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Root Coverage for Single Deep Gingival Recessions: Outcomes Based on a Decision-Making Algorithm.

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A new algorithm effectively treats deep gingival recession (GR) defects (≥5mm), achieving significant root coverage (RC). This approach offers predictable outcomes comparable to those for shallower defects.

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Area of Science:

  • Periodontology
  • Oral Surgery
  • Regenerative Dentistry

Background:

  • Deep gingival recession (GR) defects (≥5mm) present a significant clinical challenge.
  • Predictable root coverage (RC) is crucial for preserving periodontal health and aesthetics.
  • Existing treatment options may have variable outcomes for deep defects.

Purpose of the Study:

  • To evaluate root coverage outcomes in single deep gingival recessions using a novel decision-making algorithm.
  • To assess the efficacy of different flap designs (coronally advanced flap, double papilla envelope flap, modified lateral sliding flap) combined with connective tissue grafts.
  • To determine the predictability of root coverage for deep GR defects treated with the proposed algorithm.

Main Methods:

  • Retrospective analysis of single deep (≥5mm) Miller Class II and III gingival recessions.
  • Application of a step-by-step decision-making algorithm to select surgical techniques.
  • Surgical treatment involved connective tissue grafts with coronally advanced flap (CAF), double papilla envelope flap (DPE), or modified lateral sliding flap (LSF).
  • Primary outcomes assessed at 6 months were recession depth (RD) and root coverage (RC).

Main Results:

  • Sixteen deep GR defects (baseline RD 6.7±1.8mm) were treated.
  • Significant reduction in RD to 1.2±0.8mm was observed at 6 months (p < 0.05).
  • Mean root coverage was 81.7±13.0%, with no significant difference between Miller Class II and III defects.
  • Increased keratinized tissue width was noted with LSF and DPE compared to CAF.

Conclusions:

  • The proposed decision-making algorithm facilitates predictable root coverage for deep gingival recessions (≥5mm).
  • Outcomes achieved with the algorithm are comparable to those reported for shallower defects.
  • Further prospective studies are recommended to validate the algorithm and surgical techniques.