Comparison Of Modified Suspensory Suturing and Anchoring Suturing Technique for Gingival Recession Coverage by Tunnelling and Pouch Technique

Main Article Content

B.A.Deepika
Thamaraiselvan Murugan

Keywords

Gingival Recessions, Suture Technique, Gingiva

Abstract

Background: Over the years there is a constant evolution in surgical and suturing techniques for gingival recession coverage, aiming at greater predictability and success. With advancement new suture materials and suturing techniques are being developed to enhance the outcome of the surgery. This study discusses a modified anchored suturing technique for management of a multiple gingival recession defect with tunnel and pouch technique.
Materials and methods: Subjects with multiple gingival recession defects were treated using pouch and tunnel technique with connective tissue graft. The coronal displacement of tissue was achieved with a modified anchored suturing technique and anchored suturing technique. A total of 20 subjects selected and were divided into 2 groups Group 1: Anchored suture technique Group 2: Modified anchored suture. This facilitated more coronal displacement of tissue and drastic reduction of mechanical contact between the tissue and the modified anchored suture, which preserved the tissue integrity. Prior to Surgery, baseline evaluation of the following clinical parameters were recorded: gingival index, plaque index, probing depth, clinical attachment level. After surgery, healing index, cleft formation, tissue necrosis index, Reduction in Recession depth and Mean Recession coverage was evaluated. Mean and Standard Deviation were assessed and P Values are assessed by using SPSS software 23.0 version.
Results: At 3rd day, 7th day, 14th day, 1-month, plaque index, gingival index, healing index was assessed. After 1 month Tissue necrosis index and Cleft formation was assessed. Follow up showed complete recession coverage with excellent aesthetic outcome. The significance of statistical tests for Gingival Index, Plaque index, Healing index at Baseline, 3rd day, 7th day for both groups are not significant p>0.05; for the 14th day and 1 month it is significant p<0.05 for both the groups. The significance of statistical tests for cleft formation and Tissue necrosis score at 1 month for both groups is significant p<0.05. The significance of statistical tests for Mean Recession coverage at Baseline is not significant p>0.05 ; and for 1 month both groups are significant p<0.05.
Conclusion: The modified anchored suturing technique anchored around incisal contact point facilitates adequate coronal displacement of gingival margins and drastically reduces the mechanical contact between tissue and suture thereby preserving the tissue integrity and enhancing outcome.

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References

1. Thamaraiselvan M, Elavarasu S, Thangakumaran S, Gadagi JS, Arthie T. Comparative clinical evaluation of coronally advanced flap with or without platelet rich fibrin membrane in the treatment of isolated gingival recession. J Indian Soc Periodontol 2015;19:66-71.
2. Miller PD Jr. Root coverage using a free soft tissue autograft following citric acid application Part 1: Technique. Int J Periodontics Restorative Dent 1982;2:65-70.
3. Fischer KR, Alaa K, Schlagenhauf U, Fickl S. Root coverage with a modified lateral sliding flap - a case series. Eur J Esthet Dent 2012;7:120-8.
4. Kanmaz B, Kanmaz MG, Kaval B, Buduneli N. Root coverage with coronally advanced flap: 6-year follow-up. Aust Dent J 2019;64:346-52.
5. Milano F. A combined flap for root coverage. Int J Periodontics Restorative Dent 1998;18:544-51.
6. Pini Prato G, Tinti C, Vincenzi G, Magnani C, Cortellini P, Clauser C. Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession. J Periodontol 1992;63:919-28.
7. Zangrando MS, Valle LA, Stuani VD, Costa MR, Shibuy SK, Damante CA. Clinical outcomes of root coverage with subepithelial connective tissue graft according to site specific factors - longitudinal retrospective clinical study. J Int Acad Periodontol 2019;21:159-67.
8. Zuhr O, Fickle S, Wachtel H, Bolz W, Hürzeler MB. Covering of gingival recessions with a microsurgical tunnel technique: case report. Int J Periodontics Restorative Dent 2007;27:457–63.
9. Ronco V, Dard M. A novel suturing approach for tissue displacement within minimally invasive periodontal plastic surgery. Clinical Case Reports 2016;4:831–7.
10. Zabalegui I, Sicilia A, Cambra J, Gil J, Sanz M. Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report. Int J Periodontics Restorative Dent 1999;19:199-206.
11. Tavelli L, Barootchi S, Namazi SS, Chan HL, Brzezinski D, Danciu T et al. The influence of palatal harvesting technique on the donor site vascular injury: A split-mouth comparative cadaver study. J Periodontol 2020;91:83-92.
12. American Academy of Periodontology: Proceedings of the world workshop in periodontics. Ann Periodontol. 1996;1:37–215.
13. Wennstrom JL, Zucchelli G, Pini Prato GP. Mucogingival surgery. In: Lang NP, Karring T, editors. Clinical Periodontology and Implant Dentistry. 5th ed. Oxford, UK: Blackwell Munksgaard; 2008. pp. 955–1011.
14. Serino G, Wennström JL, Lindhe J, Eneroth L. The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene. J Clin Periodontol. 1994;21:57–63
15. Vadivel JK, Govindarajan M, Somasundaram E, Muthukrishnan A. Mast cell expression in oral lichen planus: A systematic review. J Investig Clin Dent. 2019 Nov;10(4):e12457.
16. Panda S, Jayakumar ND, Sankari M, Varghese SS, Kumar DS. Platelet rich fibrin and xenograft in treatment of intrabony defect. Contemp Clin Dent. 2014 Oct;5(4):550–4.
17. Mehta M, Dhanjal DS, Paudel KR, Singh B, Gupta G, Rajeshkumar S, et al. Cellular signalling pathways mediating the pathogenesis of chronic inflammatory respiratory diseases: an update. Inflammopharmacology. 2020 Aug;28(4):795–817.
18. Venkatesan J, Singh SK, Anil S, Kim SK, Shim MS. Preparation, Characterization and Biological Applications of Biosynthesized Silver Nanoparticles with Chitosan-Fucoidan Coating. Molecules [Internet]. 2018 Jun 12;23(6). Available from: http://dx.doi.org/10.3390/molecules23061429
19. Bhansali KJ, Balinge KR, Raut SU, Deshmukh SA, Senthil Kumar M, Ramesh Kumar C, et al. Visible light assisted sulfonic acid-functionalized porphyrin comprising benzimidazolium moiety for photocatalytic transesterification of castor oil. Fuel. 2021 Nov 15;304:121490.
20. Deepanraj B, Senthilkumar N, Mala D, Sathiamourthy A. Cashew nut shell liquid as alternate fuel for CI engine—optimization approach for performance improvement. Biomass Conversion and Biorefinery. 2022 May 1;12(5):1715–28.
21. Kamath M, Rao SK, Jaison, Sridhar, Kasthuri, Gopinath, et al. Melatonin delivery from PCL scaffold enhances glycosaminoglycans deposition in human chondrocytes – Bioactive scaffold model for cartilage regeneration. Process Biochem. 2020 Dec;99:36–47.
22. Paramasivam A, Priyadharsini JV. Novel insights into m6A modification in circular RNA and implications for immunity [Internet]. Vol. 17, Cellular & MolecularImmunology.2020.p.668–9.Availablefrom:http://dx.doi.org/10.1038/s41423-020-0387-x
23. Li Z, Veeraraghavan VP, Mohan SK, Bolla SR, Lakshmanan H, Kumaran S, et al. Apoptotic induction and anti-metastatic activity of eugenol encapsulated chitosan nanopolymer on rat glioma C6 cells via alleviating the MMP signaling pathway [Internet]. Vol. 203, Journal of Photochemistry and Photobiology B: Biology.2020.p.111773.Availablefrom:http://dx.doi.org/10.1016/j.jphotobiol.2019.111773
24. Nambi G, Kamal W, Es S, Joshi S, Trivedi P. Spinal manipulation plus laser therapy versus laser therapy alone in the treatment of chronic non-specific low back pain: a randomized controlled study. Eur J Phys Rehabil Med. 2018 Dec;54(6):880–9.
25. Ahathya RS, Deepalakshmi D, Ramakrishnan T, Ambalavanan N, Emmadi P. Subepithelial connective tissue grafts for the coverage of denuded root surfaces: A clinical report. Indian J Dent Res. 2008;19:134–40.
26. Silverstein LH, Kurtzman GM, Shatz PC. Suturing for optimal soft-tissue management. J Oral Implantol 2009;35:82–90.
27. Burkhardt R, Lang NP. Coverage of localized gingival recessions: comparison of micro- and macrosurgical techniques. J Clin Periodontol 2005;32:287–93