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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (1): 80-85. doi: 10.19723/j.issn.1671-167X.2019.01.015

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Vestibular incision subperiosteal tunnel access with connective tissue graft for the treatment of Miller classⅠ and Ⅱ gingival recession

Ke-ang FAN,Jin-sheng ZHONG,Xiang-ying OUYANG(),Ying XIE,Zi-yuan CHEN,Shuang-ying ZHOU,Yuan ZHANG   

  1. Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2018-10-15 Online:2019-02-18 Published:2019-02-26
  • Contact: Xiang-ying OUYANG E-mail:kqouyangxy@bjmu.edu.cn

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Abstract:

Objective: To evaluate the clinical outcomes of vestibular incision subperiosteal tunnel access (VISTA) with connective tissue graft (CTG) in the treatment of Miller classes Ⅰ and Ⅱ localized gingival recession. Methods: Ten patients with 10 Miller classes Ⅰ and Ⅱ localized gingival recessions were enrolled in the study. All defects were equal to or above 2 mm in recession depth. All the patients received treatment with VISTA+CTG. Their clinical parameters, including recession depth (Rec), recession width (RW), keratinized tissue width (KT), clinical attachment loss (CAL), probing depth (PD) were recorded and compared before surgery and 6 months later. The mean root coverage (MRC) and complete root coverage (CRC) were calculated at the end of 6 months. A visual analogue scale (VAS) was used to estimate the patients’ discomfort during the operation and during the 2 weeks post-operation. Patient-based aesthetic satisfaction 6 months after surgery was evaluated by a VAS. Results: The mean Rec was (2.65±0.82) mm at baseline, and (0.35±0.58) mm after 6 months. The VISTA+CTG treatment resulted in an improvement of (2.30±0.98) mm in recession depth (P<0.001). MRC was 86.67%±21.94% and CRC reached 70% at the end of 6 months. KT increased (0.90±1.22) mm (P<0.05) . Aesthetic satisfaction on the patients’ level was 8.30 based on VAS (0=unsatisfied, 10=extremely satisfied). The patients’ discomfort during the operation and 2 weeks post operation were 2.40 and 4.30 (0=no pain, 10=extreme pain). Furthermore, clinical outcomes showed no statistically significant difference between the gingival biotypes, and between the teeth positioned in maxillary and in mandibular. Conclusion: VISTA+CTG could be an effective treatment for Miller classes Ⅰ and Ⅱ localized gingival recession. Clinical outcomes indicated decrease in recession depth and width, and increase in width of keratinized tissue. Patients suffered little pain during the operation and 2 weeks post-operation of healing and accessed good aesthetic satisfaction. VISTA+CTG could be an option for the treatment of Miller classes Ⅰ and Ⅱ localized gingival recession.

Key words: Gingival recession, Vestibular incision subperiosteal tunnel access, Connective tissue graft

CLC Number: 

  • R781.4

Figure 1

VISTA+CTG operating procedure A, Miller class Ⅰ recession defect on #23; B-C, thorough scaling and root planing and odontoplasty cervical prominences of roots; D, vestibular access incision; E, subperiosteal tunnel creation; F-G, connective tissue harvest; H, connective tissue placed into the tunnel and sutured; I, the gingival margin is advanced coronally to the CEJ and stabilized in new position by bonded the suture to facial aspect of the tooth with composite resin; J-L, comparison of initial defect, 2 weeks of postoperative healing, 6 months of postoperative healing."

Table 1

Comparison of clinical parameters before and 6 months after the treatment /mm"

Items Baseline 6 months Change P value
Rec 2.65±0.82 0.35±0.58 2.30±0.98 <0.001
RW 3.55±0.64 1.00±1.55 2.55±1.61 0.001
KT 2.20±1.30 3.10±1.29 0.90±1.22 0.045
PD 2.40±0.34 2.63±0.53 0.23±0.52 0.191
CAL 2.90±0.32 2.35±0.94 1.90±1.27 0.060

Table 2

Clinical outcomes of different biotype"

Biotype Thick (n=4) Thin (n=6) P value
ΔRec/mm 2.67±1.00 1.75±0.50 0.156
ΔRW/mm 2.92±1.88 2.00±1.08 0.409
ΔKT/mm 0.67±1.03 1.25±1.55 0.492
MRC/% 91.67±20.41 79.17±25.00 0.409
CRC/% 83 50 0.312

Table 3

Clinical outcomes of different site"

Site Maxillary (n=5) Mandibular (n=5) P value
ΔRec/mm 2.20±1.15 2.40±0.89 0.767
ΔRW/mm 2.80±2.08 2.30±1.15 0.651
ΔKT/mm 1.20±1.10 0.60±1.39 0.470
MRC/% 80.00±27.39 93.33±14.91 0.367
CRC/% 60 80 0.545
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