Department of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
J Periodontol. 2021 Jun;92(6):814-822. doi: 10.1002/JPER.19-0646. Epub 2020 Oct 21.
This split-mouth randomized clinical trial compared two different types of subepithelial connective tissue grafts (SCTG) considering clinical parameters and patient-centered outcomes in patients with bilateral recession type 1 multiple gingival recessions after 6 months postoperatively.
A total of 21 patients were surgically treated with coronally advanced flap (CAF) associated with SCTG harvested by: double blade scalpel (DBS) and de-epithelialized (DE) SCTG. Periodontal clinical parameters and esthetics were evaluated by a calibrated periodontist at baseline and after 6 months. Patient-centered outcomes related to pain/discomfort and esthetics were assessed with visual analogue scale after 7 days and 6 months, respectively.
All clinical parameters, with the exception of probing depth, demonstrated differences in intragroup evaluation, comparing baseline to 6-month evaluation (P <0.05). Both groups presented reduction of recession depth and recession width and gain of keratinized tissue thickness, keratinized tissue width, and clinical attachment level (P <0.05). Intergroup comparison (DBS × DE) demonstrated no significant differences considering clinical parameters and periods. Both techniques improved esthetics evaluated by patients, without a difference between groups in patients and professional analysis. However, DBS group presented inferior pain/discomfort compared with DE (P <0.05).
DBS and DE associated with CAF presented satisfactory clinical outcomes. However, DBS presented inferior morbidity, an important fact for decision-making process.
本随机对照临床试验采用两种不同类型的黏膜下结缔组织移植(SCTG),比较了双侧 1 型牙周退缩伴多个牙龈退缩患者在手术后 6 个月时的临床参数和以患者为中心的结局。
共有 21 名患者接受了手术治疗,采用冠向推进瓣(CAF)联合双层刀片手术刀(DBS)或去上皮化 SCTG(DE)。在基线和术后 6 个月时,由一位经过校准的牙周病学家评估牙周临床参数和美观度。术后 7 天和 6 个月时,分别采用视觉模拟量表评估与疼痛/不适和美观度相关的患者为中心的结局。
所有临床参数(除探诊深度外)在组内比较中均显示出与基线相比在术后 6 个月时的差异(P<0.05)。两组均显示出了退缩深度和退缩宽度的减少,以及角化组织厚度、角化组织宽度和临床附着水平的增加(P<0.05)。组间比较(DBS×DE)显示,在临床参数和时间上均无显著差异。两种技术均改善了患者评估的美观度,且在患者和专业分析中,两组之间无差异。然而,与 DE 相比,DBS 组的疼痛/不适程度较低(P<0.05)。
DBS 和 DE 联合 CAF 均具有令人满意的临床效果。然而,DBS 术后的发病率较高,这是决策过程中的一个重要因素。