Abstract
This study evaluated the clinical and radiographic outcomes of surgical treatment of intrabony defects and gingival recessions using connective tissue grafts. A systematic exploratory review followed the PRISMA-ScR guidelines, searching databases such as PubMed, SCOPUS, and SciELO. Clinical trials, cohort studies, and case reports that provided clinical and radiographic outcomes such as probing depth, clinical attachment level, gingival recession coverage, and keratinized tissue characteristics were considered. Nine studies with follow-ups from six to thirty-six months were included. The results show an average reduction in probing depth of 4.73 mm and a gain in clinical attachment level of 4.63 mm. Coverage of associated gingival recessions showed favorable results, including full coverage in several cases, along with an increase in apical-coronal height and keratinized tissue thickness of up to 3 mm. Radiographically, stable bone fill was evident in all cases, accompanied by greater radiopacity and preservation of interproximal bone support. The use of connective tissue grafting together with enamel matrix derivatives and/or bone grafts improves clinical parameters and produce a radiographically visible bone fill. It provides additional improvement in soft tissue characteristics, with the potential to improve the prognosis and comfort of the treated teeth.
References
Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, Sculean A, Tonetti MS; EFP Workshop Participants and Methodological Consultants. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020 Jul;47 Suppl 22(Suppl 22):4-60. doi: 10.1111/jcpe.13290.
Aimetti M, Fratini A, Manavella V, et al. Pocket resolution in regenerative treatment of intrabony defects with papilla preservation techniques: A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. 2021;48(6):843-858. doi:10.1111/jcpe.13428
Tsai SJ, Ding YW, Shih MC, Tu YK. Systematic review and sequential network meta-analysis on the efficacy of periodontal regenerative therapies. J Clin Periodontol. 2020 Sep;47(9):1108-1120. doi: 10.1111/jcpe.13338.
Cortellini P, Cortellini S, Bonaccini D, Tonetti MS. Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials-10-year follow-up of a randomized clinical trial: Tooth retention, periodontitis recurrence, and costs. J Clin Periodontol. 2022;49(6):528-536. doi:10.1111/jcpe.13627
Stavropoulos A, Bertl K, Spineli LM, Sculean A, Cortellini P, Tonetti M. Medium- and long-term clinical benefits of periodontal regenerative/reconstructive procedures in intrabony defects: Systematic review and network meta-analysis of randomized controlled clinical studies. J Clin Periodontol. 2021;48:410–30. DOI: 10.1111/jcpe.13409
Ossa-Sherman M, Araya-Contador R, Segovia-Chamorro J. Tratamiento regenerativo de defectos intraóseos mediante colgajos mínimamente invasivos: Revisión sistemática exploratoria. Odontoestomatologia. 2023;24(40). DOI: 10.22592/ode2022n40e318
Nibali L, Koidou VP, Nieri M, Barbato L, Pagliaro U, Cairo F. Regenerative surgery versus access flap for the treatment of intrabony periodontal defects: A systematic review and meta analysis. J Clin Periodontol. 2020;47(Suppl 22):320–51. DOI: 10.1111/jcpe.13237
Rasperini G, Tavelli L, Barootchi S, McGuire MK, Zucchelli G, Pagni G, Stefanini M, Wang HL, Giannobile WV. Interproximal attachment gain: The challenge of periodontal regeneration. J Periodontol. 2021 Jul;92(7):931-946. doi: 10.1002/JPER.20-0587.
Rasperini G, Acunzo R, Barnett A, Pagni G. The Soft Tissue Wall Technique for the Regenerative Treatment of Non-contained Infrabony Defects: A Case Series. Int J Periodontics Restorative Dent. 2013;33(3):e79–87. DOI: 10.11607/prd.1628.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467–73. DOI: 10.7326/M18-0850
Joanna Briggs Institute. Critical Appraisal Tools [Internet]. JBI. 2020. Available from: https://jbi.global/critical-appraisal-tools
Santoro G, Zucchelli G, Gherlone E. Combined regenerative and mucogingival treatment of deep intrabony defects associated with buccal gingival recession: Two case reports. Int J Periodontics Restorative Dent. 2016;36(6):849–57. DOI: 10.11607/prd.2764
Zucchelli G, Bentivogli V, Ganz S, Bellone P, Mazzotti C. The connective tissue graft wall technique to improve root coverage and clinical attachment levels in lingual gingival defects. Int J Esthet Dent. 2016;11(4):524–37. PMID: 27730223
Mourlaas J, Cortasse B, Vigouroux F, Dagba A. The tunnel wall approach and enamel matrix derivative to cover exposed roots and improve clinical attachment levels in Cairo Class III defects associated with an intrabony lesion in the anterior area: Three cases. Int J Periodontics Restorative Dent. 2023;43(1):95–102. DOI: 10.11607/prd.6352
Elfana A, Elbehwashy M. Periodontal regeneration using connective tissue graft wall and xenograft with coronally advanced flap in noncontained intrabony defects: A novel combination technique. J Indian Soc Periodontol. 2022;26(3):295–8. DOI: 10.4103/jisp.jisp_347_21
Moreno Rodríguez JA, Ortiz Ruiz AJ, Zamora GP, Pecci-Lloret M, Caffesse RG. Connective Tissue Grafts with Nonincised Papillae Surgical Approach for Periodontal Reconstruction in Noncontained Defects. Int J Periodontics Restorative Dent. 2019;39(6):781-787. doi:10.11607/prd.4282
Bravard M, Agossa K. Combination therapy with connective tissue graft, amelogenins, and bone substitutes for treatment of deep intrabony defects associated with gingival recession: 1 Year follow-up of 12 cases. Int J Periodontics Restorative Dent. 2022;42(3):321–9. DOI: 10.11607/prd.5479
Zucchelli G, Mazzotti C, Tirone F, Mele M, Bellone P, Mounssif I. The Connective Tissue Graft Wall Technique and Enamel Matrix Derivative to Improve Root Coverage and Clinical Attachment Levels in Miller Class IV Gingival Recession. Int J Periodontics Restorative Dent. 2014;34(5):601–9. DOI: 10.11607/prd.1978
Zucchelli G, Mounssif I, Marzadori M, Mazzotti C, Felice P, Stefanini M. Connective Tissue Graft Wall Technique and Enamel Matrix Derivative for the Treatment of Infrabony Defects: Case Reports. Int J Periodontics Restorative Dent. 2017;37(5):673–81. DOI: 10.11607/prd.3083
Trombelli L, Simonelli A, Minenna L, Rasperini G, Farina R. Effect of a Connective Tissue Graft in Combination With a Single Flap Approach in the Regenerative Treatment of Intraosseous Defects. J Periodontol. 2017;88(4):348–56. DOI: 10.1902/jop.2016.160471
Matarasso M, Iorio-Siciliano V, Blasi A, Ramaglia L, Salvi GE, Sculean A. Enamel matrix derivative and bone grafts for periodontal regeneration of intrabony defects. A systematic review and meta-analysis. Clin Oral Investig. 2015;19(7):1581-1593. doi:10.1007/s00784-015-1491-7
Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, et al. Twenty years of enamel matrix derivative: The past, the present and the future. J Clin Periodontol. 2016;43(8):668–83. DOI: 10.1111/jcpe.12546
Tavelli L, Chen CY, Barootchi S, Kim DM. Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis. J Periodontol. 2022;93(12):1803–26. DOI: 10.1002/JPER.22-0120
Yang Z, Yu Q, Ren L, Wang H, Zhu L. Efficacy of OFD with EMD for treatment of periodontal defects: A systematic review and meta-analysis. Oral Dis. 2024;30(2):250–70. DOI: 10.1111/odi.15029
Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root coverage procedures for the treatment of localized recession-type defects: A Cochrane systematic review. J Periodontol. 2010;81(4):452–78. DOI: 10.1902/jop.2010.090540
Rasperini G, Kazarian E, Aslan S. Coronally Advanced Entire Papilla Preservation (CA-EPP) Flap in the Treatment of an Isolated Intrabony Defect to Promote Buccal and Interproximal Soft Tissue Stability: Case Reports. Int J Periodontics Restorative Dent. 2024;44(1):9–16. DOI: 10.11607/prd.6851
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