A comparison of three techniques to obtain root coverage on mandibular incisors

Multiple variations on the subepithelial connective tissue graft have been shown to produce good clinical results. The goal of this study was to compare three variations in the treatment of recession on mandibular incisors.

An a priori analysis was done to determine the sample size. Three groups of patients received root coverage procedures on mandibular incisors. Each group was treated with a different variation of a subepithelial graft. The first group received a connective tissue (CT) graft with a coronally positioned flap (CPF) (CPF + CT). The second group received a connective tissue graft with a double pedicle (DP) graft (DP + CT). The third group received a connective tissue graft with a tunneling (TUN) procedure and a laterally positioned (LAT) pedicle (TUN-LAT + CT). The clinical results of these procedures were compared to determine if one procedure offered an advantage over the other procedures.

All of the procedures produced a statistically significant improvement in the clinical parameters. The groups treated with the DP + CT and TUN-LAT + CT had greater mean root coverage (95.5% and 90.5%, respectively) than the CPF + CT group (80.2%). Additionally, DP + CT produced a greater increase in keratinized tissue (3 mm) than CPF + CT (1.4 mm) or TUN-LAT + CT (1.9 mm). There was no statistically significant difference in the mean root coverage of any technique treating defects <3 mm deep (CPF + CT, 90.9%; DP + CT, 96.4%; and TUN-LAT + CT, 92.1%) or the defects >3 mm deep treated with DP + CT (95.4%) or TUN-LAT + CT (88.3%). However, the CPF + CT produced less mean root coverage (68.4%) when treating defects > or =3 mm deep. When defects treated as isolated defects were compared to cases where multiple defects were treated, the cases with multiple defects treated with the CPF + CT had less mean root coverage (77%) than cases where single defects were treated with the CPF + CT (90.3%), DP + CT (isolated, 96.7% and multiple, 95.6%), and TUN-LAT + CT (isolated, 97.2% and multiple, 87.8%).

All three of the procedures were effective in obtaining root coverage and improved clinical parameters on mandibular incisors. Overall, the DP + CT and TUN-LAT + CT procedures had greater mean root coverage than the CPF + CT technique. Based on this study, when treating defects > or =3 mm deep, one should consider using the DP + CT or TUN-LAT + CT rather than the CPF + CT. Additionally, when treating multiple defects at a time, one should consider using the DP + CT or TUN-LAT + CT rather than the CPF + CT. In cases where an increased amount of keratinized tissue is desired, based on this study, the DP + CT may be the best procedure to use.