Periodontics Brazil – Partial vs Full Thickness Flap

Gingival recession is among the most common periodontal problems in young adults.[] Epidemiologic studies have shown that more than 50 percent of the population have one or more gingival recession sites of 1 mm or more.[] Gingival recession can occur in patients with fair or poor oral hygiene. There is a clear relationship between gingival recession and several risk factors such as dental plaque, calculus, tobacco consumption, tooth brushing frequency, traumatic tooth brushing, high frenal attachment, trauma, and malposition of teeth.[]

Complications of gingival recession include tooth sensitivity, esthetic problems, food impaction, and plaque accumulation leading to root caries, lack of attached gingiva, hyperemic pulp, endodontic problems, difficulties in restoration, and finally tooth loss.[]

Currently, numerous researchers have attempted to treat marginal tissue recession. Treatments for gingival recession include gingival grafting,[] guided tissue regeneration (GTR),[] and orthodontic therapy.[] Using gingival grafts for root coverage has a historical background. However, most studies on this subject were conducted in the second half of the 20th century.[]

Different surgical techniques have been proposed and employed by researchers for root coverage such as laterally sliding flap,[] free gingival graft,[] sub-epithelial connective tissue graft,[] coronally-positioned flap[] and GTR.[]

Studies showed that the mean root coverage (MRC) was not equal in different techniques. The MRC was reported to be 55-91.2% for coronally advanced flap (CAF), 43-85.3% for free gingival graft and 53.5-87.1% for GTR.[]

The two latest methods applied successfully are subpedicle connective tissue graft and connective tissue with partial thickness double pedicle graft introduced by Nelson and Harris who are the pioneers of these methods, respectively.[] They reported 91% and 97.7% MRT, respectively. The success of Harris’s technique was more than that of other procedures described earlier, which seems to be due to the mucosal flap design.[]

Recent studies have shown that using connective tissue graft (CTG) in conjunction with CAF, modified coronally advanced flap (MCAF) or double pedicle graft (DPG) results in more complete root coverage (CRC) or MRC than the bio-absorbable membranes.[] Thus, using CTG in different procedures is still recommended as the most efficient method for covering the denuded root surfaces.

Periodontics Brazil – Partial vs Full Thickness Flap

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