Abstract
Root conditioning or root preparation was considered for many years as a fundamental principle and a step in surgical treatment of gingival recession defects [1–3]. This root treatment may be mechanical and/or chemical. The aims of mechanical root instrumentation are removing root caries [4], reducing root convexity [5, 6], reducing the cementum toxins [7], and smoothening the root surface [8] (Table 7.1). It was suggested that this mechanical treatment might enhance a close adaptation of the graft to the surface of the root, which was flattened [5, 6]. This intimate contact could consequently avoid flap shrinkage and graft exposure [14]. However, Saletta et al. [15] demonstrated that root instrumentation did not change root surface convexity, which could be flattened moderately.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bernimoulin JP, Lüscher B, Mühlemann HR. Coronally repositioned periodontal flap. Clinical evaluation after one year. J Clin Periodontol. 1975;2:1–13.
Grupe H, Warren R. Repair of gingival defects by a sliding flap operation. J Periodontol. 1956;27:92–5.
Cohen DW, Ross SE. The double papillae repositioned flap in periodontal therapy. J Periodontol. 1968;39:65–70.
Miller PD. Root coverage using a free soft tissue autograft following citric acid application. Part II. Treatment of the carious root. Inter J Periodontics and Rest Dent. 1983;3:38–51.
Holbrook T, Ochsenbein C. Complete coverage of the denuded root surface with a one-stage gingival graft. Inter J Periodontics Rest Dent. 1983;3:9–27.
Miller PD. Root coverage using a free soft tissue autograft following citric acid application. III. A successful and predictable procedure in areas of deep-wide recession. Inter J Periodontics Rest Dent. 1985;5:15–37.
Bertrand PM, Dunlap RM. Coverage of deep, wide gingival clefts with free gingival autografts: root planing with and without citric acid demineralization. Inter J Periodontics Rest Dent. 1988;8:64–77.
Wennstrom JL. Mucogingival therapy. World Workshop in periodontics. Ann Periodontol. 1996;1:671–701.
Otomo JA, Sims N. Effects of citric acid demineralization on coronally repositioned flaps. J Dent Res. 1979;58(Special Issue A):347.
Liu WJ, Solt CW. A surgical procedure for the treatment of localized gingival recession in conjunction with root surface citric acid conditioning. J Periodontol. 1980;51:505–10.
Shiloah J. The clinical effects of citric acid and laterally positioned pedicle grafts in the treatment of denuded root surfaces. A Pilot study. J Periodontol. 1980;51:652–4.
Miller PD. Root coverage using a free soft tissue autograft following citric acid application. Part 1: technique. Inter J Periodontics Rest Dent. 1982;2:65–70.
de Sanctis M, Clementini M. Flap approaches in plastic peri-odontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014;41(Suppl. 15):S108–22.
Zucchelli G, Mounssif I. Periodontal plastic surgery. J Periodontol. 2015;68:333–68.
Saletta D, Baldi C, Nieri M, Ceppatelli P, Franceschi D, Rotundo R, Cairo F, Pini Prato GP. Root curvature: differences among dental morphotypes and modifications after mechanical instrumentation. J Periodontol. 2005;76:723–30.
Pini Prato GP, Baldi C, Pagliaro U, Nieri M, Saletta D, Rotundo R, Cortellini P. Coronally advanced flap procedure for root coverage. Treatment of root surface: root planing versus polishing. J Periodontol. 1999;70:1064–76.
Zucchelli G, Mounssif I, Stefanini M, Mele M, Montebugnoli L, Sforza NM. Hand and ultrasonic instrumentation in combination with root-coverage surgery: a comparative controlled randomized clinical trial. J Periodontol. 2009b;80:577–85.
Pini Prato G, Rotundo R, Franceschi D, Cairo F, Cortellini P, Nieri M. Fourteen-year outcomes of coronally advanced flap for root coverage: follow-up from a randomized trial. J Clin Periodontol. 2011;38:715–20.
Trombelli L, Scabbia A, Wikesjo UME, Catura G. Fibrin glue application in conjunction with tetracycline root conditioning and coronally positioned flap procedure in the treatment of human gingival recession defects. J Clin Periodontol. 1996;23:861–7.
Bittencourt S, del Peloso Ribeiro E, Sallum EA, Sallum A, Nociti FH Jr, Casati MZ. Root surface biomodification with EDTA for the treatment of gingival recession with a semilunar coronally repositioned flap. J Periodontol. 2007;78:1695–701.
Cheng Y-F, Chen J-W, Lin S-J, Lu H-K. Is coronally positioned flap procedure adjunct with enamel matrix derivative or root conditioning a relevant predictor for achieving root coverage? A systemic review. J Periodontal Res. 2007;42:474–85.
Oliveira G, Muncinelli E. Efficacy of root surface biomodification in root coverage: a systematic review. J Can Dent Assoc. 2012;78:c122.
Lin Z, Rios HF, Cochran DL. Emerging regenerative approaches for periodontal reconstruction: a systematic review from the AAP regeneration workshop. J Periodontol. 2015;86(Suppl):S134–S52.
Cairo F, Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol. 2008;35(Suppl. 8):136–62.
Chambrone L, Sukekava F, Araujo M, Pustiglioni F, LA Chambrone L. Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review. J Periodontol. 2010;81:452–78.
Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized gingival recessions. A systematic review. J Clin Periodontol. 2014;41(Suppl. 15):S44–62.
Tonetti MS, Jepsen S. Clinical efficacy of periodontal plastic surgery procedures: consensus report of group 2 of the 10th European workshop on periodontology. J Clin Periodontol. 2014;41(Suppl. 15):S36–43.
Zuhr O, Rebele SF, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient-centred outcomes. J Clin Periodontol. 2013;41:582–92.
Rebele SF, Zuhr O, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part II. Volumetric studies on healing dynamics and gingival dimensions. J Clin Periodontol. 2014;41:593–603.
Amine K, El Amrani Y, Chemlali S, Kissa J. Alternatives to connective tissue graft in the treatment of localized gingival recessions: a systematic review. J Stomatol Oral Maxillofac Surg. 2018;119(1):25–32.
Blomlof J, Blomlof L, Lindskog S. Effect of different concentrations of EDTA on smear removal and collagen exposure in periodontitis-affected root surfaces. J Clin Periodontol. 1997;24:534–7.
Ozcelik O, Haytac MC, Seydaoglu G. Treatment of multiple gingival recessions using a coronally advanced flap procedure combined with button application. J Clin Periodontol. 2011;38:572–80.
Pini Prato GP, Baldi C, Nieri M, Franceschi D, Cortellini P, Clauser C, Rotundo R, Muzzi L. Coronally advanced flap: the post-surgical position of the gingival margin is an important factor for achieving complete root coverage. J Periodontol. 2005;76:713–22.
Zucchelli G, de Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol. 2000;71:1506–14.
Zucchelli G, Cesari C, Amore C, Montebugnoli L, de Sanctis M. Laterally moved, coronally advanced flap: a modified surgical approach for isolated recession-type defects. J Periodontol. 2004;75:1734–41.
Pini Prato G, Pagliaro U, Baldi C, Nieri M, Saletta D, Cairo F, Cortellini P. Coronally advanced flap procedure for root coverage. Flap with tension versus flap without tension: a randomized controlled clinical study. J Periodontol. 2000;71:188–201.
Cortellini P, Tonetti M, Prato GP. The partly epithelialized free gingival graft (pe-fgg) at lower incisors. A pilot study with implications for alignment of the mucogingival junction. J Clin Periodontol. 2012;39:674–80.
Mormann W, Ciancio SG. Blood supply of human gingiva following periodontal surgery. A fluorescein angiographic study. J Periodontol. 1977;48:681–92.
Greenwell H, Vance G, Munninger B, Johnston H. Superficial-layer split-thickness flap for maximal flap release and coronal positioning: a surgical technique. Int J Periodontics Restorative Dent. 2004;24:521–7.
Allen EP, Miller PD. Coronal positioning of existing gingiva: short term results in the treatment of shallow marginal tissue recession. J Periodontol. 1989;60:316–9.
Aroca S, Keglevich T, Barbieri B, Gera I, Etienne D. Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet rich fibrin membrane for the treatment of adjacent multiple gingival recessions. A 6-month study. J Periodontol. 2009;80:244–52.
Zuhr O, Rebele SF, Thalmair T, Fickl S, Hurzeler MB. A modified suture technique for plastic periodontal and implant surgery – the double-crossed suture. Eur J Esth Dent. 2009;4(4):338–47.
Burkhardt R, Lang NP. Coverage of localized gingival recessions: comparison of micro- and macrosurgical techniques. J Clin Periodontol. 2005;32:287–93.
Shanelec DA. Current trends in soft tissue. Californian Dent Association J. 1991;19:57–60.
Shanelec DA, Tibbetts LS. Periodontal microsurgery. Periodontal Insights. 1994;1:4–7.
Tibbetts LS, Shanelec DA. An overview of periodontal microsurgery. Curr Opin Periodontol. 1994;2:187–93.
Tibbetts LS, Shanelec D. Current status of periodontal microsurgery. Curr Opin Periodontol. 1996;3:118–25.
Shanelec DA, Tibbetts LS. A perspective on the future of periodontal microsurgery. Periodontology 2000. 1996;11:58–64.
Michaelides PL. Connective-tissue root coverage using microsurgery. Dent Today. 1996;15(10):74, 76, 78–9. Review.
Shanelec DA. Periodontal microsurgery. Dent Today. 1997;16(12):88, 90, 92–4. Review.
Tibbetts LS, Shanelec D. Periodontal microsurgery. Dent Clin N Am. 1998;42(2):339–59. Review.
Burkhardt R, Hürzeler MB. Utilization of the surgical microscope for advanced plastic periodontal surgery. Pract Periodontics Aesthet Den. 2000;12:171–80.
Harris RJ. The connective tissue and partial thickness double pedicle graft: a predictable method of obtaining root coverage. J Periodontol. 1992;63:477–86.
Bittencourt S, Del Peloso RE, Sallum EA, Nociti FH Jr, Casati MZ. Surgical microscope may enhance root coverage with subepithelial connective tissue graft: a randomized- controlled clinical trial. J Periodontol. 2012;83(6):721–30.
Francetti L, Del Fabbro M, Calace S, Testori T, Weinstein RL. Microsurgical treatment of gingival recession: a controlled clinical study. Int J Periodontics Restorative Dent. 2005;25:181–8.
Andrade PF, Grisi M, Marcaccini AM, Fernandes PG, Reino DM, Souza SLS, Taba M, Palioto DB, Novaes AB. Comparison between micro- and macrosurgical techniques for the treatment of localized gingival recessions using coronally positioned flaps and enamel matrix derivative. J Periodontol. 2010;81:1572–9.
Pandey S, Mehta DS. Treatment of localized gingival recession using the free rotated papilla autograft combined with coronally advanced flap by conventional (macrosurgery) and surgery under magnification (microsurgical) technique: a comparative clinical study. J Indian Soc Periodontol. 2013;17(6):765–70.
Kang J, Meng S, Li C, Luo Z, Guo S, Wu Y. Microsurgery for root coverage: a systematic review. Pak J Med Sci. 2015;31(5):1263–8.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Amine, K., El Kholti, W., Kissa, J. (2019). Critical Factors in Execution. In: Periodontal Root Coverage . Springer, Cham. https://doi.org/10.1007/978-3-030-20091-6_9
Download citation
DOI: https://doi.org/10.1007/978-3-030-20091-6_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-20090-9
Online ISBN: 978-3-030-20091-6
eBook Packages: MedicineMedicine (R0)