Aesthetic Periodontal Therapy – Root Coverage
15
Abbas
et al.,
2003
; Hägewald S, et al., 2002; McGuire and Nunn, 2003; Nemcovsky et al.,
2004;Cueva et al., 2004; Modica et al., 2000).
The technique as described by Berlucchi et al. (2005) is as follows:
An intrasulcular incision is made, under local anesthesia, on the buccal aspect of the
gingiva. The incision is extended horizontally up to one or two teeth mesially and distally to
the tooth involved in order to mobilize the flap, avoiding vertical releasing incisions to
preserve as much blood supply as possible. A full thickness flap was
then elevated beyond the
mucogingival junction; next, a partial thickness flap is elevated in order to mobilize the flap,
ensuring a passive coronal adaptation 1 to 2 mm above the cemento-enamel junction.
Afterwards, the papillae adjacent to the involved tooth were de-epithelialized and a sling
suture is placed, but left untied, mesially and distally to the recession. Then, the root surface
is conditioned with an ethylenediamine-tetraacetic acid (EDTA) gel 24% for 2 minutes, in
accordance with the manufacturer‘s indication, and rinsed with saline solution. EMD is
applied on the conditioned root surface and the suture is tied, positioning the flap 1 to 2 mm
above the cemento-enamel junction. Single or sling sutures are used to secure the other
papillae (Berlucchi et al., 2005).
Cheng et al. (2007) reviewed 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. Clinically, the present
analysis demonstrated that all three groups are useful in treating Miller‘s class I and II
recession defects. All three groups achieved considerable root coverage and gains in clinical
attachment, and maintained the amount of keratinized tissue and shallow probing pocket
depths. The application of EMD to denuded root surfaces treated with the coronally
positioned flap procedure significantly increased the percentage of root coverage and the
attachment level compared with coronally positioned flap alone and the coronallypositioned
flap + chemical root surface conditioning procedure. In thepresent review, the coronally
positioned flap and coronally positioned flap + chemical root surface conditioning groups
resulted in root coverage percentage values ranging from 55 to 75%. The mean root coverage
percentage of coronally positioned flap + EMD-treated sites ranged from 71.7 to 95.1%.
The average root coverage of coronally positioned flap plus EMD amounted to 84.33 ±
7.72% after 6 mo and 84.42 ± 8.75% at 12 mo. The outcome of coronally positioned flap +
EMD was better than coronally positioned flap alone after 6 months (74.12 ± 15.80%) and 12
months (79.00 ± 0.00%). The amount of root coverage obtained was quite stable between 6
and 12 mo in the coronally positioned flap + EMD group for root coverage. This suggests that
root coverage procedures in the coronally positioned flap alone and coronally positioned flap
+ chemical root surface conditioning procedures were unpredictable. They became more
predictable when the coronally positioned flap procedure was improved by the modification
of adding EMD (Cheng et al., 2007).
4.2. Free Soft Tissue Grafts
The autogenous free soft tissue graft procedures may be performed as (1) an epithelized
graft or (2) a subepithelial connective tissue graft (non-epithelized graft), both usually taken
from the area of the masticatory mucosa in the palate.