Effectiveness of surgical root coverage on dentin hypersensitivity: A systematic review and meta-analysis.

AIM: To assess the effect of surgical root coverage (RC) on dentin hypersensitivity (DH) associated with gingival recession. MATERIALS AND METHODS: Two independent reviewers conducted electronic literature searches in MEDLINE (PubMed), EMBASE, Cochrane Library, Web Of Science, Dentistry & Oral Sciences Source, ScienceDirect, and ClinicalTrials.gov databases as well as a manual search to identify eligible clinical studies from January 2000 to March 2022. Randomized controlled trials (RCTs) comparing two surgical RC techniques or a surgical RC technique with or without adjuvant were included. Meta-analyses were performed on data provided by RCTs. RESULTS: Thirteen RCTs with a total of 701 patients (1086 recessions) were included. The percentage of DH suppression was 70.8% (95% confidence interval [CI] [64.4-76.6]; I2  = 39.2% [3.5-61.8], Q-test = 0.02) after surgical RC. Recession reduction and percentage of RC were both statistically significantly associated with DH suppression (estimate = 0.66 [0.10-1.23], p = .022, R2  = 14.45% and estimate = 0.04 [0.01-0.08], p = .012, R2  = 29.54%, respectively). Coronally advanced flap (CAF) + connective tissue graft showed results statistically more effective than CAF + xenogeneic collagen matrix in DH suppression (73.3% [65.6-79.8] and 61.4% [51.7-70.3], respectively; p = .048). CONCLUSIONS: Success of surgical RC is associated with DH suppression.

Laser therapy for dentinal hypersensitivity.

BACKGROUND: Dentinal hypersensitivity is characterized by short, sharp pain from exposed dentine that occurs in response to external stimuli such as cold, heat, osmotic, tactile or chemicals, and cannot be explained by any other form of dental defect or pathology. Laser therapy has become a commonly used intervention and might be effective for dentinal hypersensitivity. OBJECTIVES: To assess the effects of in-office employed lasers versus placebo laser, placebo agents or no treatment for relieving pain of dentinal hypersensitivity. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 20 October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2020, Issue 9), MEDLINE Ovid (1946 to 20 October 2020), Embase Ovid (1980 to 20 October 2020), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 20 October 2020), and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; from 1982 to 20 October 2020). Conference proceedings were searched via the ISI Web of Science and ZETOC, and OpenGrey was searched for grey literature. The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomized controlled trials (RCTs) in which in-office lasers were compared to placebo or no treatment on patients aged above 12 years with tooth hypersensitivity. DATA COLLECTION AND ANALYSIS: Two review authors independently and in duplicate screened the search results, extracted data, and assessed the risk of bias of the included studies. Disagreement was resolved by discussion. For continuous outcomes, we used mean differences (MD) and 95% confidence intervals (CI). We conducted meta-analyses only with studies of similar comparisons reporting the same outcome measures. We assessed the overall certainty of the evidence using GRADE. MAIN RESULTS: We included a total of 23 studies with 936 participants and 2296 teeth. We assessed five studies at overall low risk of bias, 13 at unclear, and five at high risk of bias. 17 studies contributed data to the meta-analyses. We divided the studies into six subgroups based on the type of laser and the primary outcome measure. We assessed the change in intensity of pain using quantitative pain scale (visual analogue scale (VAS) of 0 to 10 (no pain to worst possible pain)) when tested through air blast and tactile stimuli in three categories of short (0 to 24 hours), medium (more than 24 hours to 2 months), and long term (more than 2 months). Results demonstrated that compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through air blast stimuli at short term (MD -2.24, 95% CI -3.55 to -0.93; P = 0.0008; 13 studies, 978 teeth; low-certainty evidence), medium term (MD -2.46, 95% CI -3.57 to -1.35; P < 0.0001; 11 studies, 1007 teeth; very low-certainty evidence), and long term (MD -2.60, 95% CI -4.47 to -0.73; P = 0.006; 5 studies, 564 teeth; very low-certainty evidence). Similarly, compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through tactile stimuli at short term (MD -0.67, 95% CI -1.31 to -0.03; P = 0.04; 8 studies, 506 teeth; low-certainty evidence) and medium term (MD -1.73, 95% CI -3.17 to -0.30; P = 0.02; 9 studies, 591 teeth; very low-certainty evidence). However, there was insufficient evidence of a difference in pain intensity for all types of lasers when tested through tactile stimuli in the long term (MD -3.52, 95% CI -10.37 to 3.33; P = 0.31; 2 studies, 184 teeth; very low-certainty evidence). Most included studies assessed adverse events and reported that no obvious adverse events were observed during the trials. No studies investigated the impact of laser treatment on participants' quality of life. AUTHORS' CONCLUSIONS: Limited and uncertain evidence from meta-analyses suggests that the application of laser overall may improve pain intensity when tested through air blast or tactile stimuli at short, medium, or long term when compared to placebo/no treatment. Overall, laser therapy appears to be safe. Future studies including well-designed double-blinded RCTs are necessary to further investigate the clinical efficacy of lasers as well as their cost-effectiveness.

Clinical Comparative Evaluation of Nd:YAG Laser and a New Varnish Containing Casein Phosphopeptides-Amorphous Calcium Phosphate for the Treatment of Dentin Hypersensitivity: A Prospective Study.

PURPOSE: The aim of this study was to compare the effect of Nd:YAG laser to that of a new varnish: MI Varnish with RECALDENT (GC), for the treatment of dentin hypersensitivity, with a follow-up of 6 months. Dentinal hypersensitivity was evaluated using a new thermal test never before used on dental tissue. MATERIALS AND METHODS: A split-mouth design was used where teeth on one side received the same type of treatment. Twelve patients suffering from dentin hypersensitivity were chosen. Fifty-four teeth were divided into 27 pairs. Twenty-seven teeth received the Nd:YAG laser treatment, and the 27 contralateral teeth received MI Varnish application. Five parameters were measured, and the measurements were taken before treatment at baseline (T0), after 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4) of the application. Air stimulation to obtain the Schiff air score, the score of discomfort according to the visual analog scale (VAS), the tactile score, and the thermal test that determines the minimum cold-stimulating temperature and the maximum heat-stimulating temperature were all used to assess sensitivity. Statistical analyses of the data were performed, and the significance level was set at p ≤ 0.05. Exact Fisher tests and Chi-Square tests were conducted to compare percentages. RESULTS: There was a clear decrease in dentin hypersensitivity for both treatments (Nd:YAG laser and MI Varnish) especially between baseline and 1 week, with maintenance of this state through the 6-month follow-up period. The difference between the two treatments was not significant, comparing, over time, the Schiff air score, the thermal test, and the VAS; however, the tactile score was significantly improved 6 months after the application of MI Varnish compared to the laser (p = 0.05). CONCLUSION: There was no significant difference between the two treatments, Nd:YAG laser and MI Varnish. Both treatments were effective and reduced dentin hypersensitivity immediately after treatment up to 6 months.

A Novel Modification of Semilunar Coronally Advanced Flap for the Treatment of Gingival Recession: Case Series.

This article aims to describe a modification of the semilunar coronally advanced flap. A total of 12 systemically and periodontally healthy patients presenting Miller Class I gingival recession were treated with the modified semilunar coronally advanced flap technique described in this article. After 1 year of follow-up, the mean root coverage was 85.4% ± 24.7%. Significant gingival recession reduction, clinical attachment gain, and reduction in dentin sensitivity was observed 1 year after surgery. This novel semilunar coronally advanced flap technique was demonstrated to be effective for root coverage in Miller Class I gingival recessions.

Effectiveness on oral pain of 808-nm diode laser used prior to composite restoration for symptomatic non-carious cervical lesions unresponsive to desensitizing agents.

This study compares sensitivity reduction after dental restoration with and without prior diode laser (DL) irradiation for cervical dentine hypersensitivity (CDH) from non-carious cervical lesions (NCCLs) unresponsive to desensitizing agents. Eighty-eight teeth of 28 subjects (21 females; age 23-64 years), with CDH from NCCL were included in this study. NCCLs of each oral quadrant were randomized in two groups (study group (SG)) to estimate the sensitivity reduction after dental restoration (SG-1) compared with the DL irradiation used prior to restoration placement (SG-2). The subjects were asked to rate the sensitivity experienced during air stimulation using a visual analog scale before (baseline), immediately after, and at 6 and 12 months from restoration. The outcomes showed a significant reduction of discomfort compared to baseline for NCCLs of SG-2 with the decrease of 78.5, 78.9, and 78.1 % immediately and at 6 and 12 months after restoration, respectively; in comparison with the decrease of 70.1, 67, and 65.3 % for NCCLs of SG-1 immediately and at 6 and 12 months after restoration, respectively; and compared to baseline. The DL irradiation prior to dental restoration can further improve the painful symptomatology of CDH from NCCL unresponsive to desensitizing agents.

Efficacy of Nd:YAG and GaAlAs lasers in comparison to 2% fluoride gel for the treatment of dentinal hypersensitivity.

Lasers demonstrate excellent therapeutic action and are often employed in dentistry for the treatment of diverse clinical conditions. The aim of this study was to compare the efficacy of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser, gallium-aluminum-arsenide (GaAlAs) laser, and 2% neutral fluoride gel in the treatment of dentinal hypersensitivity. Twenty-three patients were evaluated, involving a total of 48 quadrants with at least 1 tooth with dentinal hypersensitivity (89 teeth total). Pain intensity was recorded on a visual analog scale at the time of clinical examination (baseline), immediately after treatment, and 1 week posttreatment. Teeth were treated with 60 seconds of 2% neutral fluoride gel application or 60 seconds of laser treatment-Nd:YAG laser at a distance of 0.5 cm (unfocused; 1 W and 10 Hz for 60 seconds, perpendicular to the cervical surfaces) or GaAlAs laser in contact (40 mW; 4 J/cm²; spot: 0.028 cm²; 15 seconds per point on 4 points [mesial, medial, distal, and apical])-as well as sham treatments so that patients remained blind to their treatment group. All treatments provided adequate pain reduction immediately posttreatment, but laser treatments resulted in significantly greater reductions in pain intensity.

Surgical treatment of single gingival recessions: clinical guidelines.

PURPOSE: The purpose of this clinical guidelines project was to determine the most appropriate surgical techniques, in terms of efficacy, complications, and patient opinions, for the treatment of buccal single gingival recessions without loss of interproximal soft and hard tissues. METHODS: Literature searches were performed (electronically and manually) for entries up to 28 February, 2013 concerning the surgical approaches for the treatment of gingival recessions. Systematic reviews (SRs) of randomised controlled trials (RCTs) and individual RCTs that reported at least 6 months of follow-up of surgical treatment of single gingival recessions were included. The full texts of the selected SRs and RCTs were analysed using checklists for qualitative evaluation according to the Scottish Intercollegiate Guidelines Network (SIGN) method. The following variables were evaluated: Complete Root Coverage (CRC); Recession Reduction (RecRed); complications; functional and aesthetic satisfaction of the patients; and costs of therapies. RESULTS: Out of 30 systematic reviews, 3 SRs and 16 out of 313 RCTs were judged to have a low risk for bias (SIGN code: 1+). At a short-term evaluation, the coronally advanced flap plus connective tissue graft method (CAF+CTG) resulted in the best treatment in terms of CRC and/or RecRed; in case of cervical abrasion and presence of root sensitivity CAF + CTG + Restoration caused less sensitivity than CAF+CTG. CAF produced less postoperative discomfort for patients. Limited information is available regarding postoperative dental hypersensitivity and aesthetic satisfaction of the patients. CONCLUSION: In presence of aesthetic demands or tooth hypersensitivity, the best way to surgically treat single gingival recessions without loss of interproximal tissues is achieved using the CAF procedure associated with CTG. Considering postoperative discomfort, the CAF procedure is the less painful surgical approach, while the level of aesthetic satisfaction resulted higher after CAF either alone or with CTG. It is unclear how much tooth hypersensitivity is reduced by surgically covering buccal recessions. It is important to note that the present recommendations are based on short-term data (less than 1 year). SOURCE OF FUNDING: The guidelines project was made possible through self-financing by the authors.

Clinical efficacy of the Er:YAG laser treatment on hypersensitive dentin.

Dentin hypersensitivity is a common symptomatic condition that causes discomfort and sometimes severe pain. The purpose of this study was to evaluate the clinical efficacy of the erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser treatment on cervically exposed hypersensitive dentin. Twenty patients with dentin hypersensitivity of caries-free teeth were selected. A visual analog scale (VAS) was used to measure dentin sensitivity in response to air stimulus. A 2-minute Er:YAG laser (energy level: 60 mJ/pulse; repetition rate: 2 Hz) was applied to cervically exposed hypersensitive dentin. After 4 weeks, the hypersensitive teeth were examined again, and the VAS score was measured again and recorded. No complications such as detrimental pulpal effects were observed. Eighteen participants reported significantly reduced dentin hypersensitivity 4 weeks after the laser desensitization treatment. The VAS scores measured 4 weeks after the Er:YAG laser desensitization treatment were significantly decreased as compared with those measured at the baseline (p < 0.05). In conclusion, the Er:YAG laser desensitization treatment can effectively reduce hypersensitivity of cervically exposed hypersensitive dentin.

Laterally moved, coronally advanced flap for the treatment of a single Stillman's cleft. A 5-year follow-up.

BACKGROUND: The treatment of gingival recessions is one of the important branches of periodontics related to esthetics. However, no surgical technique has been reported for the treatment of a particular type of gingival recession called Stillman's cleft. METHODS: The technique proposed is a laterally moved, coronally advanced flap. After local anesthesia, two parallel incisions, one along the cleft and the second parallel to the first one, have been placed beyond the mucogingival junction, allowing a rotating partial-thickness flap to cover the recession. RESULTS: The procedure, in this case presentation, resulted in successfully covering the previously exposed root surface. CONCLUSION: Root coverage of a Stillman's cleft can be obtained and maintained for 5 years follow-up with a laterally moved, coronally advanced flap.

Is surgical root coverage effective for the treatment of cervical dentin hypersensitivity? A systematic review.

BACKGROUND: Cervical dentin hypersensitivity (CDH) is characterized by tooth pain arising from root exposure. The aim of the present systematic review is to survey the literature on the efficacy of surgical root coverage techniques at reducing CDH in cases of gingival recession. METHODS: An online electronic search was performed in PubMed, Web of Science, and Cochrane Library databases. Randomized clinical trials dating from the inception of the respective databases through November 2011 were selected. Studies addressing clinical parameters of periodontal plastic surgery outcomes and variables related to CDH in patients ≥18 years of age were included. The studies were evaluated by two independent reviewers. For each article, methodologic quality, size effect, the periodontal parameters measured, study design, methods, and results were analyzed. RESULTS: Nine relevant articles were analyzed in the present review. A decrease in CDH was observed after periodontal surgery for root coverage. The risk of bias was considered low in two studies, and the size effect was considered large in one study. CONCLUSIONS: There is not enough scientific evidence to conclude that surgical root coverage procedures predictably reduce CDH. Well-conducted clinical trials are needed to establish scientific evidence that allows periodontists to indicate root coverage as treatment for CDH.

Patient-centered outcomes after subepithelial connective tissue grafts and coronally advanced flaps.

OBJECTIVE: The use of a coronally advanced flap (CAF) and connective tissue graft (CTG) is a well-established procedure to cover single and multiple recessions and improve soft tissue esthetics. However, until now, there are still limited data evaluating patient morbidity, the fear of imminent tooth loss, and modification of sensitivity in surgical areas. The aim of the present study was to evaluate the patient-centered outcomes associated with CAF + CTG. METHOD AND MATERIALS: Thirty-four patients (mean age, 30.76 ± 6.88 years) with single or multiple Class I and II gingival recessions were treated using a CAF + CTG. The following parameters were evaluated at 14 days and 1, 3, 6, and 12 months after surgery: esthetics, root hypersensitivity, fear of imminent tooth loss, daily activities or nutritional habits, and the levels of postsurgical morbidities. A visual analog scale was used to evaluate patient-centered outcomes. The percentage of patients belonging to each of the severity scales, the mean values associated with each parameter, and the statistical significance of the modification of the monitored parameters were calculated. The parametric F (Fisher) test and the least significant difference post hoc pair-wise comparisons were computed. RESULTS: There were statistically significant differences between baseline and all follow-up time points in root hypersensitivity and in fear of tooth loss. Preoperative prevalence of fear of tooth loss was 99%. Esthetics were statistically significantly improved at the 1-, 3-, 6-, and 12-month visits compared with the evaluation at 14 days. No palatal bleeding was recorded. The pain perception in the donor area was mild: Only 3% of patients reported severe palatal pain, and the mean VAS score for palatal pain was 3.79 ± 1.49. CONCLUSION: Treatment of single and multiple gingival recessions with CAF + CTG resulted in predictable improvements of soft tissue esthetics and root hypersensitivity but was associated with a slight increase in patient morbidity, mainly related to the harvesting of CTG. This should be considered when treating patients with esthetic demands.

An evaluation of the occluding effects of Er;Cr:YSGG, Nd:YAG, CO2 and diode lasers on dentinal tubules: a scanning electron microscope in vitro study.

OBJECTIVE AND BACKGROUND: Dentin hypersensitivity (DH) is one of the most frequent problems causing patients' complaints following stimulation of cervically exposed dentin. Studies have shown that different lasers have various occluding effects on dentinal tubules. This study is aimed at evaluating the occluding effects of Er;Cr:YSGG (P:0.25W,F:20Hz,Pd:140µS), Nd:YAG (P:1W,F:20Hz), CO(2) (P:1W, Pd:50µs), and 810-nm diode (P:2 W, Pd:30ms) lasers on dentinal tubules. METHODS: Fifteen human third molars were collected and ground-sectioned vertically on the buccal and lingual surfaces to yield two dentin disks of 2-mm thickness. Then, four sites for laser irradiation and one control site were marked in the cervical areas of the dentin disks. Before laser application, specimens were exposed to a 14% EDTA solution to expose dentinal tubules and were then evaluated by scanning electron microscopy (SEM). The tubules' entrance diameters were determined by "scale-bar" software (Phillips Scale-Bar, Phillips, Amsterdam, The Netherlands), which is specifically designed for SEM. The mean diameters for the tubules were then estimated for each site and analyzed statistically. RESULTS: The mean dentinal tubule entrance diameters for Er;Cr:YSGG, 810-nm diode, CO(2), and Nd:YAG, were 1.73, 3.27, 2.10, and 1.64 microns, respectively, compared with 3.52 microns before laser irradiation. Overall, the furthest reduction in mean tubule diameter resulted from the Nd: YAG laser (53%). However, tubular diameter reduction in all laser groups (p<0.05) was found to be statistically significant. In all laser groups, melting of the peritubular dentin was the dominant observed phenomenon. CONCLUSION: Our results indicate that Nd: YAG, Er; Cr: YSGG, and CO(2) lasers, through their ability to melt peritubular dentin, can occlude dentinal tubules partially or totally, and therefore reduce patients' hypersensitivity symptoms. The 810-nm diode laser sealed tubules to a far lesser degree, with negligible effects on desensitization.

Effectiveness of laser therapy and topical desensitising agents in treating dentine hypersensitivity: a systematic review.

The aim of this systematic review was to compare the effectiveness of laser therapy with that of topical desensitising agents in treating dentine hypersensitivity. A secondary objective was to determine the safety of laser application according to the relevant studies. A systematic search was performed in the MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the National Research Register, the Cochrane Oral Health Group's Trials Register database to retrieve all articles that were about randomised controlled trials involving the application of laser desensitising procedures and topical desensitising agents in the treatment of dentine hypersensitivity. A total of eight trials that met all inclusion criteria involving 234 participants were reviewed. Based upon the 'quality' of evidence, one study was classified as A level, five as B level and two as C level. Owing to the heterogeneity of the studies, a meta-analysis was not performed. Half of the included studies compared GaALAS laser with topical desensitising agents, but the findings were conflicting. The remaining studies involved Nd:YAG laser, Er:YAG laser and CO2 laser, and all showed that the three types of lasers were superior to topical desensitising agents, but the superiority was slight. A systematic review of the literature indicates the likelihood that laser therapy has a slight clinical advantage over topical medicaments in the treatment of dentine hypersensitivity. More large sample-sized, long-term, high-quality randomised controlled clinical trials are needed before definitive conclusions were made.

Comparative study in desensitizing efficacy using the GaAlAs laser and dentin bonding agent.

OBJECTIVE: To compare the clinical efficacy of the GaAlAs laser and dentin bonding agent in treating dentin hypersensitivity. METHODS: One hundred and forty teeth from 70 patients diagnosed with dentin hypersensitivity, were divided into two groups: In group I, teeth were irradiated with 30 mW GaAlAs laser for 1 min and in group II, teeth were applied with dentin bonding agent. Sensitivity was assessed by tactile and thermal tests, measured with the criteria proposed by Uchida at baseline and after treatment; immediately, at 15 and at 30 days. RESULTS: The reduction of dentin hypersensitivity was observed in both treatments using the GaAlAs laser and dentin bonding agent. However, a greater reduction was observed over time up to day 15 and no significant change was observed between days 15 and 30. Statistically significant differences in the level of dentin hypersensitivity between bonding agent and the GaAlAs laser were found at each observation period (p < 0.05). CONCLUSION: The GaAlAs laser had less desensitizing efficacy compared with dentin bonding agent. However, the desensitizing effect of the GaAlAs laser still could be considered an effective therapy for treating dentin hypersensitivity.

Current trends in gingival recession coverage--Part II: Enamel matrix derivative and platelet-rich plasma.

The recession of the gingiva is increasingly becoming a prominent condition in the oral health of many patients and should be treated at its earliest detection. Part I of this discussion reviewed the multifactorial etiology and decision modality; a treatment option was demonstrated for gingival recession using the tunneling technique. This concluding part of the discussion highlights two clinical cases using alternative approaches. The correction of Class I and II gingival recessions are presented as a means of minimizing surgical trauma and achieving predictable aesthetic results.

Coronally positioned flap with subepithelial connective tissue graft for root coverage: various indications and flap designs.

Aesthetic concerns and functional abnormalities, such as dentin hypersensitivity, are often associated with gingival recession defects. Root coverage procedures aim to restore both gingival aesthetics and function in recession defects. The coronally positioned flap combined with the subepithelial connective tissue graft is one of the most widely used root coverage procedures. The present report illustrates four different indications where this procedure has been successfully employed. An isolated Miller class II recession defect associated with frenum pull, multiple adjacent Miller class I defects in the aesthetic zone, an isolated Miller class I defect associated with dentin hypersensitivity, and an isolated Miller class II defect on a retained deciduous tooth are the four diverse conditions treated by periodontal plastic surgery. Different approaches were used to create the coronally positioned flap. Treatment resulted in complete root coverage, resolution of hypersensitivity, and satisfaction of the patients' aesthetic concerns. An effective and predictable treatment modality, such as the coronally positioned flap combined with the subepithelial connective tissue graft, should be considered when treatment planning for gingival recession defects.

Laser Er: YAG na Dentística Restauradora / Er: YAG laser in Restorative Dentistry

A Odontologia vem apresentando grande evolução em relação aos procedimentos restauradores, por meio de novos equipamentos e materiais adesivos, com o propósito de minimizar ou eliminar a microinfiltração ao redor das restaurações. Atualmente, o laser Er:YAG tem se destacado na remoção da cárie e dos tecidos duros dentais, assim como agente condicionador do esmalte e dentina, em substituição ao condicionamento convencional com ácido fosfórico. A capacidade desse laser em ablacionar os tecidos duros dentais resulta em preparos cavitários com superfícies irregulares, proporcionando uma forma adicional de retenção micromecânica para os materiais restauradores estéticos, melhorando o selamento marginal. O objetivo do presente trabalho foi verificar mediante uma breve revisão de literatura pesquisas in vitro e in vivo que visaram investigar a efetividade do laser Er:YAG quanto à microinfiltração marginal, adesão ao esmalte e à dentina, efeito térmico sobre o órgão pulpar, sensibilidade operatória e pós-operatória, alterações morfológicas sobre as estruturas dentárias, como, também, compará-lo com turbinas de alta rotação e condicionamento com ácido fosfórico

Coronally advanced flap procedure for root coverage. Flap with tension versus flap without tension: a randomized controlled clinical study.

BACKGROUND: This clinical controlled study was designed to measure the tension of coronally advanced flaps (CAF) performed to treat shallow gingival recessions and to compare the recession reduction (Rec Red) achieved in a test group (flaps with tension) and in a control group (flaps without tension) 3 months after surgery. METHODS: Eleven patients, aged 22 to 41 years, with high levels of oral hygiene (full mouth plaque score <20%) were selected for the study. Each patient showed 2 bilateral Miller Class I maxillary or mandibular gingival recessions located on homologous teeth. A total of 22 recessions were treated. The recession depth at the right site was similar to that at the left site (difference < or =1 mm). For each patient, the 2 recessions underwent CAF procedure in the same surgical session. Before suturing, the residual tension (FTens) of both right and left flaps was measured with a dynamometer. Then, one site was randomly assigned to the test group and the contralateral site to the control group. In the test site the flap was sutured. In the control site the flap was further relaxed, the tension was measured again, and the flap was sutured. RESULTS: In the test group (with tension) the initial mean recession depth was 2.82 +/- 0.64 mm and mean FTens was 6.5 g, while in the control group (without tension) the initial mean recession depth was 2.68 +/- 0.81 mm and mean FTens was 0.4 g. Three months later, the test group showed a mean recession reduction of 2.18 +/- 0.60 mm, a mean percent root coverage of 78 +/- 15%, and complete root coverage was achieved on 2 teeth (18%). In the control group the mean recession reduction was 2.32 +/- 0.81 mm and mean percent root coverage was 87 +/- 13%. Complete root coverage was obtained on 5 teeth (45%). The difference of recession reduction between the test and control group was not statistically significant (P = 0.3911). In the test group, linear regression analysis showed a statistically significant association between recession reduction and both recession depth at baseline (P= 0.0001) and mean of the 3 tensions recorded on the test side (MFTens) (P = 0.0009). CONCLUSIONS: This study shows that minimal flap tension does not influence recession reduction after 3 months when shallow recessions are treated by means of CAF. In the test group (with tension), the statistical analysis suggests that the higher the flap tension, the lower the recession reduction.