Ultrasonographic Evaluation of the Connective Tissue Grafts Obtained With Two Different Methods in Root Coverage

Summary

Gingival recession is a clinical problem that increases with age and affects patient comfort. It is defined as the displacement of the gingival margin to a more apical position of the cementum-enamel border of the tooth.

Coronally advanced flap (CAF) or tunnel technique (TUN) with subepithelial connective tissue procedures have been reported to be the most predictable methods of single gingival recession treatments. The ultimate goal of these plastic periodontal surgical procedures is to close the exposed root surface and achieve optimum aesthetic results. The main indications for root coverage (RC) procedures are aesthetic concern, root hypersensitivity, prevention of cervical abrasion and root caries, improvement of restorative results, and facilitation of plaque control. The use of a subepithelial connective tissue graft (SCGT) combined with a coronally positioned flap is considered the gold standard by many authors for single gingival recession treatments.

De-epithelialization of free gingival grafts (DGG) has been proposed, especially when palatal tissue thickness is insufficient (≤2.5 mm) and larger graft size in the apico-coronal or mesio-distal directions is required. In this technique, the graft of the required width and length is separated from the lateral side of the palate, and then the 0.3-0.5 mm thick epithelial layer of the resulting graft is cut from the connective tissue layer.

Ultrasonography (USG) is based on the principle of recording data obtained as a result of ultrasound waves sent with the help of a probe hitting and reflecting on substances of different densities. This technique is widely used in medical practice. In dentistry, the USG method is used to measure the alveolar bone level and the dimensions of the periodontium to evaluate the gingival thickness. It also has functions to evaluate color power and color speed, as well as blood flow.

The study hypothesizes that combining SCGT and DGG with a coronally positioned flap could yield different clinical outcomes in patients with a single buccal gingival recession. This study aims to compare the clinical success of connective tissue grafts obtained by two different surgical methods in covering the root surface with ultrasonography (USG).

Conditions

• Gingival Recession, Localized

Interventions

PROCEDURE

subepithelial connective tissue graft

The area where the gingival recession occurred was prepared with the modified coronally positioned flap technique developed by Zuchelli. The subepithelial connective tissue graft was obtained in each patient using the single incision technique from the region between the mesial of the canine and the mesial of the first molar in the palate. Connective tissue dimensions were approximately 10x5x2 mm. The graft thickness was measured with an endodontic spreader from 3 points (mesial, buccal, and distal) and an electronic caliper during surgery.

PROCEDURE

de- epithelize gingival graft

The area where the gingival recession occurred was prepared with the modified coronally positioned flap technique developed by Zuchelli. A shallow horizontal incision was made at ≈3 mm apical from the gingival margin of the maxillary molar teeth using a number 15 scalpel blade. Subsequently, a parallel horizontal incision, at ≈ 4 mm apical from the first horizontal incision, was traced in conjunction with two vertical releasing incisions to delineate a rectangular area. Then, the uppermost epithelial layer was scraped off using a size 11 scalpel tip. The connective tissue graft to be taken from the palate area was 10x5x2 mm in size, and the graft thickness was measured with an endodontic spreader from 3 points (mesial, buccal, and distal) and electronic caliper during surgery.

DIAGNOSTIC_TEST

ultrasonography

Clinical parameter measurements (probing depth (PD), clinical attachment level (CAL), gingival recession depth and width, keratinized tissue width and height) were taken on the day of surgery, the 3rd days, the 14th days, the 1st month, the 3rd months and the 6th months. Ultrasonography measurements A 6-18 MHz intraoral probe was used in intraoral USG examinations. Sterile gel was applied to the intraoral probe and covered with a stretch film. Then, it was placed directly on the mucosal surface of the receiver site in the buccal area. Mucosal thickness was evaluated using the B-mode of the device, and vascularization was evaluated using the color doppler and pulsed wave doppler modes of the device. The following equation is used and calculated by US unit pulsatility index (PI) = (Vmax-Vmin) (Vmean) (Vmax is peak systolic flow velocity. Vmin is diastolic flow velocity and Vmean is mean flow velocity.) The mean PI values of each patient were measured.

Sponsors & Collaborators

• Pamukkale University

  lead OTHER

Principal Investigators

• GİZEM TORUMTAY CİN, assist prof. · PAMUKKALE UNIVERSITY FACULTY of DENTISTIRY

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2023-06-15

Primary Completion

2024-01-15

Completion

2024-03-16

Countries

• Turkey (Türkiye)

Study Locations