Clinical and patient-centred long-term results of root coverage using the envelope technique in a private practice setting: 10-year results-A case series.

AIM: Evaluation of long-term results after connective tissue graft (CTG) using the envelope technique and the effect on patient-centred outcomes (Oral Health Impact Profile: OHIP) in a private practice setting. MATERIALS AND METHODS: Fifteen patients (11 female, mean age: 45.0 ± 8.88 years) underwent root coverage procedure using a CTG involving maxillary Miller class I teeth. Pre-operatively, 3 and 120 ± 12 months after surgery, all patients were examined, completed OHIP questionnaire, and were asked to assess improvement and their satisfaction with the results of surgery. All procedures were performed by the same investigator. RESULTS: Recession depth at 3 months of 1.19 ± 0.93 mm was reduced to that of 0.63 ± 0.64 mm at 120 ± 12 months after surgery (p = .117). Recession width (-1.23 ± 2.27 mm) decreased as well (p = .117), while relative root coverage increased from 48.46 ± 32.18% at 3 months to 71.22 ± 30.86% at 120 months (p = .011). The number of cases with complete root coverage increased from two (15.4%) to six (40.0%) from 3 to 120 months (p = .046). OHIP score (12.07 ± 10.15) did not change after 10 years (12.13 ± 9.86, p = .889). Ten years after surgery, 12 patients (80%) reported they would make the decision again to undergo CTG transplantation. CONCLUSIONS: Within the limitations of the study design with a high risk of bias in a practice setting, long-term stability of recession reduction, OHIP and patient-perceived satisfaction remained stable over 10 years.

Infrabony defects 20 years after open flap debridement and guided tissue regeneration.

AIM: Evaluation of 20-year results after open flap debridement (OFD) and guided tissue regeneration (GTR) of infrabony defects in a randomized controlled trial. MATERIALS AND METHODS: In originally 16 periodontitis patients (baseline examination), periodontal surgery was performed in 44 infrabony defects. Polylactide acetyltributyl citrate barriers were randomly assigned to 23 out of these 44 defects (parallel). Ten of these patients (GTR) exhibited a second, contra-lateral defect (OFD) each (split-mouth). At baseline, 12, 120 and 240 ± 12 months after surgery probing depths, attachment level, bleeding on probing as well was Plaque Index, Gingival Bleeding Index and plaque control record were obtained. RESULTS: Twelve patients contributing 38 defects were available at 240 months. At 12, 120 and 240 ± 12 months, both groups showed significant (p < 0.01) attachment gain (split-mouth: OFD: 12 months: 4.15 ± 2.93 mm; 120 months: 3.35 ± 2.37 mm, 240 months: 3.60 ± 2.55 mm; GTR: 12 months: 3.50 ± 2.47 mm; 120 months: 3.90 ± 2.76 mm, 240 months: 3.80 ± 2.69 mm; parallel: OFD: 12 months: 3.53 ± 2.04 mm; 120 months: 3.59 ± 2.54 mm, 240 months: 3.53 ± 2.50 mm; GTR: 12 months: 4.07 ± 2.88 mm; 120 months: 3.13 ± 2.22 mm, 240 months: 3.13 ± 2.22 mm). Seven teeth (3 OFD, 4 GTR) were lost. Only 1 patient out of 12 was kept in regular supportive periodontal therapy (SPT) over 20 years. The study failed to show significant attachment gain differences between both groups after 240 months. CONCLUSIONS: Twenty years after OFD and GTR in infrabony defects in a population with lack of regular SPT attachment gains at 12 months after surgery were stable. About 82% of the initially included teeth were still in place.

Direct thickness measurements of the hard palate mucosa.

OBJECTIVE: To measure directly the thickness of the palatal mucosa using sharp cannulas and to evaluate potential correlations with gender and body mass index (BMI). METHOD AND MATERIALS: Thirty-three participants (19 women) 23 to 41 years of age (27.8 +/- 4.1) were examined. Mucosal thickness from maxillary left canine to left second molar was measured at defined sites under local anesthesia using single-use cannulas with silicone stops. The cannulas were evaluated on video images. RESULTS: The mean thickness of the palatal mucosa was lowest in the first molar areas (4.39 +/- 1.05 mm), increased considerably in the canine/premolar regions, and was highest in the second molar areas (5.75 +/- 1.78 mm). Women exhibited higher mucosal thickness values than men in all tooth regions (P < .05 for the canine and the molar regions). Multivariate analysis revealed a relation of palatal mucosal thickness to gender and BMI. CONCLUSION: The thickness of the palatal mucosa is characterized by variations that correlate with tooth regions, gender, and BMI. Direct measurements with sharp cannulas provide higher thickness values than measurements with blunt periodontal probes or ultrasonographic measurements. This finding is important particularly with regard to the hard palate as a donor site for connective tissue grafts.

Ten-year results after connective tissue grafts and guided tissue regeneration for root coverage.

BACKGROUND: This study clinically evaluates the 10-year results of connective tissue graft (CTG) and guided tissue regeneration (GTR) therapies using bioabsorbable barriers for root coverage (i.e., the reduction of recession depth). METHODS: In 15 patients, 38 Miller Class I and II recessions were treated. Recession defects received a CTG or GTR by random assignment. At baseline (immediately prior to surgery) and 6 and 120 +/- 12 months after surgery, clinical parameters were obtained. RESULTS: Nine patients, who contributed 24 recession defects, were available for re-examination at 120 +/- 12 months. Six and 120 +/- 12 months after receiving a CTG, statistically significant (P <0.05) root coverage was observed compared to baseline root coverage (6 months: 3.07 +/- 1.74 mm; 120 +/- 12 months: 2.07 +/- 1.89 mm). The GTR therapy resulted in statistically significant root coverage compared to baseline root coverage only after 6 months (2.28 +/- 1.77 mm; P <0.05). Both groups experienced a statistically significant loss of coverage from 6 to 120 +/- 12 months (CTG: -1.0 +/- 0.78 mm; GTR: -2.03 +/- 2.24 mm). At 120 +/- 12 months after CTG surgery, the stability of root coverage was statistically significantly better than 120 +/- 12 months after GTR surgery (P = 0.002). The CTG caused more post-surgical discomfort (P <0.05), but it resulted in a better treatment outcome (P <0.05) than GTR as perceived by patients. CONCLUSION: The long-term stability of root coverage (i.e., the reduction of recession depth) and esthetic results perceived by patients were significantly better 10 years after CTG surgery, statistically, than after GTR surgery using bioabsorbable barriers.

Open flap debridement and guided tissue regeneration after 10 years in infrabony defects.

OBJECTIVE: Evaluation of the 10-year results after open flap debridement (OFD) and guided tissue regeneration (GTR) therapy of infrabony defects in a randomized controlled clinical trial. MATERIALS AND METHODS: In 16 periodontitis patients OFD or polylactide acetyltributyl citrate barriers (GTR; n=23) were assigned randomly to 44 infrabony defects. In a subgroup of 10 patients exhibiting 2 contra-lateral defects each OFD and GTR was assigned to either side (split-mouth). At baseline, 12, and 120 +/- 12 months after surgery clinical parameters were obtained. RESULTS: Fifteen patients (41 defects) were available at 120 months. Twelve and 120 +/- 12 months after therapy both groups showed statistically significant (p<0.01) attachment gain (split-mouth: OFD: 12 months: 3.60 +/- 2.67 mm; 120 months: 3.65 +/- 3.36 mm; GTR: 12 months: 3.50 +/- 1.90 mm; 120 months: 2.85 +/- 2.24 mm; parallel: OFD: 12 months: 3.47 +/- 2.80 mm; 120 months: 3.41 +/- 2.75 mm; GTR: 12 months: 3.67 +/- 2.11 mm; 120 months: 2.89 +/- 2.12 mm). From 12 to 120 months both groups experienced insignificant attachment changes, however, six teeth (two OFD, four GTR) were lost (all for prosthodontic reasons). The study failed to show statistically significant attachment gain differences between both groups after 120 months. CONCLUSIONS: Ten years after OFD and GTR in infrabony defects 35 of 41 teeth were still in place.

Long-term results of root coverage with connective tissue in the envelope technique: a report of 20 cases.

Connective tissue grafts (CTGs) are generally viewed as the most successful technique for root coverage. The aim of this retrospective study was to assess the long-term clinical and patient-centered esthetic results of the envelope technique for CTG. Thirty-nine defects in 20 patients (22 to 57 years of age; mean 37.8 +/- 11.5 years) had received CTG that had been harvested from the palate and grafted according to the envelope technique of Raetzke. Factors influencing root coverage were identified by multilevel analysis. The patients were also asked to judge the results of treatment. Follow-up examinations were performed 6 to 22 years (mean, 11.4 +/- 5.4 years) after surgery. Mean baseline recession was 3.1 +/- 1.3 mm (range, 1 to 6 mm). Clinical re-examination revealed mean root coverage of 89.7% +/- 25.1%. In 32 of 39 defects (82%), complete root coverage was achieved. Recessions were statistically significantly reduced by a mean of 2.7 +/- 1.2 mm (P < .001), to a postsurgical mean of 0.4 +/- 0.94 mm. Higher baseline Miller classes resulted in less favorable prognoses for complete and relative root coverage. Baseline recession height had a negative influence and location at a canine had a positive influence on the percentage of relative root coverage. All patients judged the situation at the respective teeth as improved.