Root coverage procedures for the treatment of localised recession-type defects

 

Abstract

Background

Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable periodontal plastic surgery (PPS) procedures.

Objectives

To evaluate the effectiveness of different root coverage procedures in the treatment of recession-type defects.

Search methods

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched up to October 2008. The main international periodontal journals were handsearched. There were no restrictions with regard to publication status or language of publication.

Selection criteria

Only randomised controlled clinical trials (RCTs) of at least 6 months' duration evaluating recession areas (Miller's Class I or II > 3 mm) and that were treated by means of PPS procedures were included.

Data collection and analysis

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals.

Main results

Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias.
The results indicated a significant greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTG) compared to guided tissue regeneration with resorbable membranes (GTR rm).
A significant greater gain in the keratinized tissue was found for enamel matrix protein when compared to coronally advanced flap (0.40 mm) and for SCTG when compared to GTR rm plus bone substitutes.
Limited data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure.

Authors' conclusions

Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for the treatment of localised recession-type defects. In cases where both root coverage and gain in the keratinized tissue are expected, the use of subepithelial connective tissue grafts seems to be more adequate.
Randomised controlled clinical trials are necessary to identify possible factors associated with the prognosis of each PPS procedure.
The potential impact of bias on these outcomes is unclear.

 

Plain language summary

Root coverage procedures for the treatment of localised recession-type defects

Gingival recession is a term that designates the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is also regularly linked to the deterioration of dental aesthetics as well as buccal cervical dentine hypersensitivity. The results of this review have shown that the majority of periodontal plastic surgery (PPS) procedures led to statistical significant gains in gingival recession depth, clinical attachment level and in the width of keratinized tissue, 23/24 studies were however judged to be at high risk of bias. Also, we observed a great variability in the percentages of complete root coverage and mean coverage. Preferably, subepithelial connective tissue grafts, coronally advanced flaps alone or associated with other graft or biomaterial and guided tissue regeneration can be used as root coverage procedures for the treatment of recession-type defects. We recommend further research to adequately confirm and identify possible factors associated with the prognosis and indications of each PPS procedure.

 

摘要

背景

以牙根覆蓋術治療局部牙齦萎縮

牙齦萎縮定義為牙根因牙齦邊緣往牙堊牙釉交界近根尖處位移而暴露於口腔中，通常與牙齒美觀的惡化有關。牙齦萎縮的成功治療是基於運用可預期性高的牙周整形手術(PPS)。

目標

評估不同牙根覆蓋術用於治療牙齦萎縮的有效性。

搜尋策略

搜尋2008年10月之前的考科藍口腔健康群組之試驗登錄，CENTRAL，MEDLINE，以及EMBASE。人工搜尋主要之國際牙周病學期刊。對於出版現況或出版語言則不加以限制。

選擇標準

只選用以PPS方式治療，至少有為期六個月萎縮區域(Miller分類第一級或大於三公厘之第二級)評估的隨機對照臨床試驗(RCTs)。

資料收集與分析

分別及重複篩選合適之研究，評估試驗方法之品質,以及選取數據。若是資訊不足則與作者聯絡。結果使用連續結果之平均差異以及二分類結果之風險比率，並採以95％的信賴區間，以隨機效應模型表示。

主要結論

總共有二十四組RCTs提供數據。只有一組試驗被認為於偏見是低風險。其他組試驗則屬高風險。結果顯示，上皮下結締組織移植(SCTG)和利用可吸收再生膜進行引導組織再生手術(GTR rm)相比，可顯著減少牙齦萎縮及增加角化組織。使用牙釉基質蛋白和冠向移前皮瓣(0.40毫米)相比;以及使用SCTG和GTR rm加骨替代物相比使用牙釉基質蛋白和使用SCTG皆能獲得更多的角化組織。關於美觀上的變化和病人的意見以及病人對特定術式的偏好之間的關係，研究取得的數據有限。

作者結論

上皮下結締組織移植術，單獨冠向移前翻瓣手術或合併使用其他生物材料，以及引導組織再生手術皆可用於牙根覆蓋術，以治療局部牙齦萎縮。在需要牙根覆蓋以及增加角化組織之病例，使用上皮下結締組織移植術式較為合適。要分辨影響不同PPS手術預後相關的可能因素需要進行隨機對照臨床試驗。但對於這些結果的潛在偏誤尚不清楚。

翻譯人

本摘要由臺灣大學附設醫院陳思齊翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

牙齦萎縮一詞定義為牙根因牙齦邊緣往牙堊牙釉交界向根尖位移而暴露於口腔中，通常與牙齒美觀的惡化以及頰側齒頸部的牙本質敏感有關。本篇文獻回顧結果顯示大部分的牙周整形手術(PPS)可在統計學上顯著改善牙齦萎縮深度，增加牙周附連高度，以及增加角化牙齦寬度，但有23/24之研究被認為在偏誤上有高風險。另外，我們觀察到牙根完全覆蓋以及平均覆蓋率的百分比之間有巨大變異。上皮下結締組織移植術，單獨冠向前移翻瓣手術或合併使用其他生物材料，以及引導組織再生手術皆可用於牙根覆蓋術，以治療局部牙齦萎縮。我們建議進一步研究，以充分確認並找出影響每種PPS術式預後及適應症的可能因素。