BRIEF RESUME OF INTENDED WORK
6.1 NEED FOR THE STUDY
Gingival recession is one of the commonest problems seen in clinical practice. Patient seeks treatment of denuded roots for reasons like esthetics, root sensitivity, root caries and for fear of loosing affected teeth.1 Obtaining predictable and esthetic root coverage has become an ultimate goal for a periodontal plastic surgeon. Of the various conventional surgical techniques, the success rate of subepithelial connective tissue graft in conjugation with coronally advanced flap is known to be superior2 but the amount of root coverage and percentage of subjects with complete root coverage showed marked variability.3 However, it is realized that, factors such as root preparation, delicate tissue handling and tissue thickness are to be controlled in order to maximize the treatment outcome. These factors may be improved by carrying out surgery with specially designed instruments and under magnification.
Microsurgery amplifies normal vision through magnification, favorable lighting and with the use of finer instrument leading to gentle tissue handling, minimal invasiveness in surgery, precise approximation of the wound margin, minimum damage to flap and periosteum. The application of magnification in mucogingival surgery accomplishes better results in terms of success and predictability and may help achieve excellent aesthetic outcome compared to conventional technique in addition to better root coverage.
In order to improve the predictability and consistency of achieving the desired clinical results, more research is essential to identify and quantify the impact of the use of magnification during surgical procedures. As there are few reports documenting the use of magnification in the treatment of gingival recession, the outcome of coronally advanced flap with subepithelial connective tissue graft procedure carried out by conventional and microsurgical approach need to be compared and evaluated.
6.2 REVIEW OF LITERATURE
In a systematic review of treatment of gingival recession, coronally advanced flap with subepithelial connective tissue graft resulted in better clinical outcome in terms of complete root coverage, recession reduction, gain in clinical attachment level and increase in keratinized tissue as compared to coronally advanced flap alone and coronally advanced flap with enamel matrix derivatives.2
A systematic review of periodontal plastic surgery for the treatment of localized gingival recession showed that the connective tissue graft was statistically significant and more effective than other procedure in recession reduction.3 The percentage of complete root coverage showed marked variability.
In a study of coronally advanced flap with subepithelial connective tissue graft as a donor source for root coverage, an increase of 2-6 mm root coverage was achieved and the donor site was closed with less postoperative discomfort.4
In another study, coronally advanced flap alone and in combination with connective tissue graft was undertaken to compare clinical outcome and patient morbidity.5 Adjunctive application of connective tissue graft under coronally advanced flap increased the probability of achieving complete root coverage in maxillary teeth for Millers class I and II defects. Patient perception of hardship between the two procedures showed no statistical difference.
A controlled clinical study by Fanciti et al showed that the application of magnification in mucogingival surgery accomplished better results in terms of success and predictability. At the end of 12 months, the mean defect coverage was 86% where magnification was used as compared to 78% in the conventional technique group, whereas the rate of complete root coverage was 58.3% and 33.4% respectively in the two groups.6
In a comparative study, Lang et al showed microsurgical approach substantially improves vascularization of the graft and percentage of root coverage as compared to conventional macroscopic approach.7 The clinical measurement revealed mean recession coverage of 99.5±1.7% in microsurgery and for the control it was 90.8±12.1%.
6.3 OBJECTIVES OF THE STUDY
To evaluate the effectiveness of magnification in plastic periodontal surgery procedure with coronally advanced flap and subepithelial connective tissue graft in treatment of Millers class I and II recession in terms of:
1. Amount of root coverage.
2. Predictability of successful root coverage.
3. Increase in width of keratinized gingiva.
4. Intraoperative and postoperative morbidity.
5. Addressing patients concerns as compared with conventional periodontal surgery done without magnification.
MATERIALS AND METHODS
7.1 SOURCE OF DATA
Patients will be recruited from the Department of Periodontics, The Oxford Dental College, Hospital and Research centre, Bangalore.
7.2 METHOD OF COLLECTION OF DATA
1. Patient aged between 20-50 years.
2. Patient compliant of maintaining good oral hygiene.
3. Isolated buccal gingival recession classified as Millers class I and II.
4. Minimum width of keratinized gingiva of 1 mm.
5. Recession depth greater than 2 mm.
1. Root surface restoration.
2. Root caries.
3. Medically compromised patient.
4. Probing pocket depth greater than 3 mm.
6. Thin palatal mucosa and presence of palatal tori.