What are the modern approaches for periodontal recession surgery?

From the Guidelines

Modern gum recession surgery should utilize L-PRF membranes as an alternative to traditional grafting materials, as they offer a significant reduction in postoperative pain and can provide optimal results when used in conjunction with a coronally advanced flap. The use of L-PRF membranes in recession coverage has been shown to improve outcomes and can be used as an alternative to connective tissue grafts, albeit with slightly inferior aesthetic improvements 1.

Key Considerations for L-PRF Membrane Use

• The number of L-PRF membranes used plays a significant role in achieving optimal results, with at least two and preferably three or four membranes recommended 1.
• The quality of L-PRF preparation is crucial, with numerous parameters to be carefully considered, including timing, blood tube selection, centrifugation protocol, and conversion from clot into membrane 1.
• L-PRF membranes can be used in conjunction with a coronally advanced flap, with a split-full-split approach in the coronal-apical direction, and optimal root planing and root conditioning 1.

Post-Operative Care

• Chlorhexidine rinses (0.12%, twice daily for 2 weeks) are recommended to reduce the risk of infection and promote healing.
• A soft diet for 2-3 weeks and avoiding brushing the surgical site for 1-2 weeks can help minimize trauma to the area and promote optimal healing.
• Prescribed antibiotics (often amoxicillin 500mg three times daily for 7 days) and anti-inflammatory medications can help reduce the risk of infection and manage pain.

Benefits of Modern Techniques

• Less pain and faster healing compared to traditional methods.
• Reduced scarring and more predictable root coverage.
• Increased patient satisfaction and improved quality of life.
• The use of L-PRF membranes and other modern techniques can help periodontists achieve optimal outcomes and improve patient care, as supported by recent studies 1.

From the Research

Modern Approaches for Gum Recession Surgery

• Various surgical techniques have been introduced to treat gingival recession, including those involving autogenous tissue grafting, various flap designs, orthodontics, and guided tissue regeneration 2.
• Non-surgical treatment options for gingival recession defects include establishment of optimal plaque control, removal of overhanging subgingival restorations, behaviour change interventions, and use of desensitising agents 3.
• In cases where a surgical approach is indicated, coronally advanced flap and tunnelling procedures combined with a connective tissue graft are considered the most predictable treatment options for single and multiple recession defects 3.

Minimally Invasive Techniques

• A minimally invasive technique using a de-epithelialized connective tissue graft via tunneling without disturbing the deeper muscular attachment can improve the phenotype of lingual recession defects 4.
• This technique can achieve partial root coverage and increase gingival thickness and vestibular depth 4.
• Keys to successful management of this case include control of gingival inflammation, precise tunneling, and use of a connective tissue graft of even thickness 4.

Long-term Assessment of Tunneling Techniques

• A modified tunneling technique using a subepithelial connective tissue graft and a volume-stable collagen matrix can achieve long-term root coverage in lower anterior gingival recession 5.
• The mean root coverage achieved was 86.2% ± 15.7%, with 77.8% of patients achieving complete root coverage at longer than 61 months follow-up 5.
• The technique appears to be reliable for the long-term management of gingival recession in the lower anterior region, even in cases involving multiple Miller class III recessions 5.

Interdisciplinary Approaches

• A combined orthodontic-periodontic approach using a torquing auxiliary spring followed by a lateral closed tunnel technique can enhance root coverage and esthetic outcomes in isolated gingival recession 6.
• The technique can achieve a mean root coverage percentage of 91.40% ± 10.25%, with 55% of sites showing complete root coverage 6.
• Keys to successful management of these cases include precise single tooth repositioning, creation of a mucoperiosteal tunnel, and avoidance of damage to surrounding tissues 6.