YAPIŞIK DİŞETİ MİKTARININ ARTTIRILMASINDA UYGULANAN SERBEST DİŞETİ GREFTİ VE MODİFİYE APİKALE REPOZİSYONE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI: PİLOT ÇALIŞMA

Melis Yılmaz; Nur Balci; Hilal Toygar; Ali Çekici

Research Article

YAPIŞIK DİŞETİ MİKTARININ ARTTIRILMASINDA UYGULANAN SERBEST DİŞETİ GREFTİ VE MODİFİYE APİKALE REPOZİSYONE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI: PİLOT ÇALIŞMA

Year 2020, Volume: 47 Issue: 1-3, 89 - 96, 31.12.2020

Melis Yılmaz Nur Balci Hilal Toygar Ali Çekici

Abstract

Amaç: Yapışık dişeti periodontal sağlığın idamesinde rol oynayan önemli bir dişeti komponentidir. Yapışık dişeti miktarını arttırmak için genellikle serbest dişeti grefti(SDG) ve modifiye apikale repozisyone flep(MARF) cerrahi yöntemleri uygulanmaktadır. Bu karşılaştırmalı vaka serisinin amacı SDG ve MARF yöntemlerinin yapışık dişeti miktarını arttırmadaki etkinliğini kısa dönem için değerlendirmektir. Gereç ve yöntem: Çalışmaya sistemik ve periodontal olarak sağlıklı, toplam 15 katılımcı ve 21 diş (SDG:10, MARF:11) dahil edilmiştir. Tedavi edilen bölgelerde yapışık dişeti miktarı en az 0.5 mm en fazla 1.5 mm’dir. SDG ve MARF yöntemleri, dahil edilen vakalara rastgele(yazıtura) seçilerek uygulanmıştır. Tüm katılımcıların işlem yapılan bölgelerinde periodontal indeksleri (Plak indeksi (PI), sondalanabilir cep derinliği(SCD), keratinize dişeti genişliği(KDG), sondalamada kanama indeksi (SKI), dişeti çekilmesi(DÇ) ve yapışık dişeti genişliği (YDG)) kaydedilmiştir. Tüm parametreler başlangıçta ve 3. ayda ölçülmüştür ve sonuçlar gruplar arasında karşılaştırılmıştır. Bulgular: Başlangıç ve operasyon sonrası 3. ay ölçüm sonuçlarına göre her iki teknikte de keratinize doku genişliği ve yapışık dişeti genişliği başlangıca göre anlamlı derecede artmıştır (p 0.05). SDG grubunda YDG’deki artış 3 ile 5.5 mm arasında iken MARF grubunda 0.75 ile 3 mm olarak tespit edilmiştir. MARF grubunun 3.ay YDG ve KDG düzeyleri, SDG grubundan istatistiksel olarak anlamlı düzeyde düşük bulunmuştur (p<0.05). Dişeti çekilmesi miktarında istatistiksel olarak anlamlı bir farklılık gözlenmemiştir (p0.05). Sonuç: Bu pilot çalışmanın sonuçları ışığında MARF tekniğinin keratinize dişeti genişliği ve yapışık dişeti miktarını arttırmada kullanılan SDG kadar geçerli ve etkin olduğu düşünülmektedir. Uygulamanın diğer mukogingival cerrahi işlemlere kıyasla daha basit ve hasta açısından konforlu olması bu tekniğin tercih edilmesini sağlayabilir.

Keywords

Serbest dişeti grefti, modifiye apikale repozisyone flep, yapışık dişeti

References

1. Wennstrom J, Lindhe J.Role of attached gingiva for maintenance of periodontal health.Healing following excisional and grafting procedures in dogs. Journal af Clinical Periodontology 1983; 10: 206-221.
2. Malathi K, Arjun S, Blaisie RMP, et al. Attached gingiva:a review, Int J of Scientific Research and Reviews 2013; 3(2): 188 - 198 .
3. Scheyer ET, Sanz M, Dibart S, et al. Periodontal soft tissue non–root coverage procedures: a consensus report from the aap regeneration workshop.J Periodontol 2015; 86 : 73-76.
4. Thoma DS, Benic GI, Zhahlen M, et al. A systematic review assessing soft tissue augmentation techniques.Clin Oral Implants Res. 2009; 20:146-65.
5. Schmitt CM, Moest T, Lutz R, et al. Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft®) versus the free gingival graft: a comparative prospective clinical trial. Clin Oral Implants Res. 2015; 0: 1-9.
6. Carnio J, Camargo PM, Pirih PQ. Surgical techniques to increase the apicocoronal dimension of the attached gingiva: a 1-year comparison between the free gingival graft and the modified apically repositioned flap. Int J Periodontics Restorative Dent. 2015; 35: 571-578.
7. Cevallos, C.A.R., de Resende, D.R.B., Damante, C.A. et al. Free gingival graft and acellular dermal matrix for gingival augmentation: a 15-year clinical study. Clin Oral Invest 2020; 24: 1197–1203.
8. Carnio J, Miller PD.Increasing the amount of attached gingiva using a modified apically repositioned flap. J Periodontol 1999; 70:1110-1117.
9. Carnio J, Camargo P, Klokkevold R et al.Use of the modified apically repositioned flap technique to create attached gingiva in areas of no keratinized tissue:a clinical and histologic evaluation. Int J Periodontics Restorative Dent 2017; 37: 363–369.
10. Swarna C, Govada S, Susmitha K, et al.Increasing the width of attached gingiva by using modified apically repositioned flap – a case series. J Indian Soc Periodontol. 2019; 23:172-176.
11. Carnio J, Camargo PM, Klokkevold PR, et al. The modified apically repositioned flap technique: a long-term (4 to 16 years) retrospective study. Int J Periodontics Restorative Dent. 2018 ;38 :519–524.
12. Keceli HG, Aylikci BU, Koseoglu S.Evaluation of palatal donor site haemostasis and wound healing after free gingival graft surgery.J Clin Periodontol. 2015; 42:582-589.
13. Carnio J, Camargo PM. The modified apically repositioned flap to increase the dimensions of attached gingiva: the single incision technique for multiple adjacent teeth, Int J Periodontics Restorative Dent. 2006; 26 :265-9.
14. Carnio J, Camargo PM, Passanezi E.Increasing the apico-coronal dimension of attached gingiva using the modified apically repositioned flap technique: a case series with a 6-month follow-up.J Periodontol. 2007; 78:1825-30.
15. Carnio J, Carnio AT, Pirih FQ, et al. The modified apically repositioned flap technique and its potential to create attached gingiva in areas with no keratinized tissue: a long-term (1 to 11 Years) retrospective case series study, Int J Periodontics Restorative Dent. 2020; 40:103-109.
16. Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations, J Periodontol. 2018; 89: 204-213.
17. Schmitt CM, Tudor C, Kiener K, et al. Vestibuloplasty: porcine collagen matrix versus free gingival graft: a clinical and histologic study. J Periodontol. 2013; 84: 914-23.
18. Vieira Ede O, Fidel Junior RA, Figueredo CM, et al. Clinical evaluation of a dermic allograft in procedures to increase attached gingiva width. Braz Dent J. 2009; 20:191-4.

Comparison between the Free Gingival Graft and the Modified Apically Repositioned Flap Techniques to Increase the Width of the Attached Gingiva: Pilot Study

Year 2020, Volume: 47 Issue: 1-3, 89 - 96, 31.12.2020

Melis Yılmaz Nur Balci Hilal Toygar Ali Çekici

Abstract

Aim: Attached gingiva is an important part of keratinized gingiva which ensures the periodontium health maintenance. The free gingival graft (FGG) and modified apically repositioned flap (MARF) procedures have been often used to correct problems associated with the lack of attached gingiva. The aim of this pilot study was to compare the effectiveness of the FGG and the MARF increasing the zone of attached gingiva in 3 months posttreatment. Material and method: The systemically and periodontally healthy 15 participants contributed to 21 teeth (SDG: 10, MARF: 11), each with attached gingiva amount between 0.5 mm and 1.5 mm without bone dehiscence were included in the study. SDG and MARF methods were selected randomly (coin-to-coin). Clinical parameters recorded at baseline and at 3 months were plaque index (PI), pocket probing depth (PPD), keratinized tissue width (KTW), attached gingiva width (AGW), bleeding on probing (BOP), gingival recession (GR) and clinical attachment level (CAL). Results: Increasing of attached and keratinized tissue width resulted in significant gain at the end of the 3 months in both FGG and MARF groups (p0.05). The increase in the AGW in the SDG group was between 3 and 5.5 mm, while it was 0.75 and 3 mm in the MARF group. The increasing in the ADW and KTW were significantly greater in the FGG group compare with the MARF group (p <0.05).The gingival recession did not significantly change between pre and posttreatment levels in either group(P>0.05). Conclusion: It is concluded that both techniques as viable however the advantages of the MARF were less surgical time and patients postoperative discomfort.

Keywords

Free gingival graft, modified apically repositioned flap, attached gingiva

References

1. Wennstrom J, Lindhe J.Role of attached gingiva for maintenance of periodontal health.Healing following excisional and grafting procedures in dogs. Journal af Clinical Periodontology 1983; 10: 206-221.
2. Malathi K, Arjun S, Blaisie RMP, et al. Attached gingiva:a review, Int J of Scientific Research and Reviews 2013; 3(2): 188 - 198 .
3. Scheyer ET, Sanz M, Dibart S, et al. Periodontal soft tissue non–root coverage procedures: a consensus report from the aap regeneration workshop.J Periodontol 2015; 86 : 73-76.
4. Thoma DS, Benic GI, Zhahlen M, et al. A systematic review assessing soft tissue augmentation techniques.Clin Oral Implants Res. 2009; 20:146-65.
5. Schmitt CM, Moest T, Lutz R, et al. Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft®) versus the free gingival graft: a comparative prospective clinical trial. Clin Oral Implants Res. 2015; 0: 1-9.
6. Carnio J, Camargo PM, Pirih PQ. Surgical techniques to increase the apicocoronal dimension of the attached gingiva: a 1-year comparison between the free gingival graft and the modified apically repositioned flap. Int J Periodontics Restorative Dent. 2015; 35: 571-578.
7. Cevallos, C.A.R., de Resende, D.R.B., Damante, C.A. et al. Free gingival graft and acellular dermal matrix for gingival augmentation: a 15-year clinical study. Clin Oral Invest 2020; 24: 1197–1203.
8. Carnio J, Miller PD.Increasing the amount of attached gingiva using a modified apically repositioned flap. J Periodontol 1999; 70:1110-1117.
9. Carnio J, Camargo P, Klokkevold R et al.Use of the modified apically repositioned flap technique to create attached gingiva in areas of no keratinized tissue:a clinical and histologic evaluation. Int J Periodontics Restorative Dent 2017; 37: 363–369.
10. Swarna C, Govada S, Susmitha K, et al.Increasing the width of attached gingiva by using modified apically repositioned flap – a case series. J Indian Soc Periodontol. 2019; 23:172-176.
11. Carnio J, Camargo PM, Klokkevold PR, et al. The modified apically repositioned flap technique: a long-term (4 to 16 years) retrospective study. Int J Periodontics Restorative Dent. 2018 ;38 :519–524.
12. Keceli HG, Aylikci BU, Koseoglu S.Evaluation of palatal donor site haemostasis and wound healing after free gingival graft surgery.J Clin Periodontol. 2015; 42:582-589.
13. Carnio J, Camargo PM. The modified apically repositioned flap to increase the dimensions of attached gingiva: the single incision technique for multiple adjacent teeth, Int J Periodontics Restorative Dent. 2006; 26 :265-9.
14. Carnio J, Camargo PM, Passanezi E.Increasing the apico-coronal dimension of attached gingiva using the modified apically repositioned flap technique: a case series with a 6-month follow-up.J Periodontol. 2007; 78:1825-30.
15. Carnio J, Carnio AT, Pirih FQ, et al. The modified apically repositioned flap technique and its potential to create attached gingiva in areas with no keratinized tissue: a long-term (1 to 11 Years) retrospective case series study, Int J Periodontics Restorative Dent. 2020; 40:103-109.
16. Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations, J Periodontol. 2018; 89: 204-213.
17. Schmitt CM, Tudor C, Kiener K, et al. Vestibuloplasty: porcine collagen matrix versus free gingival graft: a clinical and histologic study. J Periodontol. 2013; 84: 914-23.
18. Vieira Ede O, Fidel Junior RA, Figueredo CM, et al. Clinical evaluation of a dermic allograft in procedures to increase attached gingiva width. Braz Dent J. 2009; 20:191-4.

There are 18 citations in total.

Details

Primary Language	Turkish
Subjects	Dentistry
Journal Section	Research Article
Authors	Melis Yılmaz This is me Nur Balci Hilal Toygar Ali Çekici
Publication Date	December 31, 2020
Published in Issue	Year 2020 Volume: 47 Issue: 1-3

Cite

APA	Yılmaz, M., Balci, N., Toygar, H., Çekici, A. (2020). YAPIŞIK DİŞETİ MİKTARININ ARTTIRILMASINDA UYGULANAN SERBEST DİŞETİ GREFTİ VE MODİFİYE APİKALE REPOZİSYONE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI: PİLOT ÇALIŞMA. Ankara Üniversitesi Diş Hekimliği Fakültesi Dergisi, 47(1-3), 89-96.
AMA	Yılmaz M, Balci N, Toygar H, Çekici A. YAPIŞIK DİŞETİ MİKTARININ ARTTIRILMASINDA UYGULANAN SERBEST DİŞETİ GREFTİ VE MODİFİYE APİKALE REPOZİSYONE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI: PİLOT ÇALIŞMA. AÜDHF dergisi. December 2020;47(1-3):89-96.
Chicago	Yılmaz, Melis, Nur Balci, Hilal Toygar, and Ali Çekici. “YAPIŞIK DİŞETİ MİKTARININ ARTTIRILMASINDA UYGULANAN SERBEST DİŞETİ GREFTİ VE MODİFİYE APİKALE REPOZİSYONE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI: PİLOT ÇALIŞMA”. Ankara Üniversitesi Diş Hekimliği Fakültesi Dergisi 47, no. 1-3 (December 2020): 89-96.
EndNote	Yılmaz M, Balci N, Toygar H, Çekici A (December 1, 2020) YAPIŞIK DİŞETİ MİKTARININ ARTTIRILMASINDA UYGULANAN SERBEST DİŞETİ GREFTİ VE MODİFİYE APİKALE REPOZİSYONE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI: PİLOT ÇALIŞMA. Ankara Üniversitesi Diş Hekimliği Fakültesi Dergisi 47 1-3 89–96.
IEEE	M. Yılmaz, N. Balci, H. Toygar, and A. Çekici, “YAPIŞIK DİŞETİ MİKTARININ ARTTIRILMASINDA UYGULANAN SERBEST DİŞETİ GREFTİ VE MODİFİYE APİKALE REPOZİSYONE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI: PİLOT ÇALIŞMA”, AÜDHF dergisi, vol. 47, no. 1-3, pp. 89–96, 2020.
ISNAD	Yılmaz, Melis et al. “YAPIŞIK DİŞETİ MİKTARININ ARTTIRILMASINDA UYGULANAN SERBEST DİŞETİ GREFTİ VE MODİFİYE APİKALE REPOZİSYONE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI: PİLOT ÇALIŞMA”. Ankara Üniversitesi Diş Hekimliği Fakültesi Dergisi 47/1-3 (December 2020), 89-96.
JAMA	Yılmaz M, Balci N, Toygar H, Çekici A. YAPIŞIK DİŞETİ MİKTARININ ARTTIRILMASINDA UYGULANAN SERBEST DİŞETİ GREFTİ VE MODİFİYE APİKALE REPOZİSYONE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI: PİLOT ÇALIŞMA. AÜDHF dergisi. 2020;47:89–96.
MLA	Yılmaz, Melis et al. “YAPIŞIK DİŞETİ MİKTARININ ARTTIRILMASINDA UYGULANAN SERBEST DİŞETİ GREFTİ VE MODİFİYE APİKALE REPOZİSYONE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI: PİLOT ÇALIŞMA”. Ankara Üniversitesi Diş Hekimliği Fakültesi Dergisi, vol. 47, no. 1-3, 2020, pp. 89-96.
Vancouver	Yılmaz M, Balci N, Toygar H, Çekici A. YAPIŞIK DİŞETİ MİKTARININ ARTTIRILMASINDA UYGULANAN SERBEST DİŞETİ GREFTİ VE MODİFİYE APİKALE REPOZİSYONE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI: PİLOT ÇALIŞMA. AÜDHF dergisi. 2020;47(1-3):89-96.