Long-term stability of gingival margin and periodontal soft-tissue phenotype achieved after mucogingival therapy: A systematic review.

Autor: Carbone AC; Implantology and Periodontology, São Leopoldo Mandic Research Institute, Campinas, Brazil., Joly JC; Implantology and Periodontology, São Leopoldo Mandic Research Institute, Campinas, Brazil., Botelho J; Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal.; Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-School of Health & Science, Almada, Portugal., Machado V; Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal.; Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-School of Health & Science, Almada, Portugal., Avila-Ortiz G; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA.; Private Practice, Atelier Dental Madrid, Madrid, Spain., Cairo F; Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy., Chambrone L; Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal.; Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogota, Colombia.; Department of Periodontics, School of Dental Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Jazyk: angličtina
Zdroj: Journal of clinical periodontology [J Clin Periodontol] 2024 Feb; Vol. 51 (2), pp. 177-195. Date of Electronic Publication: 2023 Nov 14.
DOI: 10.1111/jcpe.13900
Abstrakt: Background: The aim of this systematic review was two-fold: (i) to evaluate the long-term (≥5 years) stability of the gingival margin position, keratinized tissue width (KTW) and gingival thickness (GT) in sites that underwent root coverage (RC) or gingival augmentation (GA); and (ii) to assess the influence of different local variables on the long-term stability of dental and gingival tissues.
Materials and Methods: Randomized controlled trials (RCTs) and non-RCTs reporting short-term (i.e., 6-12 months after baseline surgical intervention) and long-term (≥5 years) follow-up data after surgical treatment of adult patients presenting single or multiple mucogingival deformities, defined as sites presenting gingival recession defects (GRDs) and/or (KTW) deficiency (i.e., <2 mm), were considered eligible for inclusion. MEDLINE-PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases were searched for articles published up to 15 May 2023. Mixed-effects multiple linear regression was used to assess the association between KTW, type of surgical procedure and time (i.e., independent variables) on the stability of the gingival margin in sites that received RC or GA therapy.
Results: Of the 2569 potentially eligible records, 41 (reporting 40 studies) met the eligibility criteria. Graphical estimates including data from all RC procedures found an upward trend in recession depth (RD) increase over time. Conversely, it was observed that in 63.63% of RC studies and in 59.32% of RC treatment arms KTW increased over time, particularly in sites treated with subepithelial connective tissue grafts (SCTGs). Conversely, sites that underwent GA procedures generally exhibited an overall reduction of KTW over time. However, sites treated with free gingival grafts (FGGs) showed a decrease in RD after 10 years of follow-up. Three main findings derived from the pooled estimates were identified: (i) Gingival margin stability was associated with the amount of KTW present during short-term assessment (i.e. the greater the KTW at 6-12 months after treatment, the more stable the gingival margin). (ii) The use of autogenous soft-tissue grafts was associated with lower RD increase over time. (iii) Treatment approaches that contribute to the three-dimensional enhancement of the gingival phenotype, as clearly demonstrated by FGG, were associated with gingival margin stability.
Conclusions: The extent of apical migration of the gingival margin appears to be directly related to the amount of KTW and GT upon tissue maturation. Interventions involving the use of autogenous grafts, either SCTG or FGG, are associated with greater short-term KTW gain and lower RD increase over time.
(© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz: