César Neto João B, Cavalcanti Marília C, Sekiguchi Ricardo T, Pannuti Claudio M, Romito Giuseppe A, Tatakis Dimitris N
Division of Periodontology, College of Dentistry, University of São Paulo, São Paulo, Brazil.
Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA.
Int J Dent. 2019 Jan 22;2019:1830765. doi: 10.1155/2019/1830765. eCollection 2019.
The aim of this study is to report root coverage outcomes in single deep gingival recessions (GR) following a proposed decision-making algorithm.
A retrospective, practice-based study included single deep (≥5 mm) Miller Class II and III defects. The step-by-step decision-making algorithm led to a choice among three different flap designs (coronally advanced flap (CAF), double papilla envelope flap (DPE) or modified lateral sliding flap (LSF)) used with a connective tissue graft. Recession depth (RD) at 6 months follow-up and the corresponding root coverage (RC) were the primary outcomes assessed.
Sixteen GR defects were included, with baseline RD of 6.7 ± 1.8 mm. Six months postoperatively, RD was significantly reduced to 1.2 ± 0.8 mm ( < 0.05). Mean RC was 81.7 ± 13.0%, without significant differences between Miller Class II (87.1 ± 9.2%; =9) and Class III (74.6 ± 14.5%; =7) GRs (=0.07). Postoperatively, keratinized tissue width increase was greater for LSF (3.5 ± 1.1) and DPE (4.2 ± 1.4 mm) than for CAF (1.9 ± 0.9 mm).
Following the proposed decision-making algorithm, root coverage outcomes for GR defects ≥5 mm were comparable to outcomes reported for shallow defects. Prospective clinical trials are needed to validate the proposed approach and techniques.
The proposed algorithm allows the clinician to select the appropriate surgical technique for treatment of single deep gingival recessions with good predictability.
本研究旨在报告采用一种拟议的决策算法治疗单个重度牙龈退缩（GR）后的牙根覆盖效果。
一项基于临床实践的回顾性研究纳入了单个重度（≥5毫米）米勒II类和III类缺损。逐步决策算法导致在三种不同的瓣设计（冠向推进瓣（CAF）、双乳头信封瓣（DPE）或改良侧向滑动瓣（LSF））中进行选择，并联合使用结缔组织移植。随访6个月时的退缩深度（RD）和相应的牙根覆盖（RC）是评估的主要结果。
纳入16例GR缺损，基线RD为6.7±1.8毫米。术后6个月，RD显著降低至1.2±0.8毫米（P<0.05）。平均RC为81.7±13.0%，米勒II类（87.1±9.2%；n=9）和III类（74.6±14.5%；n=7）GR之间无显著差异（P=0.07）。术后，LSF（3.5±1.1）和DPE（4.2±1.4毫米）的角化组织宽度增加大于CAF（1.9±0.9毫米）。
按照拟议的决策算法，≥5毫米的GR缺损的牙根覆盖效果与浅缺损报道的效果相当。需要进行前瞻性临床试验来验证所提出的方法和技术。
所提出的算法使临床医生能够选择合适的手术技术来治疗单个重度牙龈退缩，具有良好的可预测性。
