Therapeutic efficacy of connective tissue autotransplants with periosteum and platelet rich plasma in the management of gingival recession

Abstract

Background/Aim. Gingival recession progression in clinical practaice has influenced the development of various surgical procedures and techniques for solving esthetic imperfections and subjective difficulties coused by gingival recession. The aim of this study was to verify efficacy of surgical procedures and to compare both of surgical procedures through the keratinized tissue width. Methods. The study included 20 teeth with gingival recesion, Müller class I and II. Ten teeth with gingival recession were treated with connective tissue autotransplants with periosteum in combination with coronary guided surgical flap (CTG group). On the contralateral side 10 teeth with gingival recession were treated with the same surgical procedures but in combination with platelet-rich plasma (CTGPRP group). We measured the keratinized tissue width. For statistical significance we used the Student's t-test. Results. The study reveled a statistical significance in reducing vertical deepress of recession by both used treatments. Root deepness in CTG and CTG-PRP group was 90% and 93.5%, respectively. With both surgical techniques we achieved larger zone of keratinized gingiva but with a wide zone of keratinized tissue in CTG - the PRP group. Conclusion. The concept regeneration technique with PRP and with the stimulating influence of platele activated growth factors results in the regeneration of deep periodontal tissue as an important prerequisite for the successful treatment of gingival recession.

Uvod/Cilj. Sve veća zastupljenost gingivalnih recesija u svakodnevnoj kliničkoj praksi uslovila je zahteve za što efikasnijim rekonstruktivnim hirurškim procedurama, u cilju rešavanja estetskih nedostataka i subjektivnih tegoba usled povlačenja gingive. Cilj rada bio je da se uporedi efikasnost lečenja autotransplantatom vezivnog tkiva (ATVT) sa periostom i plazme obogaćene trombocitima (PRP) sa ATVT sa periostom, ali bez PRP, na širinu keratinizirane gingive. Metode. Studijama je bilo obuhvaćeno 20 zuba sa recesijama gingive klase I i II prema Mülleru. U toku terapije 10 recesija lečeno je ATVT sa periostom u kombinaciji sa koronarno pomerenim režnjima (ATVT grupa). Na kontralateralnoj strani, isti broj recesija lečen je ATVT uz koronarno pomeren režanj i uz primenu PRP (PRP + ATVT grupa). Od kliničkih parametara praćena je širina keratinizovane gingive kao pokazatelj pokrenutih regenerativnih procesa. U statističkoj obradi rezultata korišćen je Studentov t-test. Rezultati. Analizom kliničkih parametara ustanovljeno je statistički značajno proširenje zone keratinizirane gingive, što je od izuzetnog značaja za regeneraciju s tim što je proširenje bilo izraženije u ATVT + PRP grupi. Procentualno gledano, prekrivenost korena u ATVT grupi iznosila je 90%, a u ATVT + PRP grupi 93,5%. Zaključak. Primenom koncepta aktivne regeneracije odnosno primenom PRP i stimulativnim dejstvom aktiviranih faktora rasta iz trombocita, postiže se regeneracija dubljeg periodontalnog tkiva što je bitan preduslov za uspešno zbrinjavanje recesije gingive.