Connective Tissue Grafts and Surgical Delay: Clinical and Biochemical Characterization
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2012
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ndltd-OhioLink-oai-etd.ohiolink.edu-osu13398147102021-08-03T06:05:47Z Connective Tissue Grafts and Surgical Delay: Clinical and Biochemical Characterization Tsolaki, Ioanna Dentistry connective tissue graft surgical delay pre-wounding gingival recession The connective tissue graft (CTG) procedure is among the most predictable and frequently used periodontal surgical procedures, indicated primarily for coverage of exposed root surfaces, i.e., the treatment of gingival recession defects. However, the need to improve CTG periodontal outcomes in challenging clinical situations has not been met. The “surgical delay” or “ischemic preconditioning” or “pre-wounding” technique, which has been used in general plastic surgery, leads to improved clinical outcomes. The aim of this randomized, parallel arm, clinical trial was to examine the feasibility of the “pre-wounding” technique in improving CTG outcomes in deep gingival recession defects. Adult non-smokers with 3mm or greater recession defects were recruited. Following IRB-approved informed consent, subjects were randomly assigned to receive on a single tooth either a routine CTG (rCTG) or a surgically delayed CTG (pwCTG). In the pwCTG group pre-wounding was performed by means of 2 parallel incisions 1mm apart and the graft was harvested 5 days later. The recipient bed flap design was the same for both CTG types. Each subject contributed one test (rCTG or pwCTG) and one control (contralateral) site. 30-second gingival crevicular (GCF) samples were collected using paper strips immediately pre-operatively, immediately following graft placement, 3 days, and 1, 2, and 3 weeks post-operatively (PO). GCF samples were analyzed with ELISA for the presence of angiogenin (ANG) and hypoxia-inducible factor 1α (HIF-1α). Recipient and donor sites clinical parameters were assessed immediately pre-operatively, 2, 3, and 6 months PO. Questionnaires completed by subjects were used to evaluate post-operative pain and discomfort, using visual analog scores (VAS) and pain effect scales.19 subjects (9 rCTG, 10 pwCTG) completed the study. There were no statistically significant intergroup differences regarding pre-operative or PO periodontal clinical parameters.The achieved root coverage (RC) 180 days (D) PO was 89.8+13.1% for the pwCTG group and 85.6+14.9% for the rCTG group with no statistically significant difference between the two groups. Both pwCTG and rCTG showed an intragroup statistically significant difference regarding RC at D180 PO compared to D60 PO. 50% of pwCTG subjects had 100% RC at the D180 PO. 44.4% of the rCTG subjects had 100% RC at D180 PO. GCF analysis did not show an intergroup statistically significant difference in ANG and HIF-1α levels at any of the predetermined GCF sampling. Regarding pain in the donor and recipient sites, there were no intergroup statistically significant differences at any of the predetermined PO visits.This is the first study to test “pre-wounding” in a CTG procedure. The present study was able to demonstrate that pre-wounding the palate does not have adverse effects on clinical outcomes of CTGs. Additionally, from the patients’ prospective there are no adverse effects by the application of the “pre-wounding” technique. The present study was not able to prove the clinical or biochemical superiority of the tested technique versus the routine CTG procedure. Further studies on subpopulations with a reduced healing capacity and/or more severe gingival recession are necessary to elucidate the potential of the surgical delay or pre-wounding technique in oral plastic surgery. 2012-07-19 English text The Ohio State University / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=osu1339814710 http://rave.ohiolink.edu/etdc/view?acc_num=osu1339814710 unrestricted This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws. |
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NDLTD |
| language |
English |
| sources |
NDLTD |
| topic |
Dentistry connective tissue graft surgical delay pre-wounding gingival recession |
| spellingShingle |
Dentistry connective tissue graft surgical delay pre-wounding gingival recession Tsolaki, Ioanna Connective Tissue Grafts and Surgical Delay: Clinical and Biochemical Characterization |
| author |
Tsolaki, Ioanna |
| author_facet |
Tsolaki, Ioanna |
| author_sort |
Tsolaki, Ioanna |
| title |
Connective Tissue Grafts and Surgical Delay: Clinical and Biochemical Characterization |
| title_short |
Connective Tissue Grafts and Surgical Delay: Clinical and Biochemical Characterization |
| title_full |
Connective Tissue Grafts and Surgical Delay: Clinical and Biochemical Characterization |
| title_fullStr |
Connective Tissue Grafts and Surgical Delay: Clinical and Biochemical Characterization |
| title_full_unstemmed |
Connective Tissue Grafts and Surgical Delay: Clinical and Biochemical Characterization |
| title_sort |
connective tissue grafts and surgical delay: clinical and biochemical characterization |
| publisher |
The Ohio State University / OhioLINK |
| publishDate |
2012 |
| url |
http://rave.ohiolink.edu/etdc/view?acc_num=osu1339814710 |
| work_keys_str_mv |
AT tsolakiioanna connectivetissuegraftsandsurgicaldelayclinicalandbiochemicalcharacterization |
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