difference between treatments. For the RH, a lower value was found in the test group compared to the control group (P <0.05). In the test group, all patients were satisfied with the esthetics obtained, and 19 patients (79.1%) were satisfied in the control group. For postoperative morbidity, 14 patients in each of the two treatment groups did not use analgesics for pain control.
Both approaches were capable of producing root coverage; however, use of the surgical microscope was associated with additional clinical benefits in the treatment of teeth with gingival recessions.
微创技术拓宽了牙周整形手术的视野，以改善治疗效果。因此，本临床试验的目的是比较上皮下结缔组织移植（SCTG）技术联合或不联合手术显微镜在治疗牙龈退缩中的根覆盖、术后发病率和美学效果。
在这项分侧研究中，选择了 24 名双侧 Miller Ⅰ类或Ⅱ类颊侧牙龈退缩≥2.0mm 的患者，犬或前磨牙。将牙龈退缩随机指定接受 SCTG 治疗，联合或不联合手术显微镜（试验组和对照组）。评估的临床参数包括：牙龈缺损的深度（RH）和宽度（RW）、角化组织的宽度（WKT）和厚度（TKT）、探诊深度（PD）和临床附着水平（CAL）。术后发病率通过模拟视觉量表和问卷调查进行评估。患者满意度也通过问卷调查进行评估。描述性统计数据表示为平均值±标准差。采用重复测量方差分析比较 PD、CAL 和 TKT 的差异。采用 Wilcoxon 检验比较组间差异，采用 Friedman 检验比较组内 WKT、RH 和 RW 的差异。
试验组和对照组治疗 12 个月后的平均根覆盖率分别为 98.0%和 88.3%（P<0.05）。在试验组和对照组中，分别有 87.5%和 58.3%的牙齿获得了完全根覆盖。除了退缩高度外，所有参数在最终检查中都有所改善，但治疗之间没有差异。对于 RH，试验组的值低于对照组（P<0.05）。在试验组中，所有患者对获得的美学效果均满意，对照组中有 19 名患者（79.1%）满意。对于术后发病率，两组各有 14 名患者无需使用镇痛药来控制疼痛。
两种方法都能产生根覆盖，但在治疗牙龈退缩的牙齿时，使用手术显微镜会带来额外的临床益处。
