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Title: Connective tissue grafts and soft tissue substitute for multiple gingival recessions: review, clinical and histology
Authors: Calado, Sónia 
Orientador: Martins, Orlando
Martins, João
Keywords: Multiple gingival recessions; Modified coronally advanced flap; Connective tissue graft; Mucograft; Histology; Complete root coverage; Morbidity
Issue Date: 2016
Abstract: Aim: This study aims to conduct a review on the efficacy of the use of a modified coronally advanced flap (MCAF) with a connective tissue graft (CTG) compared to MCAF and Mucograft (MG) in terms of complete root coverage (CRC), after a minimal 6-month follow-up in patients with maxillary multiple gingival recessions (MGR), and post-operative pain in patients that underwent CTG harvesting will be determined. CTG obtained from patients and also a soft tissue substitute (MG) implanted in mice at 15 and 30 days will also be histologically characterized. Material and Methods: A bibliographic review was conducted through an electronic and hand search. Eligibility of the resulting articles was assessed through title and abstract analysis and subsequently full-text-analysis by two independent reviewers. Primary (CRC) and secondary outcomes (recession reduction (RecRed) and keratinized tissue(KT) gain) were evaluated. Two patients with maxillary Cl I or II MGR on adjacent teeth that needed root coverage were included in this study. One underwent MCAF/CTG while the other MCAF/MG. Post-operative pain questionnaires were handed out to 6 patients that experienced CTG harvesting. Primary (CRC) and secondary (mean of root coverage (MRC) and post-operative pain) outcomes were evaluated at 6-months post-operative. Palatal biopsies of the CTG donor site were obtained for posterior histomorphometric evaluation, and MG was implanted subcutaneously in mice with subsequent histological evaluation at 15 and 30-days post-implantation. Results: After an extensive search, only 3 studies were included, in which 1 reported the use of MCAF/MG. The studies were only comparable at 12-months, where MCAF/CTG obtained a mean CRC value of 73.7% while MCAF/MG attained 88.1%. The patients that underwent MCAF/CTG and MCAF/MG responded well to the surgical treatment. Healing was uneventful and the 1-week post-operative pain was low in both approaches. At the 6-month evaluation, CRC was obtained in 75% of the treated sites with MCAF/CTG. Patients who underwent CTG harvesting, regardless of the surgical technique reported a low pain intensity that subsided by the fourth day after surgery. Five in six patients referred that both the donor and the receptor site hurt equally. Two palatal biopsies revealed tissue with a highly dense connective tissue, the lamina propria (LP), and tissue also dense in connective tissue but with a greater presence of adipose tissue, the submucosa (SM). The histologic evaluation of MG in mice showed a well-integrated membrane with increasing remodulating and formation of new vascular structures from 15 to 30 days. Conclusion: More studies with standardized outcomes and follow-ups are needed to determine which approach, MCAF/CTG or MCAF/MG, is more efficacious after 6-months post-operative. It can also not be assessed whether MCAF/MG will have the same tendency for a coronal shift of the gingival margin that MCAF/CTG has over time. A larger number of included patients with the same follow-up period would be necessary to draw conclusions about the CRC at 6-months post-operative. Low pain levels were reported and although the donor site may not necessarily be the cause of more pain, more investigation is needed with a larger amount of standardized patients. The palatal biopsies confirmed that the LP had dense connective tissue and enough thickness for its use as a CTG, while the SM had more adipose tissue, even if some variability was observed. The implanted MG revealed optimal integration, its bilayered structure acted as barrier for preferential tissue ingrowth.
Description: Trabalho final do 5º ano com vista à atribuição do grau de mestre no âmbito do ciclo de estudos de Mestrado Integrado em Medicina Dentária apresentado à Faculdade de Medicina da Universidade de Coimbra.
Rights: openAccess
Appears in Collections:FMUC Med. Dentária - Teses de Mestrado
UC - Dissertações de Mestrado

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