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Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial

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Abstract

Background and objective

Subepithelial connective tissue grafts (SeCTG) in conjunction with a coronally advanced flap (CAF) or with tunneling technique (TT) are common periodontal procedures with similar indications for the treatment of a denuded root surface; however, it is unclear whether patient discomfort and postoperative morbidity are comparable in both approaches. The aim of this randomized controlled clinical trial was to compare the patient morbidity and root coverage outcomes of a SeCTG used in combination with a CAF or TT.

Materials and methods

For this single-center, randomized, clinical trial, patients were randomly assigned to receive SeCTG + CAF (control group) or SeCTG + TT (test group). Postoperative questionnaires at 3 days post intervention were administered to evaluate postoperative discomfort, bleeding, and inability to masticate. Evaluation of patients’ perception of pain was performed using a visual analog scale (VAS). Clinical outcomes including percentage of root coverage (RC) and complete root coverage (CRC) were recorded 12 months postoperatively.

Results

Fifty patients (25 SeCTG + CAF and 25 SeCTG + TT) completed the study. Healing was uneventful for all test and control patients. The SeCTG + TT group showed a longer chair time (33.6 (3.6) and 23.6 (4.2) min for the SeCTG + TT and the SeCTG + CAF, respectively), as well as more painkiller consumption: 2736 vs. 1536 mg (p < 0.001). At the same time, the SeCTG + CAF group reported less pain or discomfort in all four sections of the questionnaire: pain experienced within the mouth as a whole, pain experienced throughout the day, pain experienced at night, and edema experienced after the surgery (p = 0.002, p = 0.001, p = 0.001, and p = 0001, respectively). Both treatments showed clinical efficacy in terms of root coverage as no differences per group were observed in the percentage of root coverage (87 vs. 85 %, p = 704) or patients with complete root coverage (60 vs. 52 %, p = 0.569).

Conclusions

SeCTG + TT is associated with a greater incidence of pain and discomfort compared to SeCTG + CAF in early postoperative periods, as well as a longer chair time. Both treatments showed similar clinical efficacy in terms of root coverage.

Clinical relevance

The results of this study may influence the surgeon’s choice on which root coverage procedure should be performed considering the need of more chair time and more painkiller assumption with the tunneling technique.

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Notes

  1. Vicryl, Johnson & Johnson; Woluwe, Belgium

  2. Vicryl, Johnson & Johnson; Woluwe, Belgium

  3. Vicryl, Johnson & Johnson; Woluwe, Belgium

  4. Vicryl, Johnson & Johnson; Woluwe, Belgium

  5. Hu-Friedy, Chicago, IL, USA

References

  1. Bouchard P, Malet J, Borghetti A (2001) Decision-making in aesthetics: root coverage revisited. Periodontol 2000 27:97–120

    Article  PubMed  Google Scholar 

  2. Roccuzzo M, Bunino M, Needleman I, Sanz M (2002) Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 29:178–194

    Article  PubMed  Google Scholar 

  3. Clauser C, Nieri M, Franceschi D, Pagliaro U, Pini-Prato G (2003) Evidence-based mucogingival therapy. Part 2: ordinary and individual patient data meta-analyses of surgical treatment of recession using complete root coverage as the outcome variable. J Periodontol 74:741–756

    Article  PubMed  Google Scholar 

  4. Cairo F, Pagliaro U, Nieri M (2008) Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol 35:136–162

    Article  PubMed  Google Scholar 

  5. Oates TW, Robinson M, Gunsolley JC (2003) Surgical therapies for the treatment of gingival recession. A systematic review. Ann Periodontol 8:303–320

    Article  PubMed  Google Scholar 

  6. Pagliaro U, Nieri M, Franceschi D, Clauser C, Pini-Prato G (2003) Evidence-based mucogingival therapy. Part 1: a critical review of the literature on root coverage procedures. J Periodontol 74:709–740

    Article  PubMed  Google Scholar 

  7. Langer B, Langer L (1985) Subepithelial connective tissue graft technique for root coverage. J Periodontol 56(12):715–720

    Article  PubMed  Google Scholar 

  8. Zucchelli G, Clauser C, De Sanctis M, Calandriello M (1998) Mucogingival versus guided tissue regeneration procedures in the treatment of deep recession type defects. J Periodontol 69:138–145

    Article  PubMed  Google Scholar 

  9. Zucchelli G, Amore C, Sforza NM, Montebugnoli L, De Sanctis M (2003) Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study. J Clin Periodontol 30:862–870

    Article  PubMed  Google Scholar 

  10. Allen EP, Miller Jr PD (1989) Coronal positioning of existing gingiva: short term results in the treatment of shallow marginal tissue recession. J Periodontol 60:316–319

    Article  PubMed  Google Scholar 

  11. Zuhr O, Rebele SF, Schneider D, Jung RE, Hürzeler MB (2014) Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient-centred outcomes. J Clin Periodontol 41:582–592

    PubMed  Google Scholar 

  12. Rebele SF, Zuhr O, Schneider D, Jung RE, Hürzeler MB (2014) Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part II. Volumetric studies on healing dynamics and gingival dimensions. J Clin Periodontol 41:593–603

    Article  PubMed  Google Scholar 

  13. Burkhardt R, Lang NP (2005) Coverage of localized gingival recessions: comparison of micro- and macrosurgical techniques. J Clin Periodontol 32:287–293

    Article  PubMed  Google Scholar 

  14. Bittencourt S, Del Peloso Ribeiro E, Sallum EA, FH NJ, Casati MZ (2012) Surgical microscope may enhance root coverage with subepithelial connective tissue graft: a randomized-controlled clinical trial. J Periodontol 83:721–730

  15. Aroca S, Keglevich T, Nikolidakis D, Gera I, Nagy K, Azzi R, Etienne D (2010) Treatment of class III multiple gingival recessions: a randomized-clinical trial. J Clin Periodontol 37:88–97

    Article  PubMed  Google Scholar 

  16. Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M (2009) Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol 80:1083–1094

    Article  PubMed  Google Scholar 

  17. JW Jr Curtis, McLain JB, Hutchinson RA. The incidence and severity of complications and pain following periodontal surgery. J Periodontol 1985;56: 597–601

  18. Griffin TJ, Cheung WS, Zavras AI, Damoulis PD (2006) Postoperative complications following gingival augmentation procedures. J Periodontol 77:2070–2079

    Article  PubMed  Google Scholar 

  19. Harris RJ, Miller R, Miller LH, Harris C (2005) Complications with surgical procedures utilizing connective tissue grafts: a follow-up of 500 consecutively treated cases. Int J Periodontics Restorative Dent 25:449–459

    PubMed  Google Scholar 

  20. Wessel JR, Tatakis DN (2008) Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Periodontol 79:425–430

    Article  PubMed  Google Scholar 

  21. Schulz KF, Altman DG, Moher D, CONSORT Group (2011) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Int J Surg 9:672–677

    Article  PubMed  Google Scholar 

  22. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG (2010) CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 23(340):c869

    Article  Google Scholar 

  23. Jr MPD (1985) A classification of marginal tissue recession. Int J Periodontics Restorative Dent 5:8–13

  24. O’Leary TJ, Drake RB, Naylor JE (1972) The plaque control record. J Periodontol 43:38

    Article  PubMed  Google Scholar 

  25. Bruno JF (1994) Connective tissue graft technique assuring wide root coverage. Int J Periodontics Restorative Dent 14:126–137

    PubMed  Google Scholar 

  26. Zucchelli G, De Sanctis M (2000) Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol 71:1506–1514

    Article  PubMed  Google Scholar 

  27. Allen EP (1988) Use of mucogingival surgical procedures to enhance esthetics. Dent Clin N Am 32:307–330

    PubMed  Google Scholar 

  28. Sanz M, Lorenzo R, Aranda JJ, Martin C, Orsini M (2009) Clinical evaluation of a new collagen matrix (Mucograft prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial. J Clin Periodontol 36:868–876

    Article  PubMed  Google Scholar 

  29. Saroff SA, Chasens AI, Eisen SF, Levey SH (1982) Free soft tissue autografts. Hemostasis and protection of the palatal donor site with a microfibrillar collagen preparation. J Periodontol 53:425–428

    Article  PubMed  Google Scholar 

  30. Marchi A, Vellucci R, Mameli S, et al. (2009) Pain biomarkers. Clin Drug Investig 29:41–46

    Article  PubMed  Google Scholar 

  31. Pulvers K, Hood A (2013) The role of positive traits and pain catastrophizing in pain perception. Curr Pain Headache Rep 17:330

    Article  PubMed  PubMed Central  Google Scholar 

  32. Matthews DC, McCulloch CA (1993) Evaluating patient perceptions as short-term outcomes of periodontal treatment: a comparison of surgical and non-surgical therapy. J Periodontol 64:990–997

    Article  PubMed  Google Scholar 

  33. Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M (2010) Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 37:728–738

    PubMed  Google Scholar 

  34. Cortellini P, Tonetti M, Baldi C, Francetti L, Rasperini G, Rotundo R, Nieri M, Franceschi D, Labriola A, Prato GP (2009) Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? A multi-centre, randomized, double-blind, clinical trial. J Clin Periodontol 36:68–79

    Article  PubMed  Google Scholar 

  35. Conrad SM, Blakey GH, Shugars DA, Marciani RD, Phillips C, Jr WRP (1999) Patients’ perception of recovery after third molar surgery. J Oral Maxillofac Surg 57:1288–1294

    Article  PubMed  Google Scholar 

  36. Snyder M, Shugars DA, White RP, Phillips C (2005) Pain medication as an indicator of interference with lifestyle and oral function during recovery after third molar surgery. J Oral Maxillofac Surg 63:1130–1137

  37. Sato FRL, Asprino L, de Araújo DES, de Moraes M (2009) Short-term outcome of postoperative patient recovery perception after surgical removal of third molars. J of Oral and Maxillofac Surg 67:1083–1091

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Cristiano Tomasi, DDS, MSc, Odont Dr. (PhD), Department of Periodontology, Institute of Odontology, the Sahlgrenska Academy at the University of Gothenburg, for his guidance and invaluable assistance in the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Periodontology, School of Dentistry, University of Padova, Padua, Italy

    Luca Gobbato, Eriberto Bressan & Fabio Mazzocco

  2. Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Carrer de Josep Trueta Sant Cugat del Vallès, 08195, Barcelona, Spain

    Jose Nart

  3. Department of Prosthodontics, School of Dentistry, University of Padova, Padua, Italy

    Gianluca Paniz

  4. Department of Prosthodontics, School of Dentistry, University of Milan, Milan, Italy

    Diego Lops

Authors
  1. Luca Gobbato
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  2. Jose Nart
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  4. Fabio Mazzocco
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  5. Gianluca Paniz
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Corresponding author

Correspondence to Jose Nart.

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Ethical approval

This prospective study was performed in accordance with the guidelines of the 1964 Declaration of Helsinki, and the research protocol was approved by the Ethics Committee of the University of Padova (No.: 2566P), prior to patient enrollment. Additionally, this clinical study was registered at the US National Institutes of Health Clinical Trials Registry (NCT02269748). Patients were notified that their data would be collected and used for a statistical analysis. This article does not contain any studies with animals performed by any of the authors.

Conflict of interest

The authors declare that they have no competing interests.

Funding

The authors declare that they received no funds or reimbursements for the completion of the study. The authors report no financial and personal relationships with other people or organizations that could inappropriately influence this paper.

Informed consent

A signed informed consent was obtained from all patients enrolled in this study.

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Gobbato, L., Nart, J., Bressan, E. et al. Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial. Clin Oral Invest 20, 2191–2202 (2016). https://doi.org/10.1007/s00784-016-1721-7

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