Management of Deep Gingival Recessions by Modified Coronally Advanced Tunnel Technique with Titanium Platelet Rich Fibrin Membrane or Connective Tissue Graft: 36 Months Follow-up Clinical Study

Year 2020, Volume: 10 Issue: 3, 297 - 303, 29.09.2020

Cenker Zeki Koyuncuoğlu , Esra Ercan , Bilge Uzun , Mustafa Tunalı , Erhan Firatli

https://doi.org/10.33808/marusbed.767457

Cited By: 1

Abstract

Objectives: The goal of the study is to evaluate the results of Titanium-Platelet rich fibrin (T-PRF) membrane and Connective Tissue Graft (CTG) with modified coronally advanced tunnel technique (MCATT) in treatment of deep gingival recession defects.
Methods: Twenty-one systemically healthy patients displaying 62 Miller Class I/II gingival recession defects ≥ 3.0 mm in depth were treated with MCATT with CTG or T-PRF membrane were included in this retrospective study. The periodontal parameters were assessed at baseline, 6 and 36 months after surgery. The percentages of the mean root coverage (MRC) and complete root coverage (CRC) were calculated.
Results: The baseline probing depth values were reduced at 36 months according to baseline for both groups (p<0.05). The keratinized tissue (KT) was increased at 6 months according to baseline for both groups (from 1.69±0.74mm to 3.61±0.67 mm for T-PRF; and 3.40±1.60 mm to 4.52±2.33 for CTG). The 36th month measurement of KT showed an increase in the T-PRF group compared to 6 months, while the CTG group showed a significant decrease (3.86±0.76 mm and 2.76±1.45 mm, respectively). The CRC ratios were 80% and 56% at 6 and 36 months, respectively for CTG group. However, this ratio remained same (64.86%) for T-PRF group. There was statistically significant difference between CRC ratio of two groups at 36 months (p<0.05).
Conclusion: T-PRF membrane with MCATT procedure is as predictable as a CTG with MCATT for management of deep gingival recessions. However, future prospective studies about this topic with a split-mouth design are needed.

Keywords

Gingival Recession, Titanium-Platelet Rich Fibrin, Root Coverage, Periodontal Plastic surgery

Supporting Institution

Yok

Project Number

Yok

Thanks

The authors thank Dr. Hakan Ozdemir (Osmangazi University, Faculty of Dentistry, Department of Periodontology, Eskisehir, Türkiye) for comments that greatly improved the manuscript.

References

• [1]. Wennström J L, Zucchelli G. Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study. J Clin Periodontol 1996;23:770-7.
• [2]. Hofmänner P, Alessandri R, Laugisch O, Aroca S, Salvi GE, Stavropoulos A, et al. Predictability of surgical techniques used for coverage of multiple adjacent gingival recessions-A systematic review. Quintessence Int. 2012;43:545-54.
• [3]. Aroca S, Keglevich T, Barbieri B, Gera I, Etienne D. Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: a 6-month study. J Periodontol. 2009;80:244-52.
• [4]. Chambrone L, Pannuti CM, Tu YK, Chambrone LA. Evidence-Based Periodontal Plastic Surgery. II. An Individual Data Meta-Analysis for Evaluating Factors in Achieving Complete Root Coverage. J Periodontol. 2012;83:477-90.
• [5]. Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review. J Periodontol. 2010;81:452-78.
• [6]. Harris RJ, Miller R, Miller LH, Harris C. Complications with surgical procedures utilizing connective tissue grafts: a follow-up of 500 consecutively treated cases. Int J Periodontics Restorative Dent. 2005;25:449-59.
• [7]. Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, et al. Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol. 20101;37:728-38.
• [8]. Al-Hezaimi K, Rudek I, Al-Hamdan KS, Javed F, Iezzi G, Piattelli A, et al. Efficacy of acellular dermal matrix and coronally advanced flaps for the treatment of induced gingival recession defects: a histomorphometric study in dogs. J Periodontol. 2013;84:1172-9.
• [9]. Jepsen K, Jepsen S, Zucchelli G, Stefanini M, de Sanctis M, Baldini N, et al. Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial. J Clin Periodontol. 2013;40:82-9.
• [10]. Keceli HG, Sengun D, Berberoglu A, Karabulut E. Use of platelet gel with connective tissue grafts for root coverage: A randomized-controlled trial. J Clin Periodontol. 2008;35:255-62.
• [11]. Eren G, Atilla G. Platelet-rich fibrin in the treatment of localized gingival recessions: a split-mouth randomized clinical trial. Clin Oral Investig 2014;18:1941-8.
• [12]. Tunalι M, Özdemir H, Arabacι T, Gürbüzer B, Pikdöken L, Firatli E. Clinical evaluation of autologous platelet-rich fibrin in the treatment of multiple adjacent gingival recession defects: a 12-month study. Int J Periodontics Restorative Dent 2015;35:105-14.
• [13]. Choukroun J, Adda F, Schoeffler C, Vervelle A. An opportunity in perio-implantology: The PRF (in French). Implantodontie 2001;42:55-62. [14]. Dohan Ehrenfest DM, Del Corso M, Diss A, Mouhyi J, Charrier JB. Three-dimensional architecture and cell composition of a Choukroun's platelet-rich fibrin clot and membrane. J Periodontol 2010;81:546-55.
• [15]. Dohan Ehrenfest DM, Diss A, Odin G, Doglioli P, Hippolyte MP, Charrier JB. In vitro effects of Choukroun’s PRF (platelet-rich fibrin) on human gingival fibroblasts, dermal prekeratinocytes, preadipocytes, and maxillofacial osteoblasts in primary cultures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:341-52.
• [16]. O'Connell SM. Safety issues associated with platelet-rich fibrin method. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:587; author reply 587-93.
• [17]. Tunali M, Ozdemir H, Kucukodaci Z, Akman S, Firatli E. In vivo evaluation of titanium-prepared platelet-rich fibrin (T-PRF): a new platelet concentrate. Br J Oral Maxillofac Surg 2013;51:438-43.
• [18]. Tunali M, Ozdemir H, Kucukodaci Z, Akman S, Yaprak E, Toker H, et al. A novel platelet concentrate: titanium-prepared platelet-rich fibrin. Biomed Res Int. 2014;2014:209548.
• [19]. Uzun BC, Ercan E, Tunalı M.Effectiveness and predictability of titanium-prepared platelet-rich fibrin for the management of multiple gingival recessions. Clin Oral Investig. 2018;22:1345-54.
• [20]. Dohan Ehrenfest DM, Pinto NR, Pereda A, Jiménez P, Corso MD, Kang BS6, et al. The impact of the centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a leukocyte- and platelet-rich fibrin (L-PRF) clot and membrane. Platelets 2017;24:1-14.
• [21]. Aroca S, Keglevich T, Nikolidakis D, Gera I, Nagy K, Azzi R, et al. Treatment of class III multiple gingival recessions: a randomized-clinical trial. J Clin Periodontol 2010;37:88-97.
• [22]. Del Corso M, Sammartino G, Dohan Ehrenfest DM. Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: a 6-month study. J Periodontol 2009;80:1694-7; author reply 1697-9.
• [23]. Uraz A, Sezgin Y, Yalim M, Taner IL, Cetiner D. Comparative evaluation of platelet-rich fibrin membrane and connective tissue graft in the treatment of multiple adjacent recession defects: A clinical study. J Dent Sci 2015;10:36-45.
• [24]. Öncü E. The Use of Platelet-Rich Fibrin Versus Subepithelial Connective Tissue Graft in Treatment of Multiple Gingival Recessions: A Randomized Clinical Trial. Int J Periodontics Restorative Dent 2017;37:265-71.
• [25]. Ustaoğlu G, Ercan E, Tunali M. The role of titanium-prepared platelet-rich fibrin in palatal mucosal wound healing and histoconduction. Acta Odontol Scand 2016;74:558-64.
• [26]. Edel A. Clinical evaluation of free connective tissue grafts used to increase the width of keratinized gingiva]. J Clin Periodontol 1974;1:185-196.
• [27]. Jankovic S, Aleksic Z, Klokkevold P, Lekovic V, Dimitrijevic B, Kenney EB, et al. Use of platelet-rich fibrin membrane following treatment of gingival recession: a randomized clinical trial. Int J Periodontics Restorative Dent 2012;32:41-50.
• [28]. Hwang D, Wang HL. Flap thickness as a predictor of root coverage: A systematic review. J Periodontol 2006;77:1625-34.
• [29]. Woodyard JG, Greenwell H, Hill M, Drisko C, Iasella JM, Scheetz J. The clinical effect of acellular dermal matrix on gingival thickness and root coverage compared to coronally positioned flap alone. J Periodontol 2004;75:44-56.