Skip to main content

Advertisement

SpringerLink
Log in

Laterally positioned flap along with acellular dermal matrix graft in the management of maxillary localized recessions

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

The aim of this study was to evaluate acellular dermal matrix graft (ADM) combination with laterally positioned flap (LPF) and to compare the results with LPF alone in terms of root coverage, esthetics, and patient perspectives in gingival recessions.

Materials and methods

Twenty-two patients with localized Miller Class I/II recessions ≥ 3 mm with gingival thickness (GT) < 0.8 mm were included. Outcome parameters such as recession height and width, keratinized tissue (KT) height, GT, mean and complete defect coverage, patient satisfaction, and root coverage esthetic score (RES) were re-evaluated at 12 months postoperatively.

Results

Mean and complete defect coverage were 94.80 and 72.73% in LPF+ADM group and 77.25 and 45.45% in LPF group, respectively. Significant differences were observed for KT and GT gain, patient satisfaction, and RES in favor of LPF group (p < 0.05). A significant positive correlation was established between GT and mean defect coverage (r = 0.448; p < 0.05).

Conclusion

LPF is a successful approach in the treatment of localized Miller I/II gingival recessions. On the other hand, when thin donor tissue was thickened with an allogenic graft, more successful results regarding complete defect coverage, patient satisfaction, and RES were obtained.

Clinical relevance

Increase in gingival thickness and keratinized tissue height represents critical improvements in the prognosis of the advanced localized recessions and will be beneficial for patient’s periodontal health and esthetics. Both approaches can be used successfully as an alternative for soft tissue root coverage in specific localized cases with a limited amount of keratinized tissue apical to the defect.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Grupe HE, Warren RF (1956) Repair of gingival defects by sliding flap operation. J Periodontol 27:92–95

    Article  Google Scholar 

  2. Grupe HE (1966) Modified technique for the sliding flap operation. J Periodontol 37:491–495

    Article  Google Scholar 

  3. Staffileno H (1964) Management of gingival recession and root exposure problems associated with periodontal disease. Dent Clin N Am 8:111–120

    Google Scholar 

  4. Roccuzzo M, Bunino M, Needleman I, Sanz M (2002) Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 29:178–194

    Article  Google Scholar 

  5. Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LE, Lima LA (2010) Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review. J Periodontol 81:452–478

    Article  Google Scholar 

  6. Zucchelli G, Cesari C, Amore C, Montebugnoli L, De Sanctis M (2004) Laterally moved, coronally advanced flap: a modified surgical approach for isolated recession-type defects. J Periodontol 75:1734–1741

    Article  Google Scholar 

  7. Chambrone LA, Chambrone L (2009) Treatment of Miller Class I and II localized recession defects using laterally positioned flaps: a 24-month study. Am J Dent 22:339–344

    PubMed  Google Scholar 

  8. Santana RB, Furtado MB, Mattos CM, De Mello Fonseca E, Dibart S (2010) Clinical evaluation of single-stage advanced versus rotated flaps in the treatment of gingival recessions. J Periodontol 81:485–492

    Article  Google Scholar 

  9. Zucchelli G, Marzador M, Mele M, Stefanini M, Montebugnoli L (2012) Root coverage in molar teeth: a comparative controlled randomized clinical trial. J Clin Periodontol 39:1082–1088

    Article  Google Scholar 

  10. Lee CT, Chang PC, Touchan N, Royzman D (2014) Root coverage with a modified laterally positioned flap combined with a subepithelial connective tissue graft in advanced recession. J Periodontal Implant Sci 44:300–306

    Article  Google Scholar 

  11. Yilmaz E, Ozcelik O, Comert M, Ozturan S, Seydaoglu G, Teughels W, Haytac MC (2014) Laser-assisted laterally positioned flap operation: a randomized controlled clinical trial. Photomed Laser Surg 32:67–74

    Article  Google Scholar 

  12. Ucak O, Ozcan M, Seydaoglu G, Haytac MC (2017) Microsurgical instruments in laterally moved, coronally advanced flap for Miller Class III isolated recession defects: a randomized controlled clinical trial. Int J Periodontics Restorative Dent 37:109–115

    Article  Google Scholar 

  13. Baldi C, Pini-Prato G, Pagliaro U, Nieri M, Saletta D, Muzzi L, Cortellini P (1999) Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol 70:1077–1084

    Article  Google Scholar 

  14. Woodyard JG, Greenwell H, Hill M, Drisko C, Iasella JM, Scheetz J (2004) The clinical effect of acellular dermal matrix on gingival thickness and root coverage compared to coronally positioned flap alone. J Periodontol 75:44–56

    Article  Google Scholar 

  15. Huang LH, Neiva RE, Wang HL (2005) Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 76:1729–1734

    Article  Google Scholar 

  16. Hwang D, Wang HL (2006) Flap thickness as a predictor of root coverage: a systematic review. J Periodontol 77:1625–1634

    Article  Google Scholar 

  17. Jepsen K, Jepsen S, Zucchelli G, Stefanini M, De Sanctis M, Baldini N, Greven B, Heinz B, Wennström J, Cassel B, Vignoletti F, Sanz M (2013) Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial. J Clin Periodontol 40:82–89

    Article  Google Scholar 

  18. Ahmedbeyli C, Ipçi SD, Cakar G, Kuru BE, Yılmaz S (2014) Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment of multiple gingival recessions with thin tissue biotype. J Clin Periodontol 41:303–310

    Article  Google Scholar 

  19. Berlucchi I, Francetti L, Del Fabbro M, Basso M, Weinstein RL (2005) The influence of anatomical features on the outcome of gingival recessions treated with coronally advanced flap and enamel matrix derivative: a 1-year prospective study. J Periodontol 76:899–907

    Article  Google Scholar 

  20. Mahajan A, Dixit J, Verma UP (2007) A patient-centered clinical evaluation of acellular dermal matrix graft in the treatment of gingival recession defects. J Periodontol 78:2348–2355

    Article  Google Scholar 

  21. Cairo F, Rotundo R, Miller PD, Pini-Prato GP (2009) Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol 80:705–710

    Article  Google Scholar 

  22. Ricci G, Silvestri M, Rasperini G, Cattaneo V (1996) Root coverage: a clinical/statistical comparison between subpedicle connective tissue graft and laterally positioned full thickness flaps. J Esthet Dent 8:66–73

    Article  Google Scholar 

  23. Agarwal C, Purohit P, Sharma SK, Sharma A (2014) Modified approach of double papillae laterally positioned flap technique using Alloderm® for root coverage. J Clin Diagn Res 8:25–27

    Google Scholar 

  24. Tal H (1999) Subgingival acellular dermal matrix allograft for the treatment of gingival recession: a case report. J Periodontol 70:1118–1124

    Article  Google Scholar 

  25. Santos A, Goumenos G, Pascual A (2005) Management of gingival recession by the use of an acellular dermal graft material: a 12-case series. J Periodontol 76:1982–1990

    Article  Google Scholar 

  26. Wainwright DJ (1995) Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns 21:243–248

    Article  Google Scholar 

  27. McFeely WJ Jr, Bojrab DI, Kartush JM (2000) Tympanic membrane perforation repair using AlloDerm. Otolaryngol Head Neck Surg 123:17–21

    Article  Google Scholar 

  28. Paolantonio M, Dolci M, Esposito P, D’archivio D, Lisanti L, Di Luccio A, Perinetti G (2002) Subpedicle acellular dermal matrix graft and autogenous connective tissue graft in the treatment of gingival recessions: a comparative 1-year clinical study. J Periodontol 73:1299–1307

    Article  Google Scholar 

  29. Rebele SF, Zuhr O, Schneider D, Jung RE, Hürzeler MB (2014) Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part II. Volumetric studies on healing dynamics and gingival dimensions. J Clin Periodontol 41:593–603

    Article  Google Scholar 

  30. Ozenci I, Ipci SD, Cakar G, Yilmaz S (2015) Tunnel technique versus coronally advanced flap with acellular dermal matrix graft in the treatment of multiple gingival recessions. J Clin Periodontol 42:1135–1142

    Article  Google Scholar 

  31. Kuka S, Ipci SD, Cakar G, Yılmaz S (2017) Clinical evaluation of coronally advanced flap with or without platelet-rich fibrin for the treatment of multiple gingival recessions. Clin Oral Inverstig 2017 22:1551–1558. https://doi.org/10.1007/s00784-017-2225-9

    Article  Google Scholar 

  32. Cairo F (2017) Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontol 2000 75:296–316

    Article  Google Scholar 

  33. Del Pizzo M, Zucchelli G, Modica F, Villa R, Debernardi C (2005) Coronally advanced flap with or without enamel matrix derivative for root coverage: a 2-year study. J Clin Periodontol 32:1182–1189

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Stomatology and Maxillofacial Surgery, Azerbaijan State Advanced Training Institute for Doctors, Baku, Azerbaijan

    Cavid Ahmedbeyli

  2. Department of Periodontology, Altınbaş University, Istanbul, Turkey

    Sebnem Dirikan Ipci & Gokser Cakar

  3. Private practice, Istanbul, Turkey

    Selcuk Yilmaz

Authors
  1. Cavid Ahmedbeyli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebnem Dirikan Ipci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gokser Cakar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Selcuk Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gokser Cakar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahmedbeyli, C., Ipci, S.D., Cakar, G. et al. Laterally positioned flap along with acellular dermal matrix graft in the management of maxillary localized recessions. Clin Oral Invest 23, 595–601 (2019). https://doi.org/10.1007/s00784-018-2475-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-018-2475-1

Keywords

Search

Navigation