Factors associated with the coronally positioned flap of one or two teeth: a literature review
Keywords:Gingival recession/surgery, Surgical flaps, Tooth root/surgery, Coronally positioned flap
Introduction: marginal tissue recessions produce esthetic problems, tooth sensitivity, root caries, and difficulty to perform proper oral hygiene. There are various periodontal plastic surgery techniques for root coverage. The goal of this literature review is to assess factors associated with the coronally positioned flap technique to cover gingival recessions, bearing in mind that several variables can intervene in the complete coverage of root surface. Methods: this was a literature review on the coronally positioned flap technique for coverage of Miller class I and class II recessions of one or two teeth. It included articles published between 2000 and 2012 by searching the PubMed, Ebsco, and Cochrane databases for studies performed in humans, including longitudinal, transverse, and cohort studies, as well as clinical trials and meta-analyses. Results and conclusions: interdental papilla height, keratinized gingiva width, and gingival thickness are prognostic factors for total root coverage and its long-term stability. Integrity of the cemento-enamel junction is important in diagnosis and success of the technique; moreover, modification of root surface with technical and/or chemical mechanisms is a prerequisite. The coronally advanced flap technique combined with connective tissue, enamel matrix derivative, porcine collagen, or dermal matrix is effective in the treatment of Miller class I and class II gingival recessions, but the one with the greatest predictability is the bilaminar technique with connective tissue.
Carranza FA Jr, Carraro JJ. Mucogingival techniques in periodontal surgery. J Periodontol 1970; 41(5): 294-299.
Pini-Prato G, Cairo F, Nieri M, Rotundo R, Franceschi D. Esthetic evaluation of root coverage outcomes: a case series study. Int J Periodontics Restorative Dent 2011; 31(6): 603-610.
Sullivan HC, Atkins JH. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics 1968; 6(3): 121-129.
Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5(2):8-13.
Miller PD Jr. Root coverage grafting for regeneration and aesthetics. Periodontol 2000 1993; 1: 118-127.
Gray JL. When not to perform root coverage procedures. J Periodontol 2000; 71(6): 1048-1050.
Miller PD Jr. Root coverage using a free soft tissue autograft following citric acid application. Part 1: Technique. Int J Periodontics Restorative Dent 1982; 2(1): 65-70.
Bernimoulin JP, Lüscher B, Mühlemann HR. Coronally repositioned periodontal flap. Clinical evaluation after one year. J Clin Periodontol 1975; 2(1): 1-13.
Liu WJ, Solt CW. A surgical procedure for the treatment of localized gingival recession in conjunction with root surface citric acid conditioning. J Periodontol 1980; 51(9): 505-509.
Mendes DN, Novaes AB Jr, Novaes AB. Root coverage of large localized gingival recession: a biometric study. Braz Dent J 1997; 8(2): 113-120.
Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. II. Clinical results. Int J Periodontics Restorative Dent 1994;14(4):302-315.
Harris RJ. The connective tissue with partial thickness double pedicle graft: the results of 100 consecutively-treated defects. J Periodontol 1994; 65(5): 448-461.
De Sanctis M, Zucchelli G. Coronally advanced flap: a modified surgical approach for isolated recession-type defects: three-year results. J Clin Periodontol 2007; 34(3): 262-268.
Cairo F, Pini-Prato GP. A technique to identify and reconstruct the cementoenamel junction level using combined periodontal and restorative treatment of gingival recession. A prospective clinical study. Int J Periodontics Restorative Dent 2010; 30(6): 573-581.
Cairo F, Rotundo R, Miller PD, Pini-Prato GP. Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol 2009; 80(4): 705-710.
Santamaria MP, Suaid FF, Casati MZ, Nociti FH, Sallum AW, Sallum EA. Coronally positioned flap plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesions: a randomized controlled clinical trial. J Periodontol 2008; 79(4): 621-628.
Cheng YF, Chen JW, Lin SJ, Lu HK. Is coronally positioned flap procedure adjunct with enamel matrix derivative or root conditioning a relevant predictor for achieving root coverage? A systemic review. J Periodontal Res 2007; 42(5): 474-485.
Bertrand PM, Dunlap RM. Coverage of deep, wide gingival clefts with free gingival autografts: root planing with and without citric acid demineralization. Int J Periodontics Restorative Dent 1988;8(1): 64-77.
Wennström JL, Zucchelli G. Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study. J Clin Periodontol 1996; 23(8): 770-777.
Fourel J. Gingival reattachment on carious tooth surfaces. A 4-year follow-up. J Clin Periodontol 1982; 9(4): 285-289.
Miller PD Jr. Root coverage using the free soft tissue autograft following citric acid application. II. Treatment of the carious root. Int J Periodontics Restorative Dent 1983; 3(5): 38-51.
Holbrook T, Ochsenbein C. Complete coverage of the denuded root surface with a one-stage gingival graft. Int J Periodontics Restorative Dent 1983; 3(3): 8-27.
Zucchelli G, Mounssif I, Stefanini M, Mele M, Montebugnoli L, Sforza NM. Hand and ultrasonic instrumentation in combination with root-coverage surgery: a comparative controlled randomized clinical trial. J Periodontol 2009; 80(4): 577-585.
Pini-Prato G, Rotundo R, Franceschi D, Cairo F, Cortellini P, Nieri M. Fourteen-year outcomes of coronally advanced flap for root coverage: follow-up from a randomized trial. J Clin Periodontol 2011; 38(8): 715-720.
Oliveira GH, Muncinelli EA. Efficacy of root surface biomodification in root coverage: a systematic review. J Can Dent Assoc 2012; 78: c122.
Spahr A, Haegewald S, Tsoulfidou F, Rompola E, Heijl L, Bernimoulin JP et al. Coverage of Miller class I and II recession defects using enamel matrix proteins versus coronally advanced flap technique: a 2-year report. J Periodontol 2005; 76(11): 1871-1880.
Del Pizzo M, Zucchelli G, Modica F, Villa R, Debernardi C. Coronally advanced flap with or without enamel matrix derivative for root coverage: a 2-year study. J Clin Periodontol 2005; 32(11): 1181-1187.
Shin SH, Cueva MA, Kerns DG, Hallmon WW, Rivera-Hidalgo F, Nunn ME. A comparative study of root coverage using acellular dermal matrix with and without enamel matrix derivative. J Periodontol 2007; 78(3): 411-421.
Cardaropoli D, Tamagnone L, Roffredo A, Gaveglio L. Treatment of gingival recession defects using coronally advanced flap with a porcine collagen matrix compared to coronally advanced flap with connective tissue graft: a randomized controlled clinical trial. J Periodontol 2012; 83(3): 321-328.
Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol 1985; 56(12): 715-720.
Da Silva RC, Joly JC, de Lima AF, Tatakis DN. Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft. J Periodontol 2004; 75(3): 413-419.
Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L et al. Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 2010; 37(8): 728-738.
Santamaria MP, Suaid FF, Nociti FH Jr, Casati MZ, Sallum AW, Sallum EA. Periodontal surgery and glass ionomer restoration in the treatment of gingival recession associated with a non-carious cervical lesion: report of three cases. J Periodontol 2007; 78(6): 1146-1153.
Lucchesi JA, Santos VR, Amaral CM, Peruzzo DC, Duarte PM. Coronally positioned flap for treatment of restored root surfaces: a 6-month clinical evaluation. J Periodontol 2007; 78(4): 615-623.
Santamaria MP, Ambrosano GM, Casati MZ, Nociti Júnior FH, Sallum AW, Sallum EA. Connective tissue graft plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesion: a randomized-controlled clinical trial. J Clin Periodontol 2009; 36(9): 791-798.
Zucchelli G, Gori G, Mele M, Stefanini M, Mazzotti C, Marzadori M et al. Non-carious cervical lesions associated with gingival recessions: a decision-making process. J Periodontol 2011; 82(12): 1713-1724.
Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M. Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol 2009; 80(7): 1083-1094.
Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol 2000; 71(9): 1506-1514.
Zucchelli G, De Sanctis M. The coronally advanced flap for the treatment of multiple recession defects: a modified surgical approach for the upper anterior teeth. J Int Acad Periodontol 2007; 9(3): 96-103.
Lafzi A, Mostofi Zadeh Farahani R, Abolfazli N, Amid R, Safaiyan A. Effect of connective tissue graft orientation on the root coverage outcomes of coronally advanced flap. Clin Oral Investig 2007; 11(4): 401-408.
De Sanctis M, Baldini N, Goracci C, Zucchelli G. Coronally advanced flap associated with a connective tissue graft for the treatment of multiple recession defects in mandibular posterior teeth. Int J Periodontics Restorative Dent 2011; 31(6): 623-630.
Mazzocco F, Comuzzi L, Stefani R, Milan Y, Favero G, Stellini E. Coronally advanced flap combined with a subepithelial connective tissue graft using full- or partial-thickness flap reflection. J Periodontol 2011; 82(11): 1524-1529.
Zucchelli G, Mele M, Stefanini M, Mazzotti C, Mounssif I, Marzadori M et al. Predetermination of root coverage. J Periodontol 2010; 81(7): 1019-1026.
Cortellini P, Pini-Prato G. Coronally advanced flap and combination therapy for root coverage. Clinical strategies based on scientific evidence and clinical experience. Periodontol 2000 2012; 59(1): 158-184.
Kassab MM, Cohen RE. Treatment of gingival recession. J Am Dent Assoc 2002; 133(11): 1499-506.
Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 2002; 29 Suppl 3: 178-194.
Huang LH, Neiva RE, Wang HL. Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 2005; 76(10): 1729-1734.
Cairo F, Cortellini P, Tonetti M, Nieri M, Mervelt J, Cincinelli S et al. Coronally advanced flap with and without connective tissue graft for the treatment of single maxillary gingival recession with loss of inter-dental attachment. A randomized controlled clinical trial. J Clin Periodontol 2012; 39(8): 760-768.
Tarnow DP. Semilunar coronally repositioned flap. J Clin Periodontol 1986; 13(3): 182-185.
Nieri M, Rotundo R, Franceschi D, Cairo F, Cortellini P, Pini-Prato G. Factors affecting the outcome of the coronally advanced flap procedure: a Bayesian network analysis. J Periodontol 2009; 80(3): 405-410.
Pini-Prato G, Franceschi D, Rotundo R, Cairo F, Cortellini P, Nieri M. Long-term 8-year outcomes of coronally advanced flap for root coverage. J Periodontol 2012; 83(5): 590-594.
Hofmänner P, Alessandri R, Laugisch O, Aroca S, Salvi GE, Stavropoulos A et al. Predictability of surgical techniques used for coverage of multiple adjacent gingival recessions--A systematic review. Quintessence Int 2012; 43(7): 545-554.
Chambrone L, Pannuti CM, Tu YK, Chambrone LA. Evidence-based periodontal plastic surgery. II. An individual data meta-analysis for evaluating factors in achieving complete root coverage. J Periodontol 2012; 83(4): 477-490.
How to Cite
Copyright comprises moral and patrimonial rights.
1. Moral rights: are born at the moment of the creation of the work, without the need to register it. They belong to the author in a personal and unrelinquishable manner; also, they are imprescriptible, unalienable and non negotiable. Moral rights are the right to paternity of the work, the right to integrity of the work, the right to maintain the work unedited or to publish it under a pseudonym or anonymously, the right to modify the work, the right to repent and, the right to be mentioned, in accordance with the definitions established in article 40 of Intellectual property bylaws of the Universidad (RECTORAL RESOLUTION 21231 of 2005).
2. Patrimonial rights: they consist of the capacity of financially dispose and benefit from the work trough any mean. Also, the patrimonial rights are relinquishable, attachable, prescriptive, temporary and transmissible, and they are caused with the publication or divulgation of the work. To the effect of publication of articles in the journal Revista de la Facultad de Odontología, it is understood that Universidad de Antioquia is the owner of the patrimonial rights of the contents of the publication.
The content of the publications is the exclusive responsibility of the authors. Neither the printing press, nor the editors, nor the Editorial Board will be responsible for the use of the information contained in the articles.
I, we, the author(s), and through me (us), the Entity for which I, am (are) working, hereby transfer in a total and definitive manner and without any limitation, to the Revista Facultad de Odontología Universidad de Antioquia, the patrimonial rights corresponding to the article presented for physical and digital publication. I also declare that neither this article, nor part of it has been published in another journal.
Open Access Policy
The articles published in our Journal are fully open access, as we consider that providing the public with free access to research contributes to a greater global exchange of knowledge.
Creative Commons License
The Journal offers its content to third parties without any kind of economic compensation or embargo on the articles. Articles are published under the terms of a Creative Commons license, known as Attribution – NonCommercial – Share Alike (BY-NC-SA), which permits use, distribution and reproduction in any medium, provided that the original work is properly cited and that the new productions are licensed under the same conditions.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.