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Miller Class I (miller + class_i)
Selected AbstractsPeriosteal pedicle graft for the treatment of gingival recession defects: a novel techniqueAUSTRALIAN DENTAL JOURNAL, Issue 3 2009A Mahajan Abstract Background:, The periosteum is a highly cellular connective tissue with rich vascularity and regenerative potential. These qualities make it a suitable autogenous graft. A technique utilizing autogenous periosteal pedicle graft (PPG) for the treatment of gingival recession defects is described. Methods:, Four patients with Miller Class I and II recessions , 3 mm were treated utilizing PPG. Results:, At the end of one year, all defects were completely covered. Conclusions:, The PPG technique can be used for the treatment of gingival recession defects successfully. [source] Coronally advanced flap: a modified surgical approach for isolated recession-type defects: Three-year resultsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2007M. De Sanctis Abstract Background: Various modifications of the coronally displaced flap have been proposed in the literature with the attempt of treating gingival recession with uneven predictable results. The goal of the present study was to evaluate the effectiveness with respect to root coverage of a modification of the coronally advanced flap procedure for the treatment of isolated recession-type defects in the upper jaw. Methods: Forty isolated gingival recessions with at least 1 mm of keratinized tissue apical to the defects were treated with a modified approach to the coronally advanced flap. The main change in the surgical procedure consisted in the modification of flap thickness and dimension of surgical papillae during flap elevation. All recessions fall into Miller class I or II. The clinical re-evaluation was performed 1 year and 3 years after the surgery. Results: At the 1-year examination, the average root coverage was 3.72±1.0 mm (98.6% of the pre-operative recession depth) and 3.64±1.1 mm (96.7%) at 3 years. The gain in probing attachment amounted to 3.65±1.10 mm at 1 year and to 3.70±1.09 mm at 3 years. The average increase of keratinized tissue between the baseline and the 3-year follow-up amounted to 1.78±0.90 mm. All changes of keratinized tissue (difference between baseline and 1 year, baseline and 3 years, and between 1 and 3 years) were statistically significant. Conclusion: The modified coronally advanced surgical technique is effective in the treatment of isolated gingival recession in the upper jaw. [source] Bilaminar techniques for the treatment of recession-type defects.JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2003A comparative clinical study Abstract Objectives: Complete root coverage is the primary objective to be accomplished when treating gingival recessions in patients with aesthetic demands. Furthermore, in order to satisfy patient demands fully, root coverage should be accomplished by soft tissue, the thickness and colour of which should not be distinguishable from those of adjacent soft tissue. The aim of the present split-mouth study was to compare the treatment outcome of two surgical approaches of the bilaminar procedure in terms of (i) root coverage and (ii) aesthetic appearance of the surgically treated sites. Material and Methods: Fifteen young systemically and periodontally healthy subjects with two recession-type defects of similar depth affecting contralateral teeth in the aesthetic zone of the maxilla were enrolled in the study. All recessions fall into Miller class I or II. Randomization for test and control treatment was performed by coin toss immediately prior to surgery. All defects were treated with a bilaminar surgical technique: differences between test and control sites resided in the size, thickness and positioning of the connective tissue graft. The clinical re-evaluation was made 1 year after surgery. Results: The two bilaminar techniques resulted in a high percentage of root coverage (97.3% in the test and 94.7% in the control group) and complete root coverage (gingival margin at the cemento-enamel junction (CEJ)) (86.7% in the test and 80% in the control teeth), with no statistically significant difference between them. Conversely, better aesthetic outcome and post-operative course were indicated by the patients for test compared to control sites. Conclusions: The proposed modification of the bilaminar technique improved the aesthetic outcome. The reduced size and minimal thickness of connective tissue graft, together with its positioning apical to the CEJ, facilitated graft coverage by means of the coronally advanced flap. Zusammenfassung Hintergrund: Die vollständige Deckung der Wurzeloberfläche ist das primäre Ziel, das bei der Therapie von fazialen Rezessionen bei Patienten mit ästhetischen Ansprüchen erreicht werden soll. Weiterhin sollte die Rezessionsdeckung, wenn sie den Ansprüchen des Patienten vollends entsprechen soll, mit einer Dicke und Farbe der Gingiva erreicht werden, die nicht vom benachbarten Gewebe zu unterscheiden sind. Zielsetzung: Vergleich der Therapieergebnisse von 2 chirurgischen Varianten der zweischichtigen Technik im Halbseitenversuch hinsichtlich (1) Rezessionsdeckung und (2) ästhetischer Erscheinung der chirurgisch behandelten Stellen. Material und Methoden: 15 junge und parodontal gesunde Personen mit jeweils 2 Rezessionsdefekten ähnlicher Größe an kontralateralen Zähnen im ästhetischen Bereich des Oberkiefers wurden in die Studie aufgenommen. Alle Rezessionen gehörten in die Miller-Klassen I oder II. Die Randomisierung für die Test- und Kontrollbehandlung erfolgte unmittelbar präoperativ durch Münzwurf. Alle Defekte wurden nach einer zweischichtigen chirurgischen Technik behandelt: Die Unterschiede zwischen Test- und Kontrollstellen bestanden in Größe, Dicke und Positionierung des Bindegewebstransplantates. Die klinische Nachuntersuchung erfolgte 1 Jahr postoperativ. Ergebnisse: Beide zweischichtigen Techniken führten zu einem hohen Prozentsatz von Wurzeldeckung (Test: 97,3%; Kontrolle: 94,7%) und kompletter Wurzeldeckung (Gingivarand an der Schmelz-Zement-Grenze [SZG]) (Test: 86,7%; Kontrolle: 80%) ohne statistisch signifikante Unterschiede zwischen beiden Gruppen. Allerdings wurden mit der Testtherapie bessere ästhetische Ergebnisse erzielt als mit der Kontrollbehandlung. Schlussfolgerung: Die vorgestellte Modifikation der zweischichtigen Technik verbesserte die ästhetischen Ergebnisse. Die reduzierte Größe und minimale Dicke des Bindegewebstransplantates zusammen mit seiner Positionierung apikal der SZG erleichterten eine Deckung mittels eines koronalen Verschiebelappens. Résumé Objectif: Un recouvrement complet de la racine est le premier objectif lorsque l'on traite des récessions gingivales chez les patients ayant une demande esthétique. De plus, afin de satisfaire totalement la demande du patient, cette couverture radiculaire doit aussi être réalisé par des tissus mous de couleur et d'épaisseur qui ne se distinguent pas des tissus mous adjacents. Le but de cette étude en bouche séparée était de comparer le devenir de deux approches chirurgicales de la technique bilaminaire pour (i) le recouvrement de la racine et (ii) l'apparence esthétique des sites traités chirurgicalement. Matériel et Méthodes: 15 sujets jeunes et indemnes de maladie parodontale et systèmique présentant deux récessions de profondeur similaires sur des dents contralatérales dans des zones esthétiques du maxillaire furent enrollés dans cette étude. Toutes les récessions étaient des classes I ou II de Miller. La répartition pour les traitements test ou contrôle fut tirée à pile ou face juste avant la chirurgie. Toutes les lésions furent traitées par la technique bilaminaire, la différence entre les groupes résidant dans la taille, l'épaisseur et le positionnement du greffon de tissus conjonctif. La réévaluation clinique fut faite un an après la chirurgie. Résultats: Les deux techniques bilaminaires ont entrainé un fort pourcentage de recouvrement radiculaire (97.3% pour le groupe test et 94.7% pour le groupe contrôle) et le recouvrement complet (gencive marginale au niveau de la CEJ) (86.7% dans le groupe test et 80% pour le groupe contrôle) sans différence statistiquement significative entre elles. Par contre, un meilleur rendu esthétique et suites post opératoires furent rapportés par les patients pour le traitement test. Conclusions: La modification proposée de cette technique bilaminaire améliore le devenir esthétique. La taille réduite et l'épaisseur minimale greffon conjonctif et son positionnement apical au CEJ, ont facilité le recouvrement du greffon par le lambeau déplacé coronairement. [source] Dynamics of mucosal dimensions after root coverage with a bioresorbable membraneJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2000Hans-Peter Müller Abstract Background: So far, the clinical effects of the placement of a resorbable membrane for guided tissue regeneration have not been studied in humans in great detail. The dynamics of the resorptive processes, in particular, appear to be rather speculative. In the present longitudinal study, specific alterations of the dimensions of the dentogingival mucosa were explored after surgical root coverage by using a bioresorbable membrane and a coronally-repositioned flap. Methods: The study population consisted of 14 patients with a total of 31 predominantly shallow, Miller class I, II or III recessions. The thickness of the masticatory and lining mucosa before and after surgical intervention was measured with an ultrasonic device. Results: Mean (±sd) recession depth and width were 2.85±1.29 and 4.46±1.14 mm, respectively. After 12 months, 51±29% of the recession depth (p<0.001) and 13±35% of its width (n.s.) were covered. Root coverage seems to be rather defect-type sensitive with best results obtained at canines with relatively shallow recessions. Mucosal thickness was considerably increased after surgery with a gradual decrease during the following 9 months. Thus, thickness of the marginal tissue rose from 0.82±0.27 mm to 1.49±0.54 mm 3 months after placement of the membrane (p<0.001). After 12 months, a mean thickness of 1.03±0.40 mm was observed (p<0.001). Even more pronounced alterations were noted for the alveolar lining mucosa with a threefold increase of thickness 3 months after surgery and a gradual decrease to about 1 mm after 12 months. Conclusions: The present results point to the considerable space making capacity of the bioresorbable membrane which probably allows for the ingrowth of a granulation tissue derived from the underlying structures. The gradual decline in mucosal thickness between months 6 and 9 after surgery may be paralleled by the maturation of the granulation tissue while complete resorption of the membrane had been accomplished. [source] Is coronally positioned flap procedure adjunct with enamel matrix derivative or root conditioning a relevant predictor for achieving root coverage?JOURNAL OF PERIODONTAL RESEARCH, Issue 5 2007A systemic review Background and Objective:, This study is a systemic review of coronally positioned flap, coronally positioned flap + chemical root surface conditioning, or coronally positioned flap + enamel matrix derivative (EMD) for the treatment of Miller class I and II gingival recession. Material and Methods:, All studies available through the Medline database by the end of October 2005 were used. Each study provided mean clinical attachment level, keratinized tissue, probing pocket depth, gingival recession depth and root coverage percentage before and after treatment with coronally positioned flap alone, coronally positioned flap + chemical root surface conditioning , or coronally positioned flap + EMD. Effectiveness was evaluated by comparing the weighted mean average in gingival recession depth, probing pocket depth, clinical attachment level, keratinized tissue and root coverage percentage achieved with the three treatments. Results:, Seven studies for the coronally positioned flap + EMD group, four studies for the coronally positioned flap + chemical root surface conditioning group, and seven studies for the coronally positioned flap group were retrieved for this weighted mean analysis. The results of clinical attachment level, gingival recession depth, and root coverage percentage in the coronally positioned flap + EMD group were statistically significantly better than the changes in the coronally positioned flap and coronally positioned flap + chemical root surface conditioning group at 6 and 12 mo (p < 0.001). There was no significant difference at the 6-mo comparison among clinical attachment level, keratinized tissue, probing pocket depth, and gingival recession depth, except in the root coverage percentage for coronally positioned flap and coronally positioned flap + chemical root surface conditioning groups. Conclusion:, The results suggest that root coverage by the coronally positioned flap and coronally positioned flap + chemical root surface conditioning procedures were unpredictable but became more predictable when the coronally positioned flap procedure was improved by the modification of adding EMD. [source] | ||||||||||