Enhancing aesthetics and functionality: Surgical approaches with connective tissue graft for gingival recession treatment
DOI:
https://doi.org/10.33448/rsd-v13i4.45465Keywords:
Plastic surgery procedures; Gingival recession; Connective tissue; Tissue grafting; Dental aesthetics.Abstract
In this context, we explore surgical techniques that use connective tissue grafts to treat gingival recessions. These approaches aim to solve aesthetic problems and improve gingival function. Considerations about biological factors that influence the predictability of root coverage are fundamental to choosing the best therapeutic alternative. There are important differences between the different surgical techniques available, with the aim of minimizing surgical trauma and obtaining better results. The connective tissue graft demonstrates significant clinical gains in terms of insertion, keratinized tissue and root coverage, making it a viable and predictable option for the treatment of Miller Class I and II gingival recessions. Even for Miller Class III recessions where root coverage is limited, treatment may be considered, especially to increase keratinized tissue. Objective: To examine, based on recent literature, the scientific evidence related to the feasibility of using free gingival grafts in the management of gingival recession. Methodology: A literature review was carried out based on studies published in the Scielo, Scholar Google and PubMed databases. Results: Gingival recession is characterized by the apical retreat of the gingival margin, a phenomenon associated with various conditions and diseases, resulting in the loss of clinical attachment.
References
American Academy of Periodontology (1992): glossary of periodontic terms. (3a ed.), American Academy of Periodontology.
Allen (1994) Use of supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique Int J Periodontics Restorative Dent., 14, pp. 216-217.
Azzi, R. D.; Etienne, H.; Takei, P. & Fenech (2002) Surgical thickening of the existing gingiva and reconstruction of interdental papillae around implant‐supported restorations Int J Periodontics Restorative Dent., 22, 71-77.
Borghetti A., et al, (2002) Cirurgia Plástica Periodontal. editora Artmed,
Borghetti, A., & Monnet Corti V (2011). Cirurgia Plástica Periodontal. (2a ed.), Artes Médicas
Borghetti, A. & Monnet–Corti, V. (2002) Cirurgia Plástica Periodontal. Artmed, 419–435
Bichaco N. (1998) Achieving optimal gingival esthetics Around restored natural teethand implants. Dent. Clin. North Am. 42(4), 763-80.
Cardoso R. J. A., Moura, A. A. M., & Antoniazzi, J. H. (1997). Avaliaçäo in vitro da qualidade do vedamento marginal cérvico-apical de alguns agentes cimentantes utilizados na fixação do retentor intra-radicular (Cytco). RPG Rev Pos-Grad.;4(1), 7-13.
Dani, S.; Dhage, A & Gundannavar, G. (2014). A técnica de bolsa e túnel para tratamento de múltiplos defeitos de recessão gengival. J Indian Soc Perio., 18.
Edel A. (1995) The Use of a fre connective Tissue graft to increase the width of attached gingival. Oral Surgery, Oral Medicine, Oral pathology (1975);1:185-196 apud Edel A. The use of a connective Tissue graft for closure over an immediate implant covered with an occlusive membrane. Clin Oral Impl Res; 6:60-65.
Han, J. S et al. (2008). Mudanças nas dimensões gengivais após enxertos de tecido conjuntivo para cobertura radicular: comparação de dois procedimentos. J Periodontol., 79, http://dx.doi.org/10.1902/jop.2008.070472.
Khoury, F., & Happe, A. (2000). The Palatal Subepithelial Connective Tissue Flap Method for Soft Tissue Management to Cover Maxillary Defects: A clinical report. Int J Oral Maxillofac Implants; 15:415- 418
Kina, J. R., Suzuki, T. Y. U., Kina, E. F. U., Kina, M., & Kina, J. (2015). Tratamento de recessão gengival unitária. Archives Of Health Investigation. 4(6). https://archhealthinvestigation.com.br/ArcHI/article/view/1289/1568.
Langer B & Langer L (1985). Subepithelial connective tissue graft for root coverage. J Periodontol. 56:715-720.
Lindhe J., Karring T., & Lang N. P (2005). Tratado de Periodontia Clinica e Implantologia Oral. editora Guanabara koogan.
Lindhe J., Karring T., & Araújo M (2008). Clinical periodontoloy and implant dentistry: The Anatomy of Periodontal Tissues. (5a ed.), Blackwell Munksgard.
Landsberg C. J (1997). Socket Seal Surgery Combined with Immediate Implant Placement: A novel approach for single-tooth replacement. Int J Periodont Rest Dent. 17, 141-149.
Langer B (1994). Spontane gingival augmentation in situ. Int J Parodontol Rest Zahnheilkd 14:507-517 apud Khoury F, Happe A. The Palatal Subepithelial Connective Tissue Flap Method for Soft Tissue Management to Cover Maxillary Defects: A clinical report. Int J Oral Maxillofac Implants 2000. 15, 415- 418.
Maluta R; Monteiro M F; Peruzzo D C & Joly J C (2021). Root coverage of multiple gingival recessions treated with coronally advanced flap associated with xenogeneic acellular dermal matrix or connective tissue graft: a 6-month split-mouth controlled and randomized clinical trial. Clin Oral Invest.;25(10):5765-5773. doi:10.1007/s00784-021-03879-8.
Motta, S., & Camilo, F. (2004). Técnica de dobra cirúrgica para reabertura de implantes osseintegrados. RPG Ver. De pós graduação CLIVO. 1(3), 1-14.
McHorris W. H (1985) Occlusal adjustment via selective cutting of natural teeth. Part II. Int J Periodontics Restorative Dent. 5(6), 8-29.
Manil A & James A (2018). Classifications for Gingival Recession: A Mini Review. Galore International Journal of Health Sciences and Research. India. 3(1).
Newman, M. G et al (2016) . Carranza: Periodontia Clínica, (12ª Ed.)., Elsevier, 2016
Neto, O. A. T. et al. (2022). Subepithelial free gingival graft: clinical case report. Brazilian Journal of Health Review. 5(4), 13474-82. https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/50697/38089.
Nelson, S. W (1987). The Subepithelial Connective Tissue Graft: A bilaminar reconstructive procedure for the coverage of denuded root surfaces. J Periodontol; Feb:95-102.
Nonato D W F & Brum R T (2006). Enxerto de tecido conjuntivo subepitelial: Uma opção para correção de defeitos de rebordo alveolar. Revista Dens.;14(2):46-53.
Nunes Filho D P & Nunes L. F P & Nunes N P (2004). Otimização estética em periodontia e implantodontia através da manipulação de tecidos moles após enxerto ósseo autógeno–relato de caso clínico. Innovations Journal.;30–33.
Orth, C F (1996). A modification of connective tissue graft procedure for the treatment of type II and type III ridge deformities. Int J Periodont Rest Dent; 16:267-277
Periódicos (2023). Ccited mai 10 relato de caso). Cirurgia de enxerto de tecido conjuntivo para recobrimento radicular: HTTPS://REVODONTOLUNESP.COM.BR/JOURNAL/ROU/ARTICLE/604A0A00A953950AA3565E34.
Raetzke, P.B (1985). Covering localized areas of root exposure employing the “envelope” technique. Journal of periodontology, v. 56, n. 7, p. 397-402.
Ribeiro., F. S. D. L. Zandim., A. E. F Pontes, R. & Mantovani, J. E. C., & Sampaio, E. (2008). Marcantonio Tunnel technique with a surgical maneuver to increase the graft extension: Case report with a 3‐year old follow‐up J Periodontol., 79, 753-758.
Rosenquist, B (1997). A comparasion of Various Methods of Soft Tissue Management following the Immediate Placement of Implants into Extraction Sockets. Int J Oral Maxillofac Implants; 12:43-51.
Saade, J et al (2015). Pouch Roll Technique for implant soft tissue augmentation of small defects: Two case reports with five year-follow-up. Journal of Oral Implantology, 41(3), 1-7.
Saadoun, A. P. (2006) Current trends in gingival recession coverage part I: The tunnel connective tissue graft Pract Proced Aesthet Dent., 18, 433-440.
Santiago de Lima, V. H., Coelho de Sousa, M. J., Braz Monteiro, L. K. et al. (2020). Enxerto subepitelial de tecido conjuntivo e enxerto gengival livre para recobrimento radicular –relato de dois casos clínicos. Acervo Saúde. 12 (4): e2791. Doi:10.25248/reas.e2791.2020
Silva, H. L. S. et al. (2023). The effectiveness of different surgical techniques for the benefit of the treatment of multiple gingival recessions in aesthetic and functional results:an integrative review. Brazilian Journal of Health Review. 6(5), 25175-84. https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/64064/46056
Shibli, J. A., D`Avila, S. & Marcantonio, J. E. (2004). Connective Tissue Graft to Correct Peri-implant soft tissuem margin: a clinical report. J Prosthet Dent. 91 (2): 119-22. Doi: 10.1016/j.prosdent.2003.09.017
Silva, L. C.; Carmo R. C. ; Sousa, Z. S; Nogueira, J. E. S.; Brandão, M. I. P.; Botão M. S. et al. (2021). Enxerto de tecido conjuntivo para recobrimento radicular de recessão gengival em paciente com fenótipo periodontal fino e pós-tratamento ortodôntico: relato de caso. Brazilian Journal of Development. 7 (5): 51900–17. https://ojs.brazilianjournals.com.br/ojs/index.php/BRJD/article/view/3029 8/23833.
Silva, E.B.E.; Januário, A.L.; Peruchi, C.M.D.S. & Cardozo, W.V (2004). Recobrimento radicular por meio da técnica cirúrgica periodontal do “envelope” - enxerto conjuntivo subepitelial: relato de casos clínicos. Rev. Odontol. Araçatuba (Impr.), p. 43-50.
Sato, N. (2000). Periodontal surgery: a clinical atlas. Japan, Quintessence Publishing
Stimmelmay, M. E; Allen,W; Gernet, D; Edelhoff & F. Beuer,M (2011). Schlee Treatment of gingival recession in the anterior mandible using the tunnel technique and a combination epithelialized‐subepithelial connective tissue graft–a case series Int J Periodontics Restorative Dent., 31, 164-173.
Stimmelmay, M. et al (2011). Tratamento da recessão gengival na região anterior da mandíbula usando a técnica do túnel e uma combinação de enxerto de tecido conjuntivo epitelizado-subepitelial – uma série de casos. Int J Periodontia Restauradora Dent., 31, pp.
Wennstrom JL (1996). Mucogingival therapy. Ann Periodontol. Gotemburgo, 1(1), 671- 701, November
Waldron C A & Shafer W G (1996). The central giant cell reparative granuloma of the jaws: An analysis of 38 cases. Am J Clin Pathol, 45(4), 437–447.
Yared K F G ; Zenobio, E G & Pacheco, W (2006). A etiologia multifatorial da recessão periodontal. R Dental Press Ortodon Ortop Facial. 11(6), 45-51, nov./dez.
Yohino, S et al (2014). Effects of Connective Tissue Grafting on the Facial Gingival Level Following Single Immediate Implant Placement and Provisionalization in the Esthetic Zone: A 1-Year Randomized Controlled Prospective Study. Internatonal Journal of Oral Maxillofacial Implants, 29, 432-440.
Zhang, M.; Wang, M. & Zhang, C. (2022) Efficacy and safety of acellular dermal matrix versus connective tissue graft for root coverage of Miller's Class I and II gingival recession: a systematic review and meta-analysis. Ann Palliat Med, 11(7), 2478-2491, https://pubmed.ncbi.nlm.nih.gov/35927781/.
Zabalegui, A.; Sicilia, J.; Cambra, J. & Gil, M (1999). Sanz Treatment of multiple gingival recessions with the tunnel subepithelial connective tissue graft: A clinical report Int J Periodontics Restorative Dent., 19, 471-479.
Zühr, O. S. & Fickl,H. & Watchtel,W. & Bolz,M.B (2007). Hurzeler Covering of gingival recessions with a modified microsurgical tunnel technique: case report Int J Periodontics Restorative Dent., 27, pp. 456-463.
Zühr, O. S. F.; Rebele, D.; Schneider ,R. E. & Jung, M. B (2014). Hurzeler Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: A RCT using 3D digital methods. Part II: Volumetric studies on healing dynamics and gingival dimensions J Clin Periodontol., 41, pp. 593-603.
Zühr, O. S F; Rebele, D.; Schneider, R. E; Jung, M B & Hurzeler, M B (2014). Técnica de túnel com enxerto de tecido conjuntivo versus retalho coronalmente avançado com derivado de matriz de esmalte para cobertura radicular: um ECR usando métodos digitais 3D. Parte I: Resultados clínicos e centrados no paciente. J Clin Periodontol., 41, pp. http://dx.doi.org/10.1111/jcpe.12178.
Zühr, O S F; Rebele, D., Schneider, R E; Jung, M B & Hurzeler, M. B. (2014). Técnica de túnel com enxerto de tecido conjuntivo versus retalho coronalmente avançado com derivado de matriz de esmalte para cobertura radicular: um ECR usando métodos digitais 3D. Parte II: Estudos volumétricos sobre dinâmica de cicatrização e dimensões gengivais. J Clin Periodontol., 41, pp. http://dx.doi.org/10.1111/jcpe.12254.
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