Jl. Wennstrom et G. Zucchelli, INCREASED GINGIVAL DIMENSIONS - A SIGNIFICANT FACTOR FOR SUCCESSFUL OUTCOME OF ROOT COVERAGE PROCEDURES - A 2-YEAR PROSPECTIVE CLINICAL-STUDY, Journal of clinical periodontology, 23(8), 1996, pp. 770-777
The aim of this study was to evaluate whether an increased thickness o
f the gingiva through the use of a free connective tissue graft, in co
njunction with a coronally advanced flap procedure, may positively inf
luence the treatment outcome with respect to (i) root coverage and (ii
) long-term stability of the position of the soft tissue margin follow
ing treatment of recession type defects. 67 consecutive patients havin
g a total of 103 buccally located recession type defects of at least 3
mm were included in the study. After an initial phase of prophylaxis
including instructions in a tooth brushing technique giving minimal ap
ically directed forces to the gingival margin, the recession sites wer
e surgically covered with a coronally advanced flap alone (control sit
es), or coronally advanced flap combined with a free connective tissue
graft taken from the palate (test sites). Clinical examinations, incl
uding assessments of oral hygiene, gingival conditions, recession dept
h, gingival height, probing pocket depth and probing attachment loss,
were performed before and 6, 12 and 24 months after surgical treatment
. The mean initial recession depth for both treatment groups was about
4.0 mm (SD 1.0) with a gingival height apical to the recession of 1.0
mm (0.5). At the re-examination performed 6 months after surgical tre
atment, the mean recession depth had decreased to 0.2 mm in both the t
est and control groups. Complete root coverage was observed at 72% of
the test sites and 74% of the control teeth. At teeth treated with the
combined surgical procedure, the mean gain in probing attachment amou
nted to 3.7 mm and the mean gingival height had increased to 3.5 mm (0
.6). The corresponding figures for control teeth were 3.6 mm and 1.5 m
m (0.5), respectively, At the 24-month follow-up examination,the mean
root coverage amounted to 98.9% (test) and 97.1% (control). 88% of the
teeth in the test group showed complete root coverage compared to 80%
for teeth in the control group. It was concluded that the 2 surgical
procedures resulted in similar degree of root coverage and that change
s of tooth brushing habits may be of greater importance than increased
gingival thickness for long-term maintenance of the surgically establ
ished position of the soft tissue margin.