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Published on: January 12, 2019
Effect of vestibular depth on root coverage predictability in Cairo recession type 2 labial gingival recession
Sushma Kumari1, Shikha Tewari2, Rajinder K Sharma1
1Department of Periodontology, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India.
Objectives:
Key clinical factors influencing root coverage (RC) outcome of gingival recession included interdental clinical attachment level (iCAL), interdental bone loss and width of keratinized tissue (KTW). Evidence showed vestibule depth (VD) may also have an impact on RC. The principal objective of the study was to evaluate the prognostic role of VD in RT2 gingival recession defects. Therefore, the study was conducted to observe the impact of deep and shallow vestibule on RC achieved after treatment with subepithelial connective tissue graft using vestibular incision subperiosteal tunnel access technique in RT2 recession defects.
Method And Materials:
Prospective cohort study included 36 patients presenting with recession type 2 (RT2) mandibular anterior teeth, equally divided into deep and shallow vestibule patients. Clinical parameters: RC%, recession depth (RD)/ gingival margin level (GML), KTW, iCAL, root aesthetic score (RES) and patient reported hypersensitivity were recorded at baseline, 3- and 6-months post-operative. Cut-off threshold for VD in predicting complete root coverage was determined by receiver operating characteristic (ROC) curve analysis.
Results:
At 6 months follow-up, RC% achieved was significantly more in deep vestibule (58.87 ± 29.61%) compared to shallow vestibule group (34.87 ± 30.44%). GML remained stable at 6 months in patients with deep vestibule, whereas the patients with shallow vestibule showed tendency for GML to recede. Significantly higher RES was achieved in deep vestibule compared to shallow vestibule (P = 0.04). Cut-off threshold for VD was found to be 5.5 mm.
Conclusion:
Patients with deep vestibule showed significantly higher RC and stability of gingival margin as compared to patients with shallow vestibule group. VD at or above 5.5 was associated with complete root coverage in RT2 recession defects.
Clinical Relevance:
Vestibular depth may be considered a prognostic factor in predicting root coverage outcome, in terms of both stability and magnitude of root coverage, for the treatment of gingival recession. Clinically relevant VD threshold/cut-off value of 5.5 mm could aid in risk stratification, outcome prediction and surgical planning for the treatment of RT2 recession in mandibular anterior region.