Giovan Paolo Pini Prato1, Debora Franceschi2, Pierpaolo Cortellini1,3, Leandro Chambrone4,5,6. 1. Tuscany Academy of Dental Research (ATRO), Florence, Italy. 2. Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. 3. European Research Group on Periodontology (ERGOPERIO), Bern, Switzerland. 4. Unit of Basic Oral Investigation (UIBO), School of Dentistry, El Bosque University, Bogota, Colombia. 5. School of Dentistry, Ibirapuera University (Unib), São Paulo, Brazil. 6. Department of Periodontics, College of Dentistry, The University of Iowa, Iowa City, IA.
Abstract
BACKGROUND: Subepithelial connective tissue graft with coronally advanced flap (SCTG + CAF) has been considered the best and most predictable root coverage procedure. Thus, the aims of this study are two-fold: 1) to evaluate the long-term outcomes following SCTG + CAF in the treatment of gingival recessions (GR) and 2) to explore the influence of several tooth/patient-related factors on the stability of gingival margin at 1 year and at 5,10, 15, and 20 years after surgery. METHODS: Forty-five patients with 45 maxillary GR (Miller's Class I or III) were treated with SCTG + CAF in a private practice between 1990 and 1997. Recession depth (RD), probing depth (PD), keratinized tissue (KT) width and patient/tooth-associated variables were recorded for each GR at baseline, 1, 5, 10, 15, and 20 years after surgery. Parametric, non-parametric, and logistic regression statistics were used throughout the study. RESULTS: A total of 21 Class I (44.67%) and 24 Class III (53.33%) GR were treated. Considering all the 45 GR, statistically significant improvements were found for RD in all evaluations (P < 0.05) compared with baseline data. Over the course of the study, mean root coverage (MRC) decreased from 74.23% (1 year) to 67.69% (20 years). Within maxillary Class I defects, complete root coverage (CRC) at 1-year follow-up was 57.14% (n = 12) and 47.62% (n = 10) at the end of study period, whereas MRC decreased from 82.37% to 77.62%, respectively. Within maxillary Class III recessions, CRC of 20.83% (n = 5) was found at both the 1-year and the 20-year follow-ups. On the other hand, MRC decreased from 66.55% to 58.18%, respectively. The results of logistic regression analysis showed that the achievement of CRC was associated with sites not presenting interdental tissue loss (i.e., Class I, odds ratio: 5.031, P = 0.024), whereas GR recurrence appeared associated with sites with attached KT < 2 mm (i.e., 5-, 10-, 15- and 20-year follow-ups), to teeth presenting root steps (i.e., 10- and 20-year follow-ups), and smoking (i.e., 15-year follow-up). CONCLUSIONS: Positive RD reduction and KT improvements achieved by SCTG + CAF at short-term may be preserved long-term with the majority of the treated sites not displaying relapse of the gingival margin. Teeth lacking a minimal 2-mm width of attached KT and presenting non-carious cervical lesions were more prone to develop an apical shift of the gingival margin during a 20-year follow-up period.
BACKGROUND: Subepithelial connective tissue graft with coronally advanced flap (SCTG + CAF) has been considered the best and most predictable root coverage procedure. Thus, the aims of this study are two-fold: 1) to evaluate the long-term outcomes following SCTG + CAF in the treatment of gingival recessions (GR) and 2) to explore the influence of several tooth/patient-related factors on the stability of gingival margin at 1 year and at 5,10, 15, and 20 years after surgery. METHODS: Forty-five patients with 45 maxillary GR (Miller's Class I or III) were treated with SCTG + CAF in a private practice between 1990 and 1997. Recession depth (RD), probing depth (PD), keratinized tissue (KT) width and patient/tooth-associated variables were recorded for each GR at baseline, 1, 5, 10, 15, and 20 years after surgery. Parametric, non-parametric, and logistic regression statistics were used throughout the study. RESULTS: A total of 21 Class I (44.67%) and 24 Class III (53.33%) GR were treated. Considering all the 45 GR, statistically significant improvements were found for RD in all evaluations (P < 0.05) compared with baseline data. Over the course of the study, mean root coverage (MRC) decreased from 74.23% (1 year) to 67.69% (20 years). Within maxillary Class I defects, complete root coverage (CRC) at 1-year follow-up was 57.14% (n = 12) and 47.62% (n = 10) at the end of study period, whereas MRC decreased from 82.37% to 77.62%, respectively. Within maxillary Class III recessions, CRC of 20.83% (n = 5) was found at both the 1-year and the 20-year follow-ups. On the other hand, MRC decreased from 66.55% to 58.18%, respectively. The results of logistic regression analysis showed that the achievement of CRC was associated with sites not presenting interdental tissue loss (i.e., Class I, odds ratio: 5.031, P = 0.024), whereas GR recurrence appeared associated with sites with attached KT < 2 mm (i.e., 5-, 10-, 15- and 20-year follow-ups), to teeth presenting root steps (i.e., 10- and 20-year follow-ups), and smoking (i.e., 15-year follow-up). CONCLUSIONS: Positive RD reduction and KT improvements achieved by SCTG + CAF at short-term may be preserved long-term with the majority of the treated sites not displaying relapse of the gingival margin. Teeth lacking a minimal 2-mm width of attached KT and presenting non-carious cervical lesions were more prone to develop an apical shift of the gingival margin during a 20-year follow-up period.