Treatment of gum recession by the method of a coronally displaced flap and application of phytoextract

Rasima R. Khaibullina; Хайбуллина Расима Рашитовна; Natalya V Lopatina; Лопатина Наталья Викторовна; Larisa P. Gerasimova; Герасимова Лариса Павловна; Damira N. Tukhvatullina; Тухватуллина Дамира Назиповна; Tat’jana V. Bashirova; Баширова Татьяна Владимировна; Al’fija R. Khaibullina; Хайбуллина Альфия Рашитовна; Vlas S. Shchekin; Щёкин Влас Сергеевич; Angelina O. Vlasova; Власова Ангелина Олеговна; Regina R. Habibullina; Хабибуллина Регина Ралифовна

doi:10.17816/dent628870

Treatment of gum recession by the method of a coronally displaced flap and application of phytoextract

Authors: Khaibullina R.R.¹, Lopatina N.V¹, Gerasimova L.P.¹, Tukhvatullina D.N.¹, Bashirova T.V.¹, Khaibullina A.R.¹, Shchekin V.S.¹, Vlasova A.O.¹, Habibullina R.R.¹
Affiliations:
1. Bashkir State Medical University
Issue: Vol 28, No 1 (2024)
Pages: 81-86
Section: Clinical Investigation
Submitted: 07.03.2024
Accepted: 05.05.2024
Published: 10.06.2024
URL: https://rjdentistry.com/1728-2802/article/view/628870
DOI: https://doi.org/10.17816/dent628870
ID: 628870

Cite item

Full Text

Open Access
Restricted Access

Access granted
Restricted Access

Subscription or Fee Access

Abstract
Full Text
About the authors
References
Supplementary files
Statistics

Abstract

BACKGROUND: Owing to the widespread prevalence of gum recession in the morbidity structure of the population, the search for optimal treatment tactics for patients with this pathology is crucial in dentistry.

AIM: To evaluate the effectiveness of treatment of patients with gum recession using the coronally displaced flap method and application of a phytoextract.

MATERIALS AND METHODS: Overall, 123 patients diagnosed with gum recession were clinically examined. During examination, all patients revealed a defect such as exposed roots in the area of the frontal group of teeth. Moreover, the size of the defect was measured, and the Miller class was determined. Then, complex treatment was performed, including conservative treatment and, if required, surgical intervention, as well as orthopedic treatment.

RESULTS: In the surgical treatment of gum recession, flap operations were performed. On postoperative day 2, to achieve the best healing and regeneration of the gums, a phytoextract was applied. Over a 3-year period after treatment of patients with gum recession, the effectiveness of treatment was monitored, and relapses of the disease were detected. The following complications were identified after treatment of patients diagnosed with gum recession: transition from class I to II to Miller, 15% of cases; class II to III according to Miller, 19.5%; temporomandibular joint diseases during recession, 16.5%; and occlusal deformation during recession, 19.8%. Stabilization in class I recession occurred in 45.0% of patients, class II in 33.4%, and class III in 8.5%.

CONCLUSION: The etiology and pathogenesis of gum recession requires long term treatment and observation and early diagnosis and an integrated approach. Therefore, new treatment methods that will be most effective and can be used in all age groups are required. One of these methods is the method developed by the authors for the treatment of gum recession using a coronally displaced flap and the application of a phytoextract, which has shown high effectiveness in the long term.

Keywords

gum recession, phytoextract, coronally displaced flap, treatment, application

Full Text

BACKGROUND

The problem of gingival recession—defined as the apical displacement of the gingival margin with exposure of the root surface—remains a relevant issue in periodontology [1–4]. Gingival recession also affects pregnant women, which plays a significant role in carrying a healthy pregnancy, and is further complicated by the contraindication of many pharmacological agents during this period. Advances in technology, equipment, and professional expertise allow clinicians to achieve highly favorable esthetic outcomes [3, 5]. However, treatment of gingival recession is often complicated by relapses, root prominence, fenestration, and loss of periodontal attachment.

Clinicians frequently encounter challenges in treating gingival recession in patients with a shallow oral vestibule, short labial or lingual frena, and thin alveolar cortical bone [6–8].

The coexistence of periodontal disease with dentoalveolar discrepancies significantly prolongs treatment duration. Gingival recession accounts for approximately 16% to 89% of all periodontal conditions [9, 10]. Patients who have completed orthodontic treatment are at greater risk of developing gingival recession than those with malocclusion who have not undergone treatment [8].

Periodontists should be proficient in techniques aimed at increasing the width of attached gingiva in the area of the exposed root. The single-stage root-coverage technique used for recession defects in the mandibular anterior teeth does not consistently provide stable long-term results. Greater effectiveness of a two-stage surgical protocol has not been conclusively demonstrated [1, 2, 8].

Existing surgical approaches utilizing pedicle flaps have substantial limitations. Therefore, given the high prevalence of gingival recession among the patients with periodontal disease, the search for optimal treatment strategies remains a critical problem in dentistry.

This work was aimed to evaluate the effectiveness of treating gingival recession using the coronally advanced flap (CAF) technique combined with the application of a chlorophyll-containing phytoconcentrate.

MATERIALS AND METHODS

A total of 123 patients diagnosed with K06.0 Gingival Recession were clinically examined. The majority were women—78 (63.4%)—likely reflecting heightened esthetic concerns.

During the clinical examination, 109 patients (88.6%) reported dentin hypersensitivity, 63 patients (51%) were dissatisfied with esthetic outcomes, and 22 patients (18%) complained of hyperemia in keratinized periodontal tissues. Medical history was obtained, and clinical examination included evaluation of the gingival margin, oral hygiene status, mucosal color and integrity, tooth mobility, and extent of root exposure.

On clinical examination, all patients exhibited gingival recession with root exposure involving the anterior teeth. The dimensions of each defect were measured, and gingival recession was classified according to Miller’s classification system.

Patients underwent comprehensive treatment, including conservative (non-surgical) therapy, surgical intervention when necessary, and prosthodontic rehabilitation.

Conservative management of patients diagnosed with gingival recession was provided at Vitadent clinics in Ufa by periodontists and general dentists, according to disease severity. Treatment followed a structured protocol:

removal of supra- and subgingival plaque and calculus;
flap surgery and antimicrobial therapy;
correction of defective restorations;
comprehensive dental treatment to eliminate oral foci of infection;
selective occlusal adjustment;
prescription of anti-inflammatory and antihistamine medications when indicated.

Surgical management of gingival recession primarily involved flap procedures. Following completion of therapeutic and surgical interventions, prosthodontic treatment included fixed prostheses with splinting elements as well as removable partial dentures (including cast metal prostheses).

The CAF technique was employed for surgical coverage of gingival recession. This approach utilized soft tissues located directly apical to the gingival recession. Variations included: trapezoidal or triangular flaps with vertical releasing incisions, oblique incisions for an envelope flap, semilunar flap, and tunnel technique with no incisions. Connective tissue grafts were harvested from the palate.

Fig. 1. Coronally advanced flap technique. a, Miller Class I gingival recession; b, suturing stage with coronally advanced flap; c, healing at 4 weeks postoperatively.

On postoperative day 2, to optimize gingival healing and regeneration, patients received applications of a chlorophyll-containing phytoconcentrate. The phytoconcentrate included: broccoli oil extract, oil extract of leaves and seeds of Crambe maritima, oil extract of first-year leaves of Isatis tinctoria, oil extract of leaves and seeds of Crambe hispanica, oil extract of Crambe abyssinica (“SANMO”), chlorophyll, and thymoquinone. This formulation provided anti-inflammatory, antioxidant, and neuroprotective effects.

RESULTS AND DISCUSSION

The following complications were identified after treatment of patients diagnosed with gingival recession (ICD-10 code K06.0): progression from Miller Class I to Class II recession in 15% of cases; progression from Class II to Class III in 19.5%; temporomandibular joint disorders associated with gingival recession in 16.5%; and occlusal deformities in 19.8%. Stabilization of gingival recession was observed in 45% of patients with Class I, 33.4% of patients with Class II, and only 8.5% of patients with Class III recession.

During the 3-year follow-up period before and after treatment of gingival recession with the CAF technique in combination with a chlorophyll-containing phytoconcentrate, disease recurrence and postoperative complications were documented. Specifically, gingival recession recurred in 53% of cases. Postoperative bleeding occurred in 30 patients (25.7%). Soft tissue necrosis was observed in 33 patients (27.3%), and graft rejection occurred in 17 patients (14.2%).

CONCLUSION

Gingival recession requires prolonged treatment and follow-up, as well as early diagnosis and a comprehensive therapeutic approach. It is therefore necessary to develop novel treatment methods that are both effective and applicable across different age groups. Excessive surgical trauma, the wide range of contraindications for surgery, and such complications as necrosis and graft rejection prompted us to search for alternative approaches. One such method is the technique developed by the authors, which combines a CAF with the application of a chlorophyll-based phytoconcentrate. This combined approach demonstrated high long-term effectiveness.

ADDITIONAL INFORMATION

Funding sources: The authors report no external funding for this study or its publication.

Conflict of interests: The authors declare no explicit or potential conflicts of interests associated with the study and publication of this article.

Author contributions: R.R. Khaibullina, N.V. Lopatina—conducting the research, general editing of the article; L.P. Gerasimova, D.N. Tukhvatullina—scientific sources review; A.R. Khaibullina, S.V. Shchekin—analysis of the results obtained, statistical data processing; A.O. Vlasova, R.R. Habibullina—writing and designing the text of the article; T.V. Bashirova—editing of the article.