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Aims: This randomized trial assessed for the first time the efficacy of coronally advanced flap (CAF) followed by micro‐needling (MN) in contrast to CAF with acellular dermal matrix (ADM) on gingival thickness (GT, primary outcome), keratinized tissue width (KTW), clinical attachment level (CAL), probing depth (PD), recession depth (RD), recession width (RW), recession reduction (Rec‐Red), complete root coverage (CRC) and percentage of root coverage (all secondary outcomes) in management of RT1 gingival recession in patients with thin gingival phenotype. Methods: A total of 24 patients (n = 24) with a thin gingival phenotype and single RT1 gingival recession in the aesthetic zone were randomly allocated to test‐ (CAF + MN; n = 12) or control group (CAF + ADM; n = 12). All clinical parameters were evaluated at baseline, 3 and 6 months. Results: Both groups independently demonstrated significant gain in GT, RW, RD, CAL, PD, Rec‐Red, CRC and percentage of root coverage, with reduced PI and BOP (p <.05) at 3 and 6 months, without intergroup differences (p >.05). At 6 months, KTW gain was significantly higher in CAF + MN (5.08 ± 0.9 mm) than in CAF + ADM‐group (4.25 ± 1.06 mm; p <.05). Stepwise linear regression model with GT as dependent variable showed that base‐line GT was the only statistically significant predictor for GT with a direct correlation between base‐line GT and GT after 6 months. Conclusion: CAF followed by MN could represent a promising graft‐less approach for increasing gingival thickness, comparable to CAF with ADM, with superior keratinized tissue width improvement, in the treatment of RT1 recession defects in patients with thin gingival phenotype. [ABSTRACT FROM AUTHOR]

Background The combination of the coronally positioned flap with connective tissue grafting in treating gingival recession defects has been shown to demonstrate the highest success rate. Aim The aim of the present study was to compare and evaluate the efficiency between autologous fibrin glue (AFG) and conventional absorbable sutures in the treatment of marginal tissue recessions using connective tissue grafts (CTGs) and the coronally advanced flap (CAF) technique. Methods Twenty Miller’s class I and II recession sites in maxillary or mandibular areas in chronic periodontitis patients were treated as group I (test): CTG + CAF + AFG; and group II (control): CTG + CAF with conventional absorbable sutures. Clinical parameters in both groups were recorded at baseline (t0) and six months (t1) postoperatively in terms of gingival recession height (RH), root coverage esthetic score (RCES), visual analogue scale (VAS), and healing index (HI). Results The RH, RCES, VAS, and HI were significantly reduced at the end of six months compared to baseline (P < 0.005) in both groups; however, there was no statistical difference between the groups, indicating the equivalent efficacy of AFG and conventional sutures in healing. Conclusion All the treated sites were found to have appreciable root coverage with satisfactory post-operative healing. Hence, it may be suggested that both AFG and absorbable sutures are equally efficient in post-surgical soft tissue healing.

This study aims to evaluate the influence of the additional use of enamel matrix derivate (EMD) in the treatment of gingival recession defects using a coronally advanced flap (CAF) and a xenogeneic dermal matrix (XDM) by means of digital and clinical assessment methods. In this prospective randomized controlled study, recession height and area, width and thickness of keratinized gingiva, pocket probing depth, and clinical attachment levels were measured at the baseline and followed up for one year. Fifteen patients (n = 15) with 24 gingival recession defects were treated between 2019 and 2021. On average, the digitally assessed root coverage of the control group (CAF + XDM) was not significantly different compared to the test group (CAF + XDM + EMD), with 69 ± 28% and 36 ± 32%, respectively (p = 0.094). One year postoperatively, there were no differences found regarding keratinized tissue width (KTW) between the control group and test group (p = 0.690). However, the control group showed superior results in the thickness of keratinized gingiva (p = 0.044). The present study showed that there were no statistically significant differences in the root coverage results in the CAF + XDM + EMD group compared to the CAF + XDM group. The adjunctive use of EMD to a CAF and XDM in the treatment of gingival recession defects does not appear to have any clinical benefit. [ABSTRACT FROM AUTHOR]

The aim of this systematic review (SR) compared the effect of xenogeneic collagen matrix (XCM) vs. connective tissue graft (CTG) for the treatment of multiple gingival recession (MGR) Miller Class I and II or Cairo type I. Five databases were searched up to August 2022 for randomized clinical trials (RCTs) comparing the clinical effects of XCM vs. CTG in the treatment of MGR. The random effects model of mean differences was used to determine reduction of gingival recession (GR), gain in keratinized tissue width (KTW), gain in gingival thickness (GT) and gain in clinical attachment level (CAL). The risk ratio was used to complete root coverage (CRC) at 6 and 12 months. 10 RCTs, representing 1095 and 649 GR at 6 and 12 months, respectively, were included in this SR. The meta-analysis showed no statistically significant difference in GR reduction, KTW gain GT gain or CAL gain between groups at 6 months. However, at 12 months of follow-up, differences favoring the control group were observed (p < 0.05). CRC was significantly higher in the CTG group at 6 and 12 months. Regarding dentine hypersensitivity (DH), no statistically significant differences were found between groups at 6 and 12 months of follow-up (p < 0.05). At 12 months, CTG showed significantly superior clinical results in the treatment of MGR: however, this difference was not observed in the decrease of DH. [ABSTRACT FROM AUTHOR]

Background: The combination of the coronally positioned flap with connective tissue grafting in treating gingival recession defects has been shown to demonstrate the highest success rate. Aim: The aim of the present study was to compare and evaluate the efficiency between autologous fibrin glue (AFG) and conventional absorbable sutures in the treatment of marginal tissue recessions using connective tissue grafts (CTGs) and the coronally advanced flap (CAF) technique. Methods: Twenty Miller's class I and II recession sites in maxillary or mandibular areas in chronic periodontitis patients were treated as group I (test): CTG + CAF + AFG; and group II (control): CTG + CAF with conventional absorbable sutures. Clinical parameters in both groups were recorded at baseline (t0) and six months (t1) postoperatively in terms of gingival recession height (RH), root coverage esthetic score (RCES), visual analogue scale (VAS), and healing index (HI). Results: The RH, RCES, VAS, and HI were significantly reduced at the end of six months compared to baseline (P < 0.005) in both groups; however, there was no statistical difference between the groups, indicating the equivalent efficacy of AFG and conventional sutures in healing. Conclusion: All the treated sites were found to have appreciable root coverage with satisfactory post-operative healing. Hence, it may be suggested that both AFG and absorbable sutures are equally efficient in post-surgical soft tissue healing. [ABSTRACT FROM AUTHOR]

Aim: The study aims to compare connective tissue graft (CTG) with Fibro-Gide® as an adjunct to the coronally advanced flap (CAF) technique for treating class I and class II gingival recession based on Miller's classification. Materials and Methods: A total of 30 participants with bilateral Miller's class I or class II multiple gingival recession contributing to 60 multiple gingival recession sites were enrolled in this prospective clinical study. Recession sites were categorized into two groups. Group 1 (CAF+ CTG; n = 30 sites) and group 2 (CAF+ Fibro-Gide®; n = 30 sites). Clinical parameters, such as gingival recession depth (GRD), probing depth (PD), clinical attachment level (CAL), gingival recession width (GRW), and keratinized tissue (KT) were evaluated at baseline, 3 months, and 12 months. Statistical analysis was performed for intergroup comparison using an independent t test and for intra-group comparison using paired t test. Results: At baseline, the mean GRD for groups 1 and 2 were 3.5 ± 0.8 and 3.4 ± 0.8, whereas GRW for group 1 and group 2 were 3.1 ± 0.1 and 3.1 ± 0.2 respectively. At 12-month follow-up, the reduction in GRD and GRW was statistically significant. The gain of KT accounted to 3.9 ± 5.5 and 3.0 ± 0.8 in group 1 and group 2, respectively, but CAL showed a significant decrease from 5.4 ± 1.02 and 5.4 ± 1.03 to 2.3 ± 0.7 and 2.4 ± 0.7 in group 1 and group 2, respectively. Conclusion: Fibro-Gide® along with CAF improved gingival recession in terms of depth and width as comparable with those of CTG. In terms of KT, CTG has better long-term stability than Fibro-Gide® when combined with the CAF technique in treating multiple gingival recessions. [ABSTRACT FROM AUTHOR]

This review assesses evolving landscape of mucogingival surgery for treatment of gingival recession and peri-implant mucosal defects, highlighting an increased awareness of the role of soft tissue and advancements in treatment modalities. In response to diverse mucogingival defects, various treatment approaches have been proposed, with ongoing updates in considerations, prognostic factors, as well as the introduction of novel techniques. A comprehensive and up-to-date exploration of the existing literature is therefore required to consolidate the current understanding of mucogingival surgery.Among all treatment modalities, coronally advanced flap (CAF) and tunneling (TUN) techniques were evaluated for treating gingival recessions and peri-implant mucosal defects, acknowledging challenges due to limited direct comparisons and heterogeneous study groups. While some evidence favored CAF for achieving higher complete root coverage, recent meta-analyses suggest comparable outcomes for both techniques, underscoring the need for better-designed studies.In conclusion, both CAF and TUN exhibit versatility in mucogingival surgery, with considerations for specific clinical scenarios. Future studies should explore surgical duration, post-operative experiences, and comprehensive outcomes such as patient satisfaction, long-term stability, and esthetic results for a more thorough evaluation of these techniques.

Abstract Objectives This systematic review aims to evaluate the efficacy of combining the amniotic membrane (AM) with the coronally advanced flap (CAF) in the treatment of Miller class I and II gingival recession (GR). Methods The protocol of this updated PRISMA-compliant systematic review was registered in PROSPERO (CRD42023431501). The following treatment outcomes were recorded; recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and clinical attachment level (CAL). We searched the following databases: MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Science Direct. Results Two independent reviewers screened the selected articles. Twenty-two eligible articles were extracted, with 689 sites of GR in 481 patients. No statistically significant difference was found in RD, RW, WKG, and CAL between (AM&CAF) in comparison to control groups. However, the subgroup analysis showed statistically significant differences in RD between the (AM & CAF) group v/s (CAF) alone (P = 0.004). Moreover, the subgroup analysis of the WKG showed statistically significant differences between (AM & CAF) v/s (CAF&CM) (p = 0.04). Additionally, a statistically significant difference was found in the subgroup analysis of CAL between both (AM & CAF) group v/s (CAF) alone (p = 0.0009). Conclusion With the limitations of this meta-analysis due to short follow-up periods (6 months), the AM can be considered a viable treatment option for GR defects with satisfactory treatment outcomes comparable to other previously investigated treatment modalities. Clinical significance While AM showed various beneficial properties as an ideal membrane for the coverage of GR, future studies are required to completely understand the potential application of AM in the treatment of GR.

Objective: To determine the efficacy of latelet-rich fibrin (PRF) and Amniotic membrane (AM) along with the coronally advanced flap (CAF) technique in treating Miller’s class I gingival recession (GR) defects. Material and methods: A total of 32 sites with Miller’s class I GR defects were distributed into Group A (CAF + PRF, n = 16) and Group B (CAF + AM, n = 16). Clinical parameters like gingival index (GI), plaque index (PI), gingival bleeding index (GBI), gingival sulcus depth (GSD), relative attachment level (RAL), and gingival marginal level (GML) were measured at baseline and at 3, 6 and 9 months after surgical intervention. Results: PRF and AM with CAF were effective treatment modalities for treating Miller’s class I GR defects, with an average root coverage value of 2.00 ± 0.75 mm in Group A and 1.5 ± 0.3 mm in Group B. Complete coverage (100 %) was obtained in 57 % sites of group A and 49 % sites of group B. At the 9-month follow-up, there was a significant increase in relative attachment levels in both groups when compared to baseline. Conclusion: In the present study it was observed that there was a clinically and statistically significant improvement in root coverage with both groups. PRF-treated sites showed > 50 % complete coverage and hence were superior. AM showed comparable results to PRF and could be used as an alternative.

Objectives: The aim of this retrospective case series was to report the performance up to 5 years of an innovative surgical design (the apically incised coronally advanced surgical technique [AICAST]) for the regenerative treatment of one- or two-walled intrabony periodontal lesions. Method and materials: After completion of standard step I to II periodontal therapy, nine isolated periodontal defects were treated through AICAST. The following clinical outcome measurements were collected before the surgical intervention and at the last available follow-up: probing pocket depth (PPD), recession depth (REC), and clinical attachment level (CAL). Periapical radiographs of the treated teeth were also taken at baseline and at the last available follow-up (18 months or 5 years postoperatively). Results: A mean (± standard deviation) PPD reduction of 6.05 ± 1.76mm (P < .01), REC reduction of 1.15 ± 1.97 mm (P = .119), and CAL gain of 7.20 ± 2.13 mm (P < .01) were attained when comparing preoperative results with the last follow-up visit. CAL gain of 6 mm or more was reached in eight out of nine treated cases (88.9%), with a residual PPD of 2 to 3 mm in all the cases. Complete radiographic fill of the intrabony component was present in all the defects, while detectable suprabony radiographic filling was identified in two cases. Conclusion: AICAST represents an innovative surgical design for the treatment of deep intrabony defects and the eventual reduction of the associated gingival recessions. Preliminary results show good performance in terms of clinical attachment gains and maintenance of the marginal tissues. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review aims to evaluate the efficacy of combining the amniotic membrane (AM) with the coronally advanced flap (CAF) in the treatment of Miller class I and II gingival recession (GR). Methods: The protocol of this updated PRISMA-compliant systematic review was registered in PROSPERO (CRD42023431501). The following treatment outcomes were recorded; recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and clinical attachment level (CAL). We searched the following databases: MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Science Direct. Results: Two independent reviewers screened the selected articles. Twenty-two eligible articles were extracted, with 689 sites of GR in 481 patients. No statistically significant difference was found in RD, RW, WKG, and CAL between (AM&CAF) in comparison to control groups. However, the subgroup analysis showed statistically significant differences in RD between the (AM & CAF) group v/s (CAF) alone (P = 0.004). Moreover, the subgroup analysis of the WKG showed statistically significant differences between (AM & CAF) v/s (CAF&CM) (p = 0.04). Additionally, a statistically significant difference was found in the subgroup analysis of CAL between both (AM & CAF) group v/s (CAF) alone (p = 0.0009). Conclusion: With the limitations of this meta-analysis due to short follow-up periods (6 months), the AM can be considered a viable treatment option for GR defects with satisfactory treatment outcomes comparable to other previously investigated treatment modalities. Clinical significance: While AM showed various beneficial properties as an ideal membrane for the coverage of GR, future studies are required to completely understand the potential application of AM in the treatment of GR. [ABSTRACT FROM AUTHOR]

Introduction: The present study evaluated the biomechanical characteristics of cyanoacrylate-based tissue adhesive (TA) compared to surgical sutures in coronally advanced flap (CAF) procedures using an ex-vivo model. Material and methods: Thirty-six half-pig mandibles were divided into three groups, n=12 each: (I) CAF fixed with sutures (sling and tag suture technique), (II) CAF fixed with TA, and (III) CAF fixed with sutures and TA. At mandibular premolars, gingival recession defects extending 3 mm apical to the cemento-enamel junction (CEJ) were created. CAF procedures were performed using a split-full-split approach, with coronal advancement of the flap to 1 mm above the marked CEJ and stabilization according to the respective groups I–III. Marginal flap stability against pull-of forces (maximum tensile force) was measured with a universal material testing machine until the CEJ became visible. Results: The comparison between groups I–III demonstrated a significantly increased maximum tensile force for the TA (II) compared to the suture group (I) (p<0.001). A significantly increased maximum tensile force was found for the suture and TA (III) compared to the suture group (I) (p<0.001). There was also a significantly increased maximum tensile force in the suture and TA (III) compared to the TA group (II) (p<0.001). Conclusion: The results suggest that cyanoacrylate-based TA can increase marginal flap stability compared to sutures in CAF procedures. Clinical relevance: Cyanoacrylate-based TA can be considered a useful and valuable adjunct to conventional suturing techniques in periodontal plastic surgery, especially in cases where high flap stability is required. The results of this ex-vivo study can only be transferred to the clinical situation with limitations. Clinical long-term follow-up data must be generated. [ABSTRACT FROM AUTHOR]

Aim: To evaluate outcomes and predictive factors for the long‐term stability of root coverage using a sub‐epithelial connective tissue graft. Materials and Methods: One‐hundred and two healthy subjects (221 gingival recessions, GRs) were treated from 1987 to 1996. Keratinized tissue width (KTW), GR depth (RD), GR width (RW) and GR area (RA) were evaluated at baseline (M0) and at 1 month (M1), 1 year (M2), 11 years (M3), 21 years (M4) and 27 years (M5) after surgery. Primary outcomes consisted of complete root coverage (cRC) and relative dimensional changes in recession depth (measured in mm [c%‐RD]), recession width (measured in mm [c%‐RW]) and recession area (measured in mm2 [c%‐RA]). Results: cRC was 88.7% at 1 year (M2), 59.8% at M3, 44.4% at M4 and 51.9% at M5. Average c%‐RD was 95.2% at 1 year, 81.9% at M3, 71.5% at M4 and 81.7% at M5. KTW increased after surgery and over time and was positively correlated with favourable outcomes. Increased baseline RA was associated with less favourable clinical outcomes. Conclusions: The sub‐epithelial connective tissue graft is effective in the treatment of GRs and facilitates long‐term stability of clinical outcomes. Wider baseline RA was a strong predictor of unfavourable short‐ and long‐term RC outcomes. [ABSTRACT FROM AUTHOR]

To determine the efficacy of latelet-rich fibrin (PRF) and Amniotic membrane (AM) along with the coronally advanced flap (CAF) technique in treating Miller's class I gingival recession (GR) defects. A total of 32 sites with Miller's class I GR defects were distributed into Group A (CAF + PRF, n = 16) and Group B (CAF + AM, n = 16). Clinical parameters like gingival index (GI), plaque index (PI), gingival bleeding index (GBI), gingival sulcus depth (GSD), relative attachment level (RAL), and gingival marginal level (GML) were measured at baseline and at 3, 6 and 9 months after surgical intervention. PRF and AM with CAF were effective treatment modalities for treating Miller's class I GR defects, with an average root coverage value of 2.00 ± 0.75 mm in Group A and 1.5 ± 0.3 mm in Group B. Complete coverage (100 %) was obtained in 57 % sites of group A and 49 % sites of group B. At the 9-month follow-up, there was a significant increase in relative attachment levels in both groups when compared to baseline. In the present study it was observed that there was a clinically and statistically significant improvement in root coverage with both groups. PRF-treated sites showed > 50 % complete coverage and hence were superior. AM showed comparable results to PRF and could be used as an alternative. [ABSTRACT FROM AUTHOR]

The importance of esthetics is increasing for the patients as well as for the dentist. With a high incidence that rises with age and a complicated soft-tissue pathology caused by a wide variety of factors, gingival recessions are a common but troublesome dental problem. They are characterized by the exposure of the root surface of the teeth due to the apical migration of the gingival border beyond the cemento-enamel junction, and they cause both functional and cosmetic disruptions. Many different surgical approaches have been offered over the years to address gingival recession, all with the goal of providing enough root coverage and achieving aesthetically pleasing results. No matter the amount of defects, Zucchelli's method is beneficial in terms of root coverage and keratinized tissue gain when treating many neighboring recessions. In this case study, Zucchelli's coronally advanced flap is used to treat numerous neighboring gingival recessions.

This study aims to evaluate the influence of the additional use of enamel matrix derivate (EMD) in the treatment of gingival recession defects using a coronally advanced flap (CAF) and a xenogeneic dermal matrix (XDM) by means of digital and clinical assessment methods. In this prospective randomized controlled study, recession height and area, width and thickness of keratinized gingiva, pocket probing depth, and clinical attachment levels were measured at the baseline and followed up for one year. Fifteen patients (n = 15) with 24 gingival recession defects were treated between 2019 and 2021. On average, the digitally assessed root coverage of the control group (CAF + XDM) was not significantly different compared to the test group (CAF + XDM + EMD), with 69 ± 28% and 36 ± 32%, respectively (p = 0.094). One year postoperatively, there were no differences found regarding keratinized tissue width (KTW) between the control group and test group (p = 0.690). However, the control group showed superior results in the thickness of keratinized gingiva (p = 0.044). The present study showed that there were no statistically significant differences in the root coverage results in the CAF + XDM + EMD group compared to the CAF + XDM group. The adjunctive use of EMD to a CAF and XDM in the treatment of gingival recession defects does not appear to have any clinical benefit.

Background: To assess linear and volumetric changes following the treatment of gingival recessions (GRs) by means of a modified coronally advanced tunnel technique combined with acellular dermal matrix (MTUN + ADM). Materials and Methods: Patients presenting GR type 1 (RT1) GRs underwent root coverage surgery consisting of MTUN + ADM. Clinical measurements were made, and intraoral scans were obtained at baseline, postoperatively, and 6 weeks, 3 and 6 months after surgery, to evaluate changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), recession area (RA), marginal gingival thickness (MGT), and mucosal volume (MV). The impact of patient‐level and surgical‐site variables upon percentage root coverage (% RC) and the likelihood of achieving complete root coverage (CRC) were explored. Results: A total of 20 patients (n = 47 teeth) were treated. After 6 months, RD and RA decreased, while KTW, MGT, and MV increased. The mean % RC was 93% at 6 months and CRC was found on 72.3% of the sites at 6 months. The postoperative MGT changes at 1.5 and 3 mm were significantly correlated to % RC and CRC at 6 months. Each additional mm of postoperative gain of gingival thickness resulted in a 4‐fold increase in the probability of achieving CRC. Additionally, gingival margin positioned ≥0.5 mm coronal to the cementoenamel junction immediately after surgery was a strong predictor of CRC. Conclusions: The MGT gain at 1.5 and 3 mm achieved in the immediate postoperative period is a significant predictor of CRC at 6 months when treating multiple GRs via MTUN + ADM. Clinical Significance: The Scientific rationale for the study relies on the lack of 3D digital measuring tools in the assessment of soft tissue healing dynamics after root coverage therapy. The principal findings of this study can be summarized as follows: tooth type, tooth position, and post‐operative gingival margin position and gingival thickness and volume changes are predictors of CRC. Therefore, the practical implications are that the more thickness and more coronal advancement achieved immediately after root coverage surgery, the higher chance of achieving CRC. [ABSTRACT FROM AUTHOR]

Copyright of Revista ADM is the property of Asociacion Dental Mexicana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The importance of esthetics is increasing for the patients as well as for the dentist. With a high incidence that rises with age and a complicated soft-tissue pathology caused by a wide variety of factors, gingival recessions are a common but troublesome dental problem. They are characterized by the exposure of the root surface of the teeth due to the apical migration of the gingival border beyond the cemento-enamel junction, and they cause both functional and cosmetic disruptions. Many different surgical approaches have been offered over the years to address gingival recession, all with the goal of providing enough root coverage and achieving aesthetically pleasing results. No matter the amount of defects, Zucchelli's method is beneficial in terms of root coverage and keratinized tissue gain when treating many neighboring recessions. In this case study, Zucchelli's coronally advanced flap is used to treat numerous neighboring gingival recessions. [ABSTRACT FROM AUTHOR]

Copyright of West China Journal of Stomatology is the property of Sichuan University, West China College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Gingival recession is defined as the apical migration of gingival margin to the cementoenamel junction. Recently, amnion membrane, the third-generation membrane which is a placental-derived tissue, has been introduced. Materials and Methods: Study included 45 subjects with age group of 20--60 years of both genders. Patients with Miller's Class I and Class II gingival recession were selected for the study. The progress was assessed at baseline one, three, and six months observation interval through clinical parameters RD, RW, PD, and CAL at the end of six months. Results: Recession depths in the first, third, and sixth month were 1.82 ± 0.442, 1.31 ± 0.47 mm, and 0.91 ± 0.29, respectively, which showed a significant reduction from the baseline. Recession widths in the first, second, and third weeks were 3.04 ± 0.442 mm, 1.31 ± 0.47 mm, and 1.49 ± 0.59 mm, respectively. There was a statistically significant reduction (P > 0.005) when compared to the baseline. Pocket depths in the first, third, and sixth month were 0.93 ± 0.447, 0.42 ± 0.50, and 0.24 ± 0.43 (P > 0.005) which is significant when compared to baseline. Clinical attachment levels in the first, third, and sixth month were 2.73 ± 0.751, 1.78 ± 0.70, and 1.18 ± 0.53 (P > 0.005) which is significant compared to six months. Conclusion: Within the limitations of the present study, the data obtained by periodic assessment of the clinical parameters indicate the use of amnion membrane and hyaluronic acid, and proper technique may thus be the panacea for root coverage procedure. [ABSTRACT FROM AUTHOR]

Background and Aim: Gingival recession is a malicious and complex phenomenon that needs to be corrected as a patient may complain of hypersensitivity, pain, increased caries risk, and compromised esthetic. Coronally advanced flap (CAF) is a successful technique for its ease of performing and predictable outcome. Guided tissue regeneration membrane such as platelet-rich fibrin (PRF) and human chorion membrane (CM) enhances periodontal regeneration. Hence, this study was conducted to evaluate and compare the efficacy of human CM and PRF with CAF in Miller's class I and II recession defect. Materials and Methods: A total of 14 patients (28 sites) with Miller's class I and II recession defect were assigned and randomly allocated to CM group (Group I) and PRF group (Group II). Clinical parameters recorded were recession depth (RD), recession width (RW), clinical attachment level (CAL), and width of keratinized gingiva (WKG) before surgery. Recession coverage by CAF technique with either CM or PRF was done, and all parameters were again recorded after 1, 3, and 6 months of surgery. Results: Significant decreases were seen from baseline to 6 months' follow-up in both groups regarding RD and RW. WKG was increased in both groups. However, CAL showed statistically significant improvement only in group I and nonsignificant improvement in group II (P = 0.420) at 6 months' follow-up. Conclusion: Both the CM and PRF are effective materials in root coverage, but CM has some amount of better result and long-time stability compared to PRF. [ABSTRACT FROM AUTHOR]

Root coverage procedures have become very common in clinical dental practice. Even though these techniques are considered safe, the clinician may face several issues during the therapy due to their surgical nature. Some of these issues can be defined strictly as complications inherent to the procedure, whereas others are medical errors or treatment errors. This review will focus on describing treatment errors and complications that may arise during different phases of the root coverage therapeutic process and on how to prevent and manage them. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to assess the clinical outcome of root coverage following coronally advanced flap with or without amniotic membrane in Miller's class I or class II localized gingival recession in relation to anteriors. Methods: Five patients with bilaterally symmetrical Miller's class I or class II localized gingival recession were included in the study. Each patient was divided into control (without amniotic membrane) and test sites (with amniotic membrane) arbitrarily. Clinical parameters including plaque index, probing pocket depth (PPD), clinical attachment level (CAL), and depth and width of the gingival recession were recorded in a pro forma at baseline and in the 2nd, 4th, 12th week. The results were tabulated and subjected to statistical analysis using analysis of variance (ANOVA). Results: A 0.600-mm, 0.400-mm, 2.630-mm, and 2.616-mm reduction in PPD and gain in CAL were observed at control and test sites in the 12th week postoperatively and was found to be statistically insignificant (P = 0.580 and P = 0.871, respectively). Changes in depth and width of the gingival recession were observed and found to be maximum between base line (2.28 mm, 3.01 mm, 2.71, and 3.09 mm) and 2nd week (0.00, 0.00 mm, 0.23, and 0.20 mm) but without statistical significance. Conclusion: From the above results of the study, it could be concluded that the use of amniotic membrane as a barrier along with coronally advanced flap did not influence the clinical outcome of root coverage procedure.

Background: Gingival recession is defined as the apical migration of gingival margin to the cementoenamel junction. Recently, amnion membrane, the third-generation membrane which is a placental-derived tissue, has been introduced. Materials and Methods: Study included 45 subjects with age group of 20–60 years of both genders. Patients with Miller's Class I and Class II gingival recession were selected for the study. The progress was assessed at baseline one, three, and six months observation interval through clinical parameters RD, RW, PD, and CAL at the end of six months. Results: Recession depths in the first, third, and sixth month were 1.82 ± 0.442, 1.31 ± 0.47 mm, and 0.91 ± 0.29, respectively, which showed a significant reduction from the baseline. Recession widths in the first, second, and third weeks were 3.04 ± 0.442 mm, 1.31 ± 0.47 mm, and 1.49 ± 0.59 mm, respectively. There was a statistically significant reduction (P > 0.005) when compared to the baseline. Pocket depths in the first, third, and sixth month were 0.93 ± 0.447, 0.42 ± 0.50, and 0.24 ± 0.43 (P > 0.005) which is significant when compared to baseline. Clinical attachment levels in the first, third, and sixth month were 2.73 ± 0.751, 1.78 ± 0.70, and 1.18 ± 0.53 (P > 0.005) which is significant compared to six months. Conclusion: Within the limitations of the present study, the data obtained by periodic assessment of the clinical parameters indicate the use of amnion membrane and hyaluronic acid, and proper technique may thus be the panacea for root coverage procedure.

Aim: The purpose of the present study was to assess root coverage outcomes 10 years after connective tissue graft plus coronally advanced flap (CTG + CAF) or CAF alone, at single RT2 maxillary gingival recession. Materials and Methods: Twenty‐one of the original 29 patients (11 treated with CAF + CTG and 10 with CAF alone) were available for the 10‐year follow‐up. A blinded and calibrated examiner performed all the measurements. Outcome measures included complete root coverage (CRC), recession reduction (RecRed), root coverage aesthetic score (RES), and keratinized tissue (KT) gain. A visual analogue scale was used to evaluate patient satisfaction. Results: CRC was maintained in 63% of the test group and 20% of the control group after 10 years, with a significant difference favouring CAF + CTG (p =.030). Furthermore, the addition of CTG was associated with greater KT gain (p =.0002) and greater papilla tip recession (p =.023) than with CAF at the last follow‐up. No difference was detected regarding RecRed, RES, and patient satisfaction. Conclusions: Adding CTG under CAF improved the probability of maintaining complete root coverage 10 years after single maxillary RT2 recession treatment. [ABSTRACT FROM AUTHOR]

Objectives: To compare and evaluate the surgical outcome of gingival recession treatment using CAF alone or in conjunction with hyaluronic acid (HA) on Miller's Class I and class II gingival recession defects. Materials and methods: After randomisation, the control group (15 patients) received CAF alone and the test group (15 patients) received HA as an adjunct to CAF technique for an isolated gingival recession accompanied by an adequate width of keratinized gingiva on maxillary canines and premolars. All patients were evaluated at 7, 15, 30, 60 and 90 days interval post-operatively. Data obtained was subjected to statistical analysis and p value <0.05 was considered as statistically significant. Results: At 90 days interval statistically highly significant root coverage was obtained with mean gain of 66.1% in control group and 86.6% in test group. Statistically significant reduction in depth of gingival recession and gain in clinical attachment level was found for control and the test groups, and intergroup comparison showed statistically significant differences for root coverage and clinical attachment level between the groups (p = 0.000), however no significant differences were found for width of attached gingiva, keratinized gingiva and gingival thickness between the groups at 90 days (p > 005). Conclusion: HA has proven to be beneficial in the field of regenerative therapy. Our analysis suggested that HA can be used as a promising adjunct with CAF for root coverage, however further studies are required to imply the results on larger population. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the influence of vestibular depth (VD) on the outcomes of root coverage therapy. Methods: Patients presenting gingival recession defects (GRD) with a minimum depth of 2 mm underwent root coverage therapy consisting of a coronally advanced flap plus a connective tissue graft (CAF + CTG). Clinical examinations were performed, and intraoral scans were obtained at baseline, 3 and 6 months after surgery to assess changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), GRD area, marginal gingival thickness (MGT), and VD. The influence of VD on percentage of root coverage (%RC) and the likelihood of achieving complete root coverage (CRC) were explored. Results: A total of 20 patients were enrolled, and 44 teeth were treated. RD decreased and MGT increased in all treated sites. At 6 months, mean %RC was 87.47 ± 18.37 and CRC was observed in 61.4% of sites. Mean baseline VD was 7.33 ± 2.67 mm. Mean VD reduction from baseline to 6 months was 1.98 ± 1.27 mm. %RC and CRC were significantly correlated with baseline VD. Each additional 1 mm of baseline VD implied a gain of 6.58% for %RC and increased 2.75 times the probability of achieving CRC. Narrow baseline KTW and mandibular arch location were associated with inferior treatment outcomes. Conclusion: Lower %RC and likelihood of achieving CRC can be expected after root coverage therapy via CAF + CTG in sites presenting a shallow vestibulum. [ABSTRACT FROM AUTHOR]

Background. Gingival recessions are common mucogingival deformities and conditions around teeth, which are described as the apical migration of tissues in the relation to the cementoenamel junction. One of the types of graft materials used to treat these recessions is the collagen graft material. The aim of this pilot study was to evaluate the effectiveness of the use of the collagen matrix combined with the coronally advanced flap surgery method to cover dental recessions, after a 12 month follow-up period. Methods. The following parameters were assessed in 20 patients, with 38 single or multiple Miller class I or II gingival recessions: depth of the recession—RD; width of the recession—RW; height of the keratinized tissue—HKT; and thickness of the keratinized gingivae—GT. The percentage of the root coverage after 12 months was also calculated. Results. There was a significant difference in the RD and RW values before and after the procedure. On average, the RD decreased by 3.39 mm, and the RW by 3.87 mm. Moreover, the values of the GT and HKT, before and after the treatment, significantly increased by 0.98 mm and 1.13 mm, respectively. The partial root coverage was 43.48%, and the total root coverage was 56.52%. Conclusion. The use of the collagen matrix with a split thickness gingival flap to cover the gingival recessions is a predictable and effective method when the clinician carefully follows the recommendation of the producer, which was confirmed in a 1 year follow-up with good clinical results. [ABSTRACT FROM AUTHOR]

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Background: The gingival recession causes tooth sensitivity, poor esthetics, and tooth mobility in severe cases. Scientific documentation revealed effective root coverage (RC) and increased keratinized tissue heights acquired with the coronally advanced flap (CAF) for multiple recession defects. Objectives: This research evaluates and compares the efficacy of CAF procedures with and without Type I collagen bio-absorbable membrane in guided tissue regeneration (GTR) in the treatment of Miller's Class I and II gingival recession. Materials and Methods: A total of 30 sites from 15 patients were selected for the study after fulfilling the presurgical phase of treatment. The chosen sites were randomly allocated into Group A CAF and Group B (CAF + Resorbable GTR membrane). The clinical variables such as plaque index, gingival index, recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), clinical attachment level (CAL), and surface area of the defect were recorded at the baseline and 6 months postoperatively. Results: Both therapies resulted in a notable gain in RC with a mean of 73.13% and 71.60%, respectively, but it was not statistically significant when compared between the groups. Both the RD and RW were significantly reduced from baseline to 6 months postoperatively. Although there was a gain in WKG and CAL in both experimental sites, no significant difference was observed between both the groups. Conclusion: Although there are several RC procedures, CAF furnishes a foreseeable, straightforward, and appropriate perspective for treating Miller's Class I and II recessions. Integrating this approach with placing a bio-absorbable membrane does not seem to improve the results following surgical treatment of such defects. However, both groups showed the potential advantage of achieving RC. [ABSTRACT FROM AUTHOR]

Previous systematic reviews have reported that coronally advanced flap (CAF) + connective tissue graft (CTG) are the gold standard in root coverage procedures (RCP). Nevertheless, adjunctive treatment with hyaluronic acid (HA) has been proposed to aim at improving clinical outcomes and reducing patient morbidity. The aim of this systematic review and meta-analysis is to compare the use of HA as an adjunctive treatment to CAF procedures in Miller class I and II (recession type 1; RT1) gingival recession (GR) defects treatment with no adjunctive/other treatments. MEDLINE, The Cochrane Central Register of Controlled Trials, Web of Science, Scopus databases and gray literature were searched up to April 2022. The primary outcome variables were mean recession coverage (MRC) and reduction of the recession depth (RecRed). Weighted mean differences and 95% confidence intervals between treatments were estimated using a random-effect mode. From 264 titles identified, 3 RCTs reporting 90 GR defects in 60 patients were included. Overall analysis of MRC and RecRed were 0.27% (p = 0.01) and 0.40 mm (p = 0.45) in favor of CAF + HA compared to CAF alone/CAF + subepithelial connective tissue graft (SCTG), respectively, with a statistically significant difference only for MRC values. Nevertheless, due to the limited number and heterogeneity of the included studies, well-performed RCTs are needed to clarify a potential advantage of HA in RCPs in the future. [ABSTRACT FROM AUTHOR]

Gingival recession is a common dental condition causing esthetic and functional problems to the patients. In the present case report gingival recession Miller class III is treated with bilaminar technique and subepithelial connective tissue graft where the tooth root surface is modified by Er:YAG laser and the case is observed for 5 months. There were no complications or side effects during the surgery and the healing period. The patient was stable after 5 months of follow-up. It could be concluded that the Er:YAG laser could be used in addition to mucogingival surgery, but longer observation and more studies are needed to clarify and prove its adjunctive application.

Gingival recession is a commonly encountered chief complaint in a dental office, most commonly presenting as pain or sensitivity on intake of food or sometimes just seen as an esthetic concern which may present in a localized or generalized form. Such interest toward dental esthetics has encouraged clinicians to formulate newer minimally invasive surgical techniques which are short but still deliver predictable long-term benefits in restoring the patient's smile. One such method was evaluated in the present short communication where a commercially available, biodegradable, and volume-stable collagen membrane was used to manage gingival recession instead of donor grafts. The clinical parameters which were assessed after a period of 9 months demonstrated an increased width of attached gingiva and overall tissue thickness after surgical intervention. These findings along with successful mean root coverage of the upper left canine would seem to challenge the results obtained while using similar procedures and donor grafts, the age-old gold standard bio-filler. The dawn of esthetic dentistry is here with more emphasis on how physical appearance bolsters confidence and morale among younger individuals. Among the various complaints concerned with patient's esthetic, periodontal plastic surgery is one of the more challenging procedures. The real obstacle while performing such procedures is achieving complete or partial root coverage over an avascular bed, whereas multiple variables seem to affect the overall clinical outcome.

Background: The importance of esthetics has escalated over the years. The purpose of any perioplastic surgery is to address gingival recession while ensuring predictable root coverage and a pleasing appearance. An array of surgical procedures have been recommended for the management of recession defects. The present study compares the clinical and patient related outcome measures of coronally advanced flap with chorion membrane and connective tissue graft in the management of multiple adjacent gingival recessions. Methods: The study was a prospective randomized controlled trial which included eight systemically healthy patients with an age range of 30-44 years with 36 labial/buccal, multiple adjacent, Cairo’s RT1 gingival recession defects, bilaterally. CAF+CM was performed on one side whereas CAF+CTG was performed on the other side. The two groups were compared clinically at three and six months postoperatively. Results: There was statistically significant decrease in recession depth, recession width, probing depth and clinical attachment level in both the groups from baseline to three and six months. However, intergroup comparisons revealed no statistically significant difference. At six months, both groups showed statistically significant improvements in keratinized tissue width and gingival thickness. The gingival thickness of the CAF+CM group increased significantly at three and six months. In terms of root coverage aesthetic score (RES), there was no significant difference observed between the two groups. In terms of patient reported outcome measures (PROMS), patients preferred the CAF+CM technique. Conclusion: Within the limits of the current study, the use of chorion membrane resulted in considerable root coverage and increased gingival thickness. Periodontal regeneration can be facilitated by the distinctive features of the chorion membrane. Coronally advanced flap plus chorion membrane is a novel approach for root coverage procedures.

The treatment of gingival recession is a frequent demand due to aesthetic concern, root caries, and /or root hypersensitivity. The purpose of this case study was to evaluate the success and predictability of coronally advanced flap (CAF) in combination with peripheral blood mesenchymal stem cells (PBMSCs) and platelet rich fibrin matrix(PRFM) for the management of Miller's Class II gingival recession. CAF followed by placement of PBMSCs and PRFM was performed on a male patient, aged 25 years having Miller’s Class II gingival recession of 5-6 mm on the upper left canine, premolars and molars. The patient was followed up for 3 months. Root coverage of 60.0% and clinical attachment gain of 3 mm were evident following 3 months of follow-up. This novel technique showed an effective way to increase the width of attached gingiva and treat gingival recession.

Numerous surgical procedures are used to correct gingival recession, like free gingival graft, pedicle graft, and connective tissue graft. Our study aimed to compare and clinically evaluate root coverage using a coronally advanced flap (CAF) with and without Biomesh® membrane to treat recession type 1 (RT1) and type 2 (RT2) defects. A total of 20 systemically stable patients, both males and females between the ages of 20 and 40, with bilateral recession defects in maxillary canines and premolars, were included in the study. Patients were divided into two groups: the control group: coronally advanced flap only and the test group: coronally advanced flap with Biomesh® membrane. All clinical parameters showed significant reductions from baseline, 1 month, 3 months, and 6 months post-surgery. Gingival recession significantly reduced both in test and control groups with no intergroup difference. The exposed root was covered by 70% in the test group and 78% in the control group. Clinical attachment level, the width of keratinized tissue, recession height, and recession width was significantly increased in the case of coronally advanced flap alone with significant intragroup comparison. The results for both treatment techniques for recession coverage were compared. CAF displayed superior results than CAF along with Biomesh® membrane in terms of clinical attachment level, root coverage percentage, and attached gingiva width. [ABSTRACT FROM AUTHOR]

Gingival recession can lead to a variety of functional and esthetic problems. The problems associated with the gingival recession include unacceptable esthetics, hypersensitivity, root caries, and difficult plaque control. Gingival recession is a common clinical condition not only in populations with poor standards of oral hygiene but also in people maintaining good oral hygiene. In an esthetically driven era, the success of root coverage requires consideration of each one of the prognostic criteria. Various procedures have been popularized to treat the gingival recession. Zucchelli's technique is a modification of the coronally advanced flap for the treatment of teeth having multiple recessions. The upper hand of this procedure includes the absence of vertical releasing incisions, an appropriate thickness, combining sites of split and full thickness, and the coronal advancement of the flap. This case report presents the treatment of multiple adjacent gingival recessions using Zucchelli's coronally advanced flap. [ABSTRACT FROM AUTHOR]

Background: This case report describes treatment of multiple gingival recession with subgingival connective tissue graft and coronally advanced flap technique in treatment of maxillary teeth. Material And Methods: Connective tissue grafting was done in relation to upper right second premolar, first premolar, canine, right central incisor, left central incisor and left lateral incisor (#15, #14, #13, #11, #21, #22). A split thickness flap was elevated without disturbing periosteum in this region. The area between canine and second premolar was selected to harvest the graft. The graft was placed on the recipient bed and suturing was done. Result: Predictable root surface coverage could be obtained with use of coronally advanced flap and subepithelial connective tissue graft. Conclusion: Subepithelial connective tissue graft along with coronally advanced flap still stand as a gold standard treatment for gingival recession coverage. [ABSTRACT FROM AUTHOR]

Background: The importance of esthetics has escalated over the years. The purpose of any perioplastic surgery is to address gingival recession while ensuring predictable root coverage and a pleasing appearance. An array of surgical procedures have been recommended for the management of recession defects. The present study compares the clinical and patient related outcome measures of coronally advanced flap with chorion membrane and connective tissue graft in the management of multiple adjacent gingival recessions. Methods: The study was a prospective randomized controlled trial which included eight systemically healthy patients with an age range of 30-44 years with 36 labial/buccal, multiple adjacent, Cairo’s RT1 gingival recession defects, bilaterally. CAF+CM was performed on one side whereas CAF+CTG was performed on the other side. The two groups were compared clinically at three and six months postoperatively. Results: There was statistically significant decrease in recession depth, recession width, probing depth and clinical attachment level in both the groups from baseline to three and six months. However, intergroup comparisons revealed no statistically significant difference. At six months, both groups showed statistically significant improvements in keratinized tissue width and gingival thickness. The gingival thickness of the CAF+CM group increased significantly at three and six months. In terms of root coverage aesthetic score (RES), there was no significant difference observed between the two groups. In terms of patient reported outcome measures (PROMS), patients preferred the CAF+CM technique. Conclusion: Within the limits of the current study, the use of chorion membrane resulted in considerable root coverage and increased gingival thickness. Periodontal regeneration can be facilitated by the distinctive features of the chorion membrane. Coronally advanced flap plus chorion membrane is a novel approach for root coverage procedures.

Gingival recession is defined as the apical displacement of the gingival margin leading to exposure of the root surface. Occurrence of the gingival recessions in the anterior teeth is a major concern for the patients as it leads to compromised aesthetics and achieving the aesthetics and functional requirements of the patients remains a major therapeutic challenge for the treating dental surgeon. Incorporating the principles of Minimally Invasive Surgical Technique (MIST), surgical trauma is minimised, thus causing less cell damage, eventually resulting in less inflammation and less discomfort. MIST aims to achieve aesthetically superior outcomes that are made possible due to improved visual acuity. Therefore, the intent of this case report was to emphasise the impact of implementing the minimally invasive surgical procedure in the management of marginal gingival recessions using the conventional Coronally Advanced Flap (CAF) and the Tarnow’s technique, with the use of microsurgical instruments and magnifying surgical loupes.

Background: The presence or absence of the interdental papilla is a topic of great esthetic concern. Several surgical and nonsurgical techniques have been proposed to rebuild lost papilla. However, there is a paucity in the literature assessing comparative studies. Aims and Objective: The aim to evaluate and compare the effectiveness of novel vestibular incision for papilla reconstruction with semilunar flap technique. Objectives: To compare effectiveness of novel vestibular incision for papilla reconstruction with semilunar flap technique. Material and Methods: Fourteen patients with the age range of 20–40 years who were conscious for their esthetics with total or partial loss of the interdental papilla were selected for the study. The patients were randomly divided into two groups, namely Group A (vestibular incision subperiosteal tunnel access [VISTA] technique) and Group B (semilunar flap technique). Result: At 6-month postsurgery, there was a statistically significant reduction in vertical dimension, mesiodistal dimension, and area of the papilla defect in Group A as compared to Group B. At 6-month postsurgery, there was an increase in the height of the papilla in Group A, whereas there was a decrease in the height of the papilla in Group B. Both the techniques exhibited satisfactory results in terms of papillary defect fill over a 6-month period. Conclusion: The novel VISTA approach for papillary reconstruction could be a better alternative owing to less postoperative scarring and predictable results. [ABSTRACT FROM AUTHOR]

Aim: To compare the outcomes of modified coronally advanced flap (mCAF) combined with either xenogeneic dermal matrix (XDM) or connective tissue graft (CTG) for the treatment of multiple adjacent gingival recessions (MAGRs). Materials and methods: Forty-two patients, in whom 130 maxillary (MAGRs) of type (RT1) were found, were randomly allocated to the two groups. Clinical, esthetic, and patient-centered outcomes were evaluated at baseline, 6, and 12 months post-treatment. Result: Group CAF+ CTG exhibited a higher mean root coverage value (mRC) (91.79%) (primary outcome variable) than group CAF+XDM (80.19%) without statistically significant difference at 12 months (p=0.06). The control group also had significantly higher percentage of teeth in which complete root coverage (CRC) and mean gain of gingival thickness (GT) were achieved, than the test group (p<0.05). With respect to patient-centered outcomes, patients of the test group reported having experienced significantly less pain than those of the control group until 7 days (p<0.05). Both surgical approaches were capable of significantly decreasing dentin hypersensitivity (p<0.05). No difference between groups was found in the esthetic score analysis (p>0.05). Mean surgical time was lower in the test group (p<0.05). Conclusion: The two treatments showed similar mRC. However, CAF+CTG was superior to CAF+XDM in providing CRC and in gaining GT. CAF+XDM demonstrated advantages over CAF+CTG with regard to patient morbidity and surgical time. Clinical relevance: Application of XDM provided a better patient experience and shortened the time to recovery after coronally advanced flaps for coverage of multiple adjacent recessions. However, CTG resulted in improved percentages of complete root coverage. Trial registration: Brazilian Clinical Trials Registry (REBEC) number: RBR-974c9j [ABSTRACT FROM AUTHOR]

Background/Aim: Gingival recession is defined as apical migration if the gingival margin associated with exposure of the cement - enamel junction. The gingival recessions are major esthetic concern in patients at any age. In cases with esthetic and functional considerations mucogingival surgery is indicated. The advantages of CAF with or without CTG are making this procedure highly recommended in the esthetic zone. The results are predictable about root coverage, widening if the gingival tissues and esthetics. The aim of the recent case report is to demonstrate the succesfull combination of coronally advanced flap with connective tissue graft in the treatment of wide and deep gingival recessions.

Introduction: Different surgical techniques (pedicle and free soft-tissue grafting) are proposed for treatment of the exposed root surface in the aesthetic zone of dentition. A coronally advanced flap is a suitable technique that can be used for root coverage in treatment of gingival recessions of single tooth as well as multiple teeth. Two different techniques of the coronally advanced flap are proposed: trapezoidal flap and triangular flap. Clinicians tend to use a surgical approach which could be minimally invasive as possible. This can be achieved by periodontal microsurgical technique. Microsurgical instruments with suitable magnification devices and illumination would be predominantly proposed. Purpose: The aim of this case report is to demonstrate the comparison in therapeutic outcome between coronally advanced flap technique with a microsurgical approach and coronally advanced flap technique with a conventional approach for root coverage in the aesthetic zone of upper jaw. Material and methods: Miller’s class I gingival recessions, affecting tooth 11 and tooth 12, are established. A microsurgical approach is used in the treatment of tooth 11 and conventional coronally advanced flap in case of tooth 12. Results: Complete root coverage and gain of clinical attachment level are achieved in both approaches. Conclusion: This case report demonstrates similar results in both approaches – conventional and microsurgical ones.

Multiple adjacent recessions are challenging defects since they present a number of critical anatomic features as large surgical field, frequently shallow vestibules and prominent roots as well as a variation in the size of defects and residual keratinized tissue. Different surgical techniques have been proposed for the treatment of multiple adjacent recessions, mainly derived from the coronally advanced flap with or without connective tissue graft or from tunnel approaches. Harvesting of connective tissue graft is time consuming, it is limited in quantity and exposes patient to another surgical wound. The overall objective of this study is to evaluate the effectiveness of Coronally advanced flap with Chorion membrane for the treatment of multiple adjacent gingival recession defects.

Introduction: One of the most common aesthetic concerns associated with the periodontal tissue is gingival recession. Covering the root surface exposed during the disease process with soft and hard tissue surgeries may decrease these problems. The aim of the study was to compare the clinical outcome of coronally advanced flap (CAF) procedure in root coverage with platelet-rich fibrin (PRF) or subepithelial connective tissue graft (SCTG) for the treatment of Miller's Class-I gingival recession. Materials and Methods: The split mouth design consisted of 15 patients with a total of 30 sites with bilateral Miller's Class-I recession on anterior teeth. They were randomly assigned into PRF group (test) or SCTG group (control). Statistical Analysis: The values obtained were tabulated and analyzed using Mann--Whitney U-test and repeated measure ANOVA test. All the statistical tests were carried out using SPSS software. Results: It was observed that both the autogenous grafts healed without any complications and at the end of 6 months the grafts were stable and recession coverage between 88-100% was achieved. Conclusion: CAF procedure with either PRF or SCTG were both effective in the treatment of Miller's Class-I gingival recessions. CAF with SCTG showed better root coverage than CAF with PRF. Use of PRF offered additional benefit of avoiding second surgical site. Therefore, PRF can be considered as a viable alternative to SCTG in certain cases.

Background and objectives Mucogingival plastic surgery is a surgical procedure performed to prevent or correct anatomical, developmental, or traumatic defects. The problem of gingival recession is common in dental practice, causing pain and dentin hypersensitivity for the patient, and remains difficult to treat surgically at the second surgical site used to harvest the connective graft. Many alternatives have been used to replace connective grafts, but none have been as effective. The importance of guided tissue regeneration remains to gain attachment because it means the formation of new periodontal tissue. This study aims to evaluate the attachment gain (AG) obtained after the management of single gingival recessions of Class I and Class II of Miller's classification. Material and methods This study was designed as a clinical randomized trial using a split-mouth technique. The study sample included 15 patients (30 symmetrical gingival recessions). The first group included the coronally advanced flap (CAF) with the connective tissue graft (CTG), and the second group included the CAF with the Xenogeneic Acellular Dermal Matrix (XDM) (Mucoderm®, Botiss Biomaterials, Zossen, Germany). AG was measured at baseline and after six months. Results The results showed that the mean relative attachment level at baseline was 8.333±0.899 in the CTG+CAF group and 8.466±0.833 in the XDM+CAF group. After six months of follow-up, the levels remained 8.333±0.899 in the CTG+CAF group and 8.466±0.833 in the XDM+CAF group, with a significant difference between the study groups after six months. Conclusion The current study concluded that both grafts applied with the coronally advanced flap led to a gain in attachment, with a greater gain in the CTG group., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Damascus University Ethics Committee issued approval DN2670. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alabed et al.)

This systematic review (SR) aims to evaluate the efficacy of modified coronally advanced flap (mCAF) on clinical and patient-reported outcomes in the treatment of multiple adjacent gingival recessions (MAGRs). Randomized controlled trials (RCTs), case-series and prospective clinical studies on treatment of Miller class I/II or RT1 MAGRs with ≥ 6 months follow-up were identified from the electronic databases and hand-searched journals. Complete root coverage (CRC) was the primary outcome variable. To evaluate treatment effects, meta-analysis was conducted, wherever appropriate. A total of 1395 recessions in 408 patients were evaluated in SR and meta-analysis was performed for four RCTs. Overall CRC achieved with mCAF was 70% and mean root coverage (MRC) ranged from 51.58 to 97.27%. Meta-analysis showed that combination of mCAF with connective tissue graft (CTG) or collagen matrix (CM) demonstrated significantly higher CRC% and recession reduction than mCAF alone. Limited evidence is available to support the use of platelet rich fibrin or enamel matrix derivative or acellular dermal matrix graft along with mCAF to further enhance its efficacy. mCAF is an effective procedure for treating MAGRs and in terms of achieving CRC and MRC. Additional use of CTG or CM further enhances treatment outcomes. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, several methods have been described for the treatment of deep Miller Class II recessions. Most of these techniques concentrate on single recessions or one deep recession accompanied by just slight neighboring root denudations. A modified technique is presented for treating two or more deep recessions beyond the mucogingival margin combining a subepithelial connective tissue graft (SCTG), enamel matrix derivative, and a multiple pedicle coronally advanced flap. To the best of our knowledge, this is the first report to describe the treatment of multiple deep Miller Class II recessions exceeding beyond the mucogingival junction using a pedicled advanced flap. Case Presentation: A 29‐year‐old woman was referred to the periodontal practice of JT for the treatment of progressive deep Miller Class II recessions. The root coverage procedure was performed by a modified multiple pedicle flap combined with a connective tissue graft harvested from the palate and enamel matrix derivative. The case was followed up for 2 years. Conclusions: This modified technique of a multiple pedicled flap is a feasible and useful method for treating several deep neighboring recessions. Due to the improved incision techniques, scar tissue formation might be reduced not to interfere with the esthetic result. [ABSTRACT FROM AUTHOR]