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27.08.2018 | Original Article

Influence of suturing technique on marginal flap stability following coronally advanced flap: a cadaver study

verfasst von: Lorenzo Tavelli, Shayan Barootchi, Andrea Ravidà, Fernando Suárez-López del Amo, Giulio Rasperini, Hom-lay Wang

Erschienen in: Clinical Oral Investigations | Ausgabe 4/2019

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Abstract

Objectives

The outcomes of periodontal soft tissue root coverage procedures can be influenced by a variety of different factors. Following coronally advanced flap (CAF), the impact of marginal flap stability (MFS) through the employment of specific suturing techniques has not yet been investigated. The purpose of this study was to compare the MFS of CAF following three different suture techniques.

Methods

Fifty-six CAF procedures were performed on seven fresh human cadaver heads. The MFS following simple interrupted, single sling or sling and tag (SAT) suture techniques were investigated through a specific tool involving a load cell-based recording device.

Results

A highly statistically significant MFS was observed for sling and SAT sutures compared to the simple interrupted suture (p < 0.001). SAT suture technique was related to the greatest MFS (p < 0.001). The addition of sutures to the vertical releasing incision was able to provide a greater MFS compared to the suturing of the papillae alone (p < 0.001). No statistically significant difference was observed with regard to the suturing sequence between the two sling groups when the vertical incisions were sutured before or after the surgical papillae (p > 0.05). Linear regression model showed a positive correlation between thicker gingival tissue and MFS changes (p < 0.001).

Conclusions

Suturing technique highly affects the MFS following CAF on cadavers. Flap thickness was shown to be a positive predictor for flap stability.

Clinical relevance

Within the limitation of this study, the suturing of CAF with the SAT technique may provide higher MFS. However, clinical studies are necessary to validate these findings.

Hu-Friedy, Chicago, IL, USA

Henry Schein, Melville, N.Y., USA

Meta, Reggio Emilia, Italy

Ethicon US., LLC, Somercille, New Jersey, USA

Robot Italy, Rome, Italy

IBM Corp., Armonk, NY, USA

Cairo F, Pagliaro U, Nieri M (2008) Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol 35(8 Suppl):136–162. https://doi.org/10.1111/j.1600-051X.2008.01267.x CrossRefPubMed

Chambrone L, Sukekava F, Araujo MG, Pustiglioni FE, Chambrone LA, Lima LA (2009) Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database Syst Rev 2:CD007161. https://doi.org/10.1002/14651858.CD007161.pub2 CrossRef

Douglas de Oliveira DW, Marques DP, Aguiar-Cantuaria IC, Flecha OD, Goncalves PF (2013) Effect of surgical defect coverage on cervical dentin hypersensitivity and quality of life. J Periodontol 84(6):768–775. https://doi.org/10.1902/jop.2012.120479 CrossRefPubMed

Cortellini P, Pini Prato G (2012) Coronally advanced flap and combination therapy for root coverage. Clinical strategies based on scientific evidence and clinical experience. Periodontol 2000 59(1):158–184. https://doi.org/10.1111/j.1600-0757.2011.00434.x CrossRef

de Sanctis M, Clementini M (2014) Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 41(Suppl 15):S108–S122. https://doi.org/10.1111/jcpe.12189 CrossRefPubMed

Sullivan HC, Atkins JH (1968) Free autogenous gingival grafts. 3. Utilization of grafts in the treatment of gingival recession. Periodontics 6(4):152–160PubMed

Zucchelli G, Cesari C, Amore C, Montebugnoli L, De Sanctis M (2004) Laterally moved, coronally advanced flap: a modified surgical approach for isolated recession-type defects. J Periodontol 75(12):1734–1741. https://doi.org/10.1902/jop.2004.75.12.1734 CrossRefPubMed

de Sanctis M, Zucchelli G (2007) Coronally advanced flap: a modified surgical approach for isolated recession-type defects: three-year results. J Clin Periodontol 34(3):262–268. https://doi.org/10.1111/j.1600-051X.2006.01039.x CrossRefPubMed

Aroca S, Molnar B, Windisch P, Gera I, Salvi GE, Nikolidakis D, Sculean A (2013) Treatment of multiple adjacent miller class I and II gingival recessions with a modified Coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial. J Clin Periodontol 40(7):713–720. https://doi.org/10.1111/jcpe.12112 CrossRefPubMed

10.

Norberg O (1926) Ar en utlakning utan vov- nadsfortust otankbar vid kirurgisk behandling av. S. K. Alveolarpyorrhoe? Svensk Tandlae- kare Tidskrift 19:171

11.

Allen EP, Miller PD Jr (1989) Coronal positioning of existing gingiva: short term results in the treatment of shallow marginal tissue recession. J Periodontol 60(6):316–319. https://doi.org/10.1902/jop.1989.60.6.316 CrossRefPubMed

12.

Zucchelli G, De Sanctis M (2000) Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol 71(9):1506–1514. https://doi.org/10.1902/jop.2000.71.9.1506 CrossRefPubMed

13.

Cairo F, Nieri M, Pagliaro U (2014) Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 41(Suppl 15):S44–S62. https://doi.org/10.1111/jcpe.12182 CrossRefPubMed

14.

Zucchelli G, Mounssif I (2015) Periodontal plastic surgery. Periodontol 2000 68(1):333–368. https://doi.org/10.1111/prd.12059 CrossRef

15.

Cairo F, Cortellini P, Pilloni A, Nieri M, Cincinelli S, Amunni F, Pagavino G, Tonetti MS (2016) Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial. J Clin Periodontol 43(10):849–856. https://doi.org/10.1111/jcpe.12590 CrossRefPubMed

16.

Saletta D, Pini Prato G, Pagliaro U, Baldi C, Mauri M, Nieri M (2001) Coronally advanced flap procedure: is the interdental papilla a prognostic factor for root coverage? J Periodontol 72(6):760–766. https://doi.org/10.1902/jop.2001.72.6.760 CrossRefPubMed

17.

Berlucchi I, Francetti L, Del Fabbro M, Basso M, Weinstein RL (2005) The influence of anatomical features on the outcome of gingival recessions treated with coronally advanced flap and enamel matrix derivative: a 1-year prospective study. J Periodontol 76(6):899–907. https://doi.org/10.1902/jop.2005.76.6.899 CrossRefPubMed

18.

Jepsen K, Jepsen S, Zucchelli G, Stefanini M, de Sanctis M, Baldini N, Greven B, Heinz B, Wennstrom J, Cassel B, Vignoletti F, Sanz M (2013) Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial. J Clin Periodontol 40(1):82–89. https://doi.org/10.1111/jcpe.12019 CrossRefPubMed

19.

Baldi C, Pini-Prato G, Pagliaro U, Nieri M, Saletta D, Muzzi L, Cortellini P (1999) Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol 70(9):1077–1084. https://doi.org/10.1902/jop.1999.70.9.1077 CrossRefPubMed

20.

Huang LH, Neiva RE, Wang HL (2005) Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 76(10):1729–1734. https://doi.org/10.1902/jop.2005.76.10.1729 CrossRefPubMed

21.

Zucchelli G, Stefanini M, Ganz S, Mazzotti C, Mounssif I, Marzadori M (2016) Coronally advanced flap with different designs in the treatment of gingival recession: a comparative controlled randomized clinical trial. Int J Periodontics Restorative Dent 36(3):319–327. https://doi.org/10.11607/prd.2698 CrossRefPubMed

22.

Pini-Prato G, Baldi C, Pagliaro U, Nieri M, Saletta D, Rotundo R, Cortellini P (1999) Coronally advanced flap procedure for root coverage. Treatment of root surface: root planning versus polishing. J Periodontol 70(9):1064–1076. https://doi.org/10.1902/jop.1999.70.9.1064 CrossRefPubMed

23.

Pini Prato GP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C, Rotundo R, Muzzi L (2005) Coronally advanced flap: the post-surgical position of the gingival margin is an important factor for achieving complete root coverage. J Periodontol 76(5):713–722. https://doi.org/10.1902/jop.2005.76.5.713 CrossRefPubMed

24.

Ozcelik O, Seydaoglu G, Haytac MC (2015) Prediction of root coverage for single recessions in anterior teeth: a 6-month study. J Clin Periodontol 42(9):860–867. https://doi.org/10.1111/jcpe.12449 CrossRefPubMed

25.

Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U (2011) The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 38(7):661–666. https://doi.org/10.1111/j.1600-051X.2011.01732.x CrossRefPubMed

26.

Burkhardt R, Lang NP (2015) Influence of suturing on wound healing. Periodontol 2000 68(1):270–281. https://doi.org/10.1111/prd.12078 CrossRef

27.

Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P (2010) Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. J Clin Periodontol 37(7):644–650. https://doi.org/10.1111/j.1600-051X.2010.01559.x CrossRefPubMed

28.

Cortellini P, Tonetti M, Baldi C, Francetti L, Rasperini G, Rotundo R, Nieri M, Franceschi D, Labriola A, Prato GP (2009) Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? A multi-Centre, randomized, double-blind, clinical trial. J Clin Periodontol 36(1):68–79. https://doi.org/10.1111/j.1600-051X.2008.01346.x CrossRefPubMed

29.

Huang LH, Wang HL (2007) Sling and tag suturing technique for coronally advanced flap. Int J Periodontics Restorative Dent 27(4):379–385PubMed

30.

Miller PD Jr (1985) A classification of marginal tissue recession. Int J Periodontics Restorative Dent 5(2):8–13PubMed

31.

Pini Prato G, Pagliaro U, Baldi C, Nieri M, Saletta D, Cairo F, Cortellini P (2000) Coronally advanced flap procedure for root coverage. Flap with tension versus flap without tension: a randomized controlled clinical study. J Periodontol 71(2):188–201. https://doi.org/10.1902/jop.2000.71.2.188 CrossRefPubMed

32.

Burkhardt R, Lang NP (2010) Role of flap tension in primary wound closure of mucoperiosteal flaps: a prospective cohort study. Clin Oral Implants Res 21(1):50–54. https://doi.org/10.1111/j.1600-0501.2009.01829.x CrossRefPubMed

33.

Cairo F, Pini-Prato GP (2010) A technique to identify and reconstruct the Cementoenamel junction level using combined periodontal and restorative treatment of gingival recession. A prospective clinical study. Int J Periodont Rest 30(6):573–581

34.

Stefanini M, Jepsen K, de Sanctis M, Baldini N, Greven B, Heinz B, Wennstrom J, Cassel B, Vignoletti F, Sanz M, Jepsen S, Zucchelli G (2016) Patient-reported outcomes and aesthetic evaluation of root coverage procedures: a 12-month follow-up of a randomized controlled clinical trial. J Clin Periodontol 43(12):1132–1141. https://doi.org/10.1111/jcpe.12626 CrossRefPubMed

35.

Cairo F, Pagliaro U, Buti J, Baccini M, Graziani F, Tonelli P, Pagavino G, Tonetti MS (2016) Root coverage procedures improve patient aesthetics. A systematic review and Bayesian network meta-analysis. J Clin Periodontol 43(11):965–975. https://doi.org/10.1111/jcpe.12603 CrossRefPubMed

36.

Zucchelli G, Mele M, Checchi L (2006) The papilla amplification flap for the treatment of a localized periodontal defect associated with a palatal groove. J Periodontol 77(10):1788–1796. https://doi.org/10.1902/jop.2006.050333 CrossRefPubMed

37.

Hiatt WH, Stallard RE, Butler ED, Badgett B (1968) Repair following mucoperiosteal flap surgery with full gingival retention. J Periodontol 39(1):11–16. https://doi.org/10.1902/jop.1968.39.1.11 CrossRefPubMed

38.

Kon S, Novaes AB, Ruben MP, Goldman HM (1969) Visualization of the microvascularization of the healing periodontal wound. IV. Mucogingival surgery: full thickness flap. J Periodontol 40(8):441–456. https://doi.org/10.1902/jop.1969.40.8.441 CrossRefPubMed

39.

Tatakis DN, Chambrone L (2016) The effect of suturing protocols on Coronally advanced flap root-coverage outcomes: a Meta-analysis. J Periodontol 87(2):148–155. https://doi.org/10.1902/jop.2015.150394 CrossRefPubMed

40.

Wikesjo UM, Claffey N, Egelberg J (1991) Periodontal repair in dogs. Effect of heparin treatment of the root surface. J Clin Periodontol 18(1):60–64CrossRefPubMed

41.

Wikesjo UM, Nilveus R (1990) Periodontal repair in dogs: effect of wound stabilization on healing. J Periodontol 61(12):719–724. https://doi.org/10.1902/jop.1990.61.12.719 CrossRefPubMed

42.

Wikesjo UM, Selvig KA (1999) Periodontal wound healing and regeneration. Periodontol 2000 19:21–39CrossRef

43.

Sculean A, Gruber R, Bosshardt DD (2014) Soft tissue wound healing around teeth and dental implants. J Clin Periodontol 41(Suppl 15):S6–S22. https://doi.org/10.1111/jcpe.12206

44.

Weinreb M, Nemcovsky CE (2015) In vitro models for evaluation of periodontal wound healing/regeneration. Periodontol 2000 68(1):41–54. https://doi.org/10.1111/prd.12079 CrossRef

45.

Burkhardt R, Preiss A, Joss A, Lang NP (2008) Influence of suture tension to the tearing characteristics of the soft tissues: an in vitro experiment. Clin Oral Implants Res 19(3):314–319. https://doi.org/10.1111/j.1600-0501.2007.01352.x CrossRefPubMed

46.

Chan HL, Wang HL, Fowlkes JB, Giannobile WV, Kripfgans OD (2017) Non-ionizing real-time ultrasonography in implant and oral surgery: a feasibility study. Clin Oral Implants Res 28(3):341–347. https://doi.org/10.1111/clr.12805 CrossRefPubMed

Titel: Influence of suturing technique on marginal flap stability following coronally advanced flap: a cadaver study
verfasst von: Lorenzo Tavelli
Shayan Barootchi
Andrea Ravidà
Fernando Suárez-López del Amo
Giulio Rasperini
Hom-lay Wang
Publikationsdatum: 27.08.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Oral Investigations / Ausgabe 4/2019
Print ISSN: 1432-6981
Elektronische ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-018-2597-5

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Influence of suturing technique on marginal flap stability following coronally advanced flap: a cadaver study