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CC BY-NC-ND 4.0 · Eur J Dent 2016; 10(01): 121-133
DOI: 10.4103/1305-7456.175686
Original Article
Dental Investigation Society

Patient-centered evaluation of microsurgical management of gingival recession using coronally advanced flap with platelet-rich fibrin or amnion membrane: A comparative analysis

Sumit Kumar Agarwal
1   Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
,
Rajesh Jhingran
1   Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
,
Vivek Kumar Bains
1   Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
,
Ruchi Srivastava
1   Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
,
Rohit Madan
1   Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
,
Iram Rizvi
1   Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
› Author Affiliations
Further Information

Publication History

Publication Date:
23 September 2019 (online)

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ABSTRACT

Objective: To evaluate the efficacy of coronally advanced flap (CAF) procedure under microsurgical approach for the management of Miller's Class I and II gingival recession defects with the use of either platelet-rich fibrin (PRF) or amnion membrane (AM) in comparison to CAF alone. Materials and Methods: A total of 45 sites with Miller's Class I or II gingival recession defect were randomly distributed for: Experimental Group I (CAF with PRF) sites (n = 15) which were treated with the microsurgical approach using CAF along with PRF; experimental Group II (CAF with AM) sites (n = 15) were treated with the microsurgical approach using CAF along with AM; control Group III (CAF alone) sites (n = 15) were treated with the microsurgical approach using CAF alone. Vertical gingival recession (VGR), horizontal gingival recession (HGR), gingival thickness (GT) (using transgingival probing [TGP] and ultrasonography [USG]) and patients’ response and acceptance were documented at baseline, 3 months and 6 months after surgical interventions. Results: CAF alone and in combination with PRF or AM, were effective techniques for root coverage with average VGR values of 1.47 ± 0.92 mm (56%), 0.67 ± 1.23 mm (36%) and 0.60 ± 1.06 mm (33%) in Group I (CAF with PRF), Group II (CAF with AM), and Group III (CAF alone), respectively. Complete coverage (100%) was obtained in 33.3% sites of Group I (CAF with PRF), 26.6% sites of Group II (CAF with AM) and 13.3% in Group III (CAF alone). Patients’ response and acceptance for surgical treatment modality in terms of patient esthetic score and decrease in hypersensitivity score was highest for Group I (CAF with PRF), whereas patient comfort score was highest for Group II (CAF with AM). At 6 months follow-up, significant increase in GT measurements (using TGP and USG) in Group I (CAF with PRF), whereas, nonsignificant increase for Group II (CAF with AM) and no change or decrease for Group III (CAF alone) as compared to baseline was observed. Conclusion: The present study observed enhancement in root coverage when PRF or AM are used in conjunction with CAF as compared to CAF alone. These results are based on 6-month followup. Therefore, the long-term evaluation may be necessary to appreciate the clinical effect of autologous PRF and AM.

Key words:

Amnion - gingival recession - gingival thickness - ultrasonography - wound healing
 

  • REFERENCES

  • 1 Avinash K, Selvan T. Coronally advanced flap in the treatment of recession coverage. Int J Dent Case Rep 2014; 4: 1-10
    Search in Google Scholar
  • 2 Prato GP, Clauser C, Cortellini P. Guided tissue regeneration and a free gingival graft for the management of buccal recession: A case report. Int J Periodontics Restorative Dent 1993; 13: 486-93
    PubMedSearch in Google Scholar
  • 3 Padma R, Shilpa A, Kumar PA, Nagasri M, Kumar C, Sreedhar A. A split mouth randomized controlled study to evaluate the adjunctive effect of platelet-rich fibrin to coronally advanced flap in Miller's class-I and II recession defects. J Indian Soc Periodontol 2013; 17: 631-6
    CrossrefPubMedSearch in Google Scholar
  • 4 Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL. et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part V: histologic evaluations of PRF effects on bone allograft maturation in sinus lift. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 299-303
    CrossrefPubMedSearch in Google Scholar
  • 5 Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J. et al. Platelet-rich fibrin PRF: A second-generation platelet concentrate. Part II: Platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: e45-50
    CrossrefPubMedSearch in Google Scholar
  • 6 Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J. et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part III: Leucocyte activation: A new feature for platelet concentrates?. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: e51-5
    CrossrefPubMedSearch in Google Scholar
  • 7 Dohan EhrenfestDM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: From pure platelet-rich plasma P-PRP to leucocyte- and platelet-rich fibrin L-PRF. Trends Biotechnol 2009; 27: 158-67
    CrossrefPubMedSearch in Google Scholar
  • 8 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: e41-50
    PubMedSearch in Google Scholar
  • 9 Parolini O, Alviano F, Bagnara GP, Bilic G, Bühring HJ, Evangelista M. et al. Concise review: Isolation and characterization of cells from human term placenta: Outcome of the first international workshop on placenta derived stem cells. Stem Cells 2008; 26: 300-11
    CrossrefPubMedSearch in Google Scholar
  • 10 Chopra A, Thomas BS. Amniotic membrane – A novel material for regeneration and repair. J Biomim Biomater Tissue Eng 2013; 18: 106
    Search in Google Scholar
  • 11 Gurinsky B. A novel dehydrated amnion allograft for use in the treatment of gingival recession: An observational case series. J Implant Adv Clin Dent 2009; 1: 124-30
    Search in Google Scholar
  • 12 Bittencourt S, Del Peloso RibeiroE, Sallum EA, Nociti Jr FH, Casati MZ. Surgical microscope may enhance root coverage with subepithelial connective tissue graft: A randomized-controlled clinical trial. J Periodontol 2012; 83: 721-30
    CrossrefPubMedSearch in Google Scholar
  • 13 Burkhardt R, Lang NP. Coverage of localized gingival recessions: Comparison of micro- and macrosurgical techniques. J Clin Periodontol 2005; 32: 287-93
    CrossrefPubMedSearch in Google Scholar
  • 14 De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J. The gingival biotype revisited: Transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol 2009; 36: 428-33
    CrossrefPubMedSearch in Google Scholar
  • 15 Kan JY, Morimoto T, Rungcharassaeng K, Roe P, Smith DH. Gingival biotype assessment in the esthetic zone: Visual versus direct measurement. Int J Periodontics Restorative Dent 2010; 30: 237-43
    PubMedSearch in Google Scholar
  • 16 Vandana KL, Savitha B. Thickness of gingiva in association with age, gender and dental arch location. J Clin Periodontol 2005; 32: 828-30
    CrossrefPubMedSearch in Google Scholar
  • 17 Lins LH, de Lima AF, Sallum AW. Root coverage: Comparison of coronally positioned flap with and without titanium-reinforced barrier membrane. J Periodontol 2003; 74: 168-74
    CrossrefPubMedSearch in Google Scholar
  • 18 Bains R, Bains VK, Loomba K, Verma K, Nasir A. Management of pulpal floor perforation and grade II Furcation involvement using mineral trioxide aggregate and platelet rich fibrin: A clinical report. Contemp Clin Dent 2012; 3 (Suppl. 02) S223-7
    PubMedSearch in Google Scholar
  • 19 Lekovic V, Camargo PM, Weinlaender M, Vasilic N, Kenney EB. Comparison of platelet-rich plasma, bovine porous bone mineral, and guided tissue regeneration versus platelet-rich plasma and bovine porous bone mineral in the treatment of intrabony defects: A reentry study. J Periodontol 2002; 73: 198-205
    CrossrefPubMedSearch in Google Scholar
  • 20 Viera AJ, Garrett JM. Understanding interobserver agreement: The kappa statistic. Fam Med 2005; 37: 360-3
    Search in Google Scholar
  • 21 Silness J, Loe H. Periodontal disease in pregnancy. Acta Odontal Scand 1964; 22: 747-59
    Search in Google Scholar
  • 22 Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963; 21: 533-51
    CrossrefPubMedSearch in Google Scholar
  • 23 Issrani R, Chavva S, Prabhu N, Keluskar V, Jirge V, Kumbujkar V. et al. Transgingival probing and ultrasonographic methods for determination of gingival thickness – A comparative study. Adv Hum Biol 2013; 3: 43-51
    Search in Google Scholar
  • 24 Gould D, Kelly D, Goldstone L, Gammon J. Examining the validity of pressure ulcer risk assessment scales: Developing and using illustrated patient simulations to collect the data. J Clin Nurs 2001; 10: 697-706
    CrossrefPubMedSearch in Google Scholar
  • 25 Tammaro S, Wennström JL, Bergenholtz G. Root-dentin sensitivity following non-surgical periodontal treatment. J Clin Periodontol 2000; 27: 690-7
    CrossrefPubMedSearch in Google Scholar
  • 26 Eren G, Atilla G. Platelet rich fibrin in the treatment of bilateral gingival recession. Clinic Adv Periodontics 2012; 2: 154-60
    Search in Google Scholar
  • 27 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
    CrossrefPubMedSearch in Google Scholar
  • 28 Wallace SC. Root coverage grafting comparing placental derived membrane to acellular dermis matrix: A case series. Dentistry 2012; 2: 137
    Search in Google Scholar
  • 29 Paolantonio M. Treatment of gingival recessions by combined periodontal regenerative techniques, guided tissue regeneration, and subpedicle connective tissue grafts. A comparative clinical study. J Periodontol 2002; 73: 53-62
    CrossrefPubMedSearch in Google Scholar
  • 30 Uraz A, Sezgin Y, Yalim M, Taner L, 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 2013; 20: 1-10
    Search in Google Scholar
  • 31 Aleksic Z, Jankovic S, Dimitrijevic B, Divnic-Resnik T, Milinkovic I, Lekovic V. The use of platelet-rich fibrin membrane in gingival recession treatment. Srp Arh Celok Lek 2010; 138: 11-8
    CrossrefPubMedSearch in Google Scholar
  • 32 Moka LR, Boyapati R, Srinivas M, Swamy N, Swarna C, Putcha M. Comparison of coronally advanced and semilunar coronally repositioned flap for the treatment of gingival recession. J Clin Diagn Res 2014; 8: ZC04-8
    Search in Google Scholar
  • 33 Akkaya M, Böke F. Shallow localized gingival recession defects treated with modified coronally repositioned flap technique: A case series. Eur J Dent 2013; 7: 368-72
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Kumar AP, Fernandes B, Surya C. Platelet rich fibrin: A promising approach for root coverage. J Interdiscip Dent 2011; 1: 115-8
    Search in Google Scholar
  • 35 Jadhav T, Thomas BS. Platelet rich fibrin membrane for recession coverage. E J Dent 2012; 2: 223-7
    Search in Google Scholar
  • 36 Shetty SS, Chatterjee A, Bose S. Bilateral multiple recession coverage with platelet-rich fibrin in comparison with amniotic membrane. J Indian Soc Periodontol 2014; 18: 102-6
    CrossrefPubMedSearch in Google Scholar
  • 37 Nanavati B, Bhavsar NV, Jaydeepchandra M. Coronally Positioned Flap for Root Coverage: Comparison between smokers and nonsmokers. J Int Oral Health 2013; 5: 21-7
    PubMedSearch in Google Scholar
  • 38 Mathur A, Bains VK, Gupta V, Jhingran R, Singh GP. Evaluation of intrabony defects treated with platelet-rich fibrin or autogenous bone graft: A comparative analysis. Eur J Dent 2015; 9: 100-8
    Thieme ConnectPubMedSearch in Google Scholar
  • 39 Gupta V, Bains VK, Singh GP, Mathur A, Bains R. Regenerative potential of platelet rich fibrin in dentistry: Literature review. Asian J Oral Health Allied Sci 2011; 1: 23-8
    Search in Google Scholar
  • 40 Savitha B, Vandana KL. Comparative assesment of gingival thickness using transgingival probing and ultrasonographic method. Indian J Dent Res 2005; 16: 135-9
    CrossrefPubMedSearch in Google Scholar
  • 41 Kolte R, Kolte A, Mahajan A. Assessment of gingival thickness with regards to age, gender and arch location. J Indian Soc Periodontol 2014; 18: 478-81
    CrossrefPubMedSearch in Google Scholar
  • 42 Douglas de OliveiraDW, Oliveira-Ferreira F, Flecha OD, Gonçalves PF. Is surgical root coverage effective for the treatment of cervical dentin hypersensitivity? A systematic review. J Periodontol 2013; 84: 295-306
    CrossrefPubMedSearch in Google Scholar
  • 43 Eger T, Müller HP, Heinecke A. Ultrasonic determination of gingival thickness. Subject variation and influence of tooth type and clinical features. J Clin Periodontol 1996; 23: 839-45
    CrossrefPubMedSearch in Google Scholar
  • 44 Bains VK, Gupta V, Srivastava R, Agarwal SK. Accretion of gingival height by gingival thickness augmentation: A clinical report. Asian J Oral Health Allied Sci 2013; 3: 25-31
    Search in Google Scholar