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Published in: Clinical Oral Investigations 3/2019

Open Access 01-03-2019 | Original Article

Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial

Authors: Andrea Pilloni, Patrick R. Schmidlin, Philipp Sahrmann, Anton Sculean, Mariana A. Rojas

Published in: Clinical Oral Investigations | Issue 3/2019

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Abstract

Objectives

The aim of this randomized controlled clinical trial was to evaluate the possible advantages of adjunctive hyaluronic acid (HA) application in the coronally advanced flap (CAF) procedure in single Miller class I/recession type 1 (RT1) gingival recession treatment.

Material and methods

Thirty patients with one recession were enrolled; 15 were randomly assigned CAF + HA and 15 to CAF alone. The recession reduction (RecRed), clinical attachment level gain (CAL-gain), changes in probing pocket depth (PPD) and in the width of keratinized tissue (KT), complete root coverage (CRC), and mean root coverage (MRC) were calculated after 18 months. Post-operative morbidity (pain intensity, discomfort, and swelling) was recorded 7 days after treatment using visual analogue scale (VAS).

Results

After 18 months, RecRed was statistically significantly higher in the test group (2.7 mm [1.0]) than in the control group (1.9 mm [1.0]; p = 0.007). PPD were found to be slightly but statistically significantly increased in both groups. No statistically significant difference was found for KT gain between treatments. CRC was 80% for test and 33.3% for control sites (p < 0.05). A MRC of 93.8 ± 13.0% for test and 73.1 ± 20.8% for control sites was calculated (p < 0.05). The test group reported lower swelling and discomfort values 7-days post-surgery (p < 0.05). Statistically significant difference was not found for pain intensity.

Conclusions

The adjunctive use of HA was effective in obtaining CRC for single Miller class I/RT1 gingival recession sites.

Clinical relevance

Adjunctive application of HA in the coronally advanced flap procedure may improve the reduction of the recessions and increase the probability of CRC in Miller class I recessions.
Literature
1.
go back to reference Löe H, Anerud A, Boysen H (1992) The natural history of periodontal disease in man: prevalence, severity and extent of gingival recession. J Periodontol 63:489–495CrossRefPubMed Löe H, Anerud A, Boysen H (1992) The natural history of periodontal disease in man: prevalence, severity and extent of gingival recession. J Periodontol 63:489–495CrossRefPubMed
2.
go back to reference Serino G, Wennstrom JL, Lindhe J, Eneroth L (1994) The prevalence and distribution of gingival recessions in subjects with a high standard of oral hygiene. J Clin Periodontol 21:57–63CrossRefPubMed Serino G, Wennstrom JL, Lindhe J, Eneroth L (1994) The prevalence and distribution of gingival recessions in subjects with a high standard of oral hygiene. J Clin Periodontol 21:57–63CrossRefPubMed
3.
go back to reference Kassab MM, Cohen RE (2003) The etiology and prevalence of gingival recession. J Am Dent Assoc 134:220–225CrossRefPubMed Kassab MM, Cohen RE (2003) The etiology and prevalence of gingival recession. J Am Dent Assoc 134:220–225CrossRefPubMed
5.
go back to reference Lindhe J, Maynard G, Miller PD (1996) American Academy of periodontology. Consensus report on mucogingival therapy. Ann Periodontol 1:702–706CrossRef Lindhe J, Maynard G, Miller PD (1996) American Academy of periodontology. Consensus report on mucogingival therapy. Ann Periodontol 1:702–706CrossRef
6.
go back to reference Clauser C, Nieri M, Franceschi D, Pagliaro U, Pini-Prato G (2003) Evidenced-based mucogingival teraphy. Part 2: ordinary and individual patient data meta-analyses of surgical treatment of reccesion using complete root coverage as the outcome variable. J Periodontol 74:741–756CrossRefPubMed Clauser C, Nieri M, Franceschi D, Pagliaro U, Pini-Prato G (2003) Evidenced-based mucogingival teraphy. Part 2: ordinary and individual patient data meta-analyses of surgical treatment of reccesion using complete root coverage as the outcome variable. J Periodontol 74:741–756CrossRefPubMed
7.
go back to reference Cairo F, Pagliaro U, Nieri M (2008) Treatment of gingival recession with coronally advanced flap procedures. A systematic review. J Clin Periodontol 35:136–162 Cairo F, Pagliaro U, Nieri M (2008) Treatment of gingival recession with coronally advanced flap procedures. A systematic review. J Clin Periodontol 35:136–162
8.
go back to reference Chambrone L, Pannuti CM, Tu YK, Cambrone LA (2012) Evidence-based periodontal plastic surgery II. An individual data meta-analysis for evaluating factors in achieving complete root coverage. J Periodontol 83:477–490CrossRefPubMed Chambrone L, Pannuti CM, Tu YK, Cambrone LA (2012) Evidence-based periodontal plastic surgery II. An individual data meta-analysis for evaluating factors in achieving complete root coverage. J Periodontol 83:477–490CrossRefPubMed
9.
go back to reference Cairo F, Nieri M, Pagliaro U (2014) Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 4:S44–S62CrossRef Cairo F, Nieri M, Pagliaro U (2014) Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 4:S44–S62CrossRef
10.
go back to reference Chambrone L, Tatakis DN (2015) Periodontal soft tissue root coverage procedures: a systematic review from the AAP regeneration workshop. J Periodontol 86:S8–S51CrossRefPubMed Chambrone L, Tatakis DN (2015) Periodontal soft tissue root coverage procedures: a systematic review from the AAP regeneration workshop. J Periodontol 86:S8–S51CrossRefPubMed
11.
go back to reference Pilloni A, Paolantonio M, Camargo PM (2006) Root coverage with a coronally positioned flap used in combination with enamel matrix derivative: 18-month clinical evaluation. J Periodontol 77:2031–2039CrossRefPubMed Pilloni A, Paolantonio M, Camargo PM (2006) Root coverage with a coronally positioned flap used in combination with enamel matrix derivative: 18-month clinical evaluation. J Periodontol 77:2031–2039CrossRefPubMed
12.
go back to reference Cheng GL, Fu E, Tu YK, Shen EC, Chiu HC, Huang RY, Yuh DY, Chiang CY (2015) Root coverage by coronally advanced flap with connective tissue graft and/or enamel matrix derivative: a meta-analysis. J Periodontal Res 50:220–230CrossRefPubMed Cheng GL, Fu E, Tu YK, Shen EC, Chiu HC, Huang RY, Yuh DY, Chiang CY (2015) Root coverage by coronally advanced flap with connective tissue graft and/or enamel matrix derivative: a meta-analysis. J Periodontal Res 50:220–230CrossRefPubMed
15.
go back to reference Bansal J, Kedige SD, Anand S (2010) Hyaluronic acid: a promising mediator for periodontal regeneration. Indian J Dent Res 21:575–578CrossRefPubMed Bansal J, Kedige SD, Anand S (2010) Hyaluronic acid: a promising mediator for periodontal regeneration. Indian J Dent Res 21:575–578CrossRefPubMed
16.
go back to reference Vänttinen E, Viljanto J (1965) Tensile strength of new connective tissue formed in pretreated viscose cellulose implants. Ann Med Exp Biol Fen 43:257–259 Vänttinen E, Viljanto J (1965) Tensile strength of new connective tissue formed in pretreated viscose cellulose implants. Ann Med Exp Biol Fen 43:257–259
17.
go back to reference Scully MF, Kakkar VV, Goodwin CA, O'Regan M (1995) Inhibition of fibrinolytic activity by hyaluronan and its alcohol ester derivatives. Thromb Res 78:255–258CrossRefPubMed Scully MF, Kakkar VV, Goodwin CA, O'Regan M (1995) Inhibition of fibrinolytic activity by hyaluronan and its alcohol ester derivatives. Thromb Res 78:255–258CrossRefPubMed
18.
go back to reference West DC, Hampson IN, Arnold F, Kumar S (1985) Angiogenesis induced by degradation products of hyaluronic acid. Science 228:1324–1326CrossRefPubMed West DC, Hampson IN, Arnold F, Kumar S (1985) Angiogenesis induced by degradation products of hyaluronic acid. Science 228:1324–1326CrossRefPubMed
19.
go back to reference Pilloni A, Bernard GW (1998) The effect of hyaluronan on mouse intramembranous osteogenesis in vitro. Cell Tissue Res 294:323–333CrossRefPubMed Pilloni A, Bernard GW (1998) The effect of hyaluronan on mouse intramembranous osteogenesis in vitro. Cell Tissue Res 294:323–333CrossRefPubMed
20.
go back to reference Pilloni A, Rimondini L, De Luca M, Bernard GW (2003) Effect of hyaluronan on calcification-nodule formation from human periodontal ligament cell culture. J Appl Biomater Biomech 1:84–90PubMed Pilloni A, Rimondini L, De Luca M, Bernard GW (2003) Effect of hyaluronan on calcification-nodule formation from human periodontal ligament cell culture. J Appl Biomater Biomech 1:84–90PubMed
21.
go back to reference Pirnazar P, Wolinsky L, Nachnani S, Haake S, Pilloni A, Bernard GW (1997) Bacteriostatic effects of hyaluronic acid. J Periodontol 70:370–374CrossRef Pirnazar P, Wolinsky L, Nachnani S, Haake S, Pilloni A, Bernard GW (1997) Bacteriostatic effects of hyaluronic acid. J Periodontol 70:370–374CrossRef
22.
go back to reference Fujioka-Kobayashi M, Muller HD, Mueller A, Lussi A, Sculean A, Schmidlin PR, Miron RJ (2017) In vitro effects of hyaluronic acid on human periodontal ligament cells. BMC Oral Health 17:1–12CrossRef Fujioka-Kobayashi M, Muller HD, Mueller A, Lussi A, Sculean A, Schmidlin PR, Miron RJ (2017) In vitro effects of hyaluronic acid on human periodontal ligament cells. BMC Oral Health 17:1–12CrossRef
23.
go back to reference Miller PD (1985) A classification of marginal tissue recession. Int J Periodontics and Restorative Dent 2:9–13 Miller PD (1985) A classification of marginal tissue recession. Int J Periodontics and Restorative Dent 2:9–13
24.
go back to reference Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U (2011) The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 38:661–666CrossRefPubMed Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U (2011) The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 38:661–666CrossRefPubMed
25.
go back to reference Cairo F, Pini Prato GP (2010) 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 30:573–581PubMed Cairo F, Pini Prato GP (2010) 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 30:573–581PubMed
26.
go back to reference Zucchelli G, Stefanini M, Ganz S, Mazzotti C, Mounssif L, Marzadori M (2016) Coronally advanced flap with different designs in the treatment of gingival recession: a comparative controlled randomized clinical trial. Int J Periodontics Restorative Dent 36:319–327CrossRefPubMed Zucchelli G, Stefanini M, Ganz S, Mazzotti C, Mounssif L, Marzadori M (2016) Coronally advanced flap with different designs in the treatment of gingival recession: a comparative controlled randomized clinical trial. Int J Periodontics Restorative Dent 36:319–327CrossRefPubMed
27.
go back to reference Pini Prato GP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C, Rotundo R, Muzzi L (2005) Coronally advanced flap: the post-surgical position of the gingival margin is an important factor for achieving complete root coverage. J Periodontol 76:713–722CrossRefPubMed Pini Prato GP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C, Rotundo R, Muzzi L (2005) Coronally advanced flap: the post-surgical position of the gingival margin is an important factor for achieving complete root coverage. J Periodontol 76:713–722CrossRefPubMed
28.
go back to reference De Sanctis M, Zuchelli G (2007) Coronally advanced flap: a modified surgical approach for isolated recession-type defects. Three years results. J Clin Periodontol 34:262–268CrossRefPubMed De Sanctis M, Zuchelli G (2007) Coronally advanced flap: a modified surgical approach for isolated recession-type defects. Three years results. J Clin Periodontol 34:262–268CrossRefPubMed
29.
go back to reference Cairo F, Cortellini P, Pilloni A, Nieri M, Cincinelli S, Amunni F, Pagavino G, Tonetti MS (2016) Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial. J Clin Periodontol 45:849–856CrossRef Cairo F, Cortellini P, Pilloni A, Nieri M, Cincinelli S, Amunni F, Pagavino G, Tonetti MS (2016) Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial. J Clin Periodontol 45:849–856CrossRef
30.
go back to reference Tatakis DN, Chambrone L, Allen EP, Langer B, MC Guire MK, Richardson CR, Zabalegui I, Zadeh HH (2015) Periodontal soft tissue root coverage procedures: a consensus report from the AAP regeneration workshop. J Periodontol 86:S52–S55CrossRefPubMed Tatakis DN, Chambrone L, Allen EP, Langer B, MC Guire MK, Richardson CR, Zabalegui I, Zadeh HH (2015) Periodontal soft tissue root coverage procedures: a consensus report from the AAP regeneration workshop. J Periodontol 86:S52–S55CrossRefPubMed
31.
go back to reference McGuire MK, Scheyer ET (2010) Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects. J Periodontol 81:1108–1117CrossRefPubMed McGuire MK, Scheyer ET (2010) Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects. J Periodontol 81:1108–1117CrossRefPubMed
32.
go back to reference Moseley R, Waddington RJ, Embery G (2002) Hyaluronan and its potential role in periodontal healing. Dent Update 29:144–148CrossRefPubMed Moseley R, Waddington RJ, Embery G (2002) Hyaluronan and its potential role in periodontal healing. Dent Update 29:144–148CrossRefPubMed
33.
go back to reference Casale M, Moffa A, Vella P, Sabatino L, Capuano F, Salvinelli B, Lopez MA, Carinci F, Salvinelli F (2016) Hyaluronic acid: perspectives in dentistry. A systematic review. Int J Inmunopathol Pharmacol 29:572–582CrossRef Casale M, Moffa A, Vella P, Sabatino L, Capuano F, Salvinelli B, Lopez MA, Carinci F, Salvinelli F (2016) Hyaluronic acid: perspectives in dentistry. A systematic review. Int J Inmunopathol Pharmacol 29:572–582CrossRef
34.
go back to reference Jentsch H, Pomowski R, Kundt G, Göcke R (2003) Treatment of gingivitis with hyaluronan. J Clin Periodontol 30:159–164CrossRefPubMed Jentsch H, Pomowski R, Kundt G, Göcke R (2003) Treatment of gingivitis with hyaluronan. J Clin Periodontol 30:159–164CrossRefPubMed
35.
go back to reference Johannsen A, Tellefsen M, Wikesjö U, Johannsen G (2009) Local delivery of hyaluronan as an adjunct to scaling and root planing in the treatment of chronic periodontitis. J Periodontol 80:1493–1497CrossRefPubMed Johannsen A, Tellefsen M, Wikesjö U, Johannsen G (2009) Local delivery of hyaluronan as an adjunct to scaling and root planing in the treatment of chronic periodontitis. J Periodontol 80:1493–1497CrossRefPubMed
36.
go back to reference Eick S, Renatus A, Heinicke M, Pfister W, Stratul SI, Jentsch H (2013) Hyaluronic acid as an adjunct after scaling and root planing: a prospective randomized clinical trial. J Periodontol 84:941–949CrossRefPubMed Eick S, Renatus A, Heinicke M, Pfister W, Stratul SI, Jentsch H (2013) Hyaluronic acid as an adjunct after scaling and root planing: a prospective randomized clinical trial. J Periodontol 84:941–949CrossRefPubMed
37.
go back to reference Ballini A, Cantore S, Capodiferro S, Grassi FR (2009) Esterified hyaluronic acid and autologous bone in the surgical correction of the infra-bone defects. Int J Med Sci 6:65–71CrossRefPubMedPubMedCentral Ballini A, Cantore S, Capodiferro S, Grassi FR (2009) Esterified hyaluronic acid and autologous bone in the surgical correction of the infra-bone defects. Int J Med Sci 6:65–71CrossRefPubMedPubMedCentral
38.
go back to reference Ferguson EL, Roberts JL, Moseley R, Griffiths PC, Thomas DW (2011) Evaluation of the physical and biological properties of hyaluronan and hyaluronan fragments. Int J Pharm 420:84–92CrossRefPubMed Ferguson EL, Roberts JL, Moseley R, Griffiths PC, Thomas DW (2011) Evaluation of the physical and biological properties of hyaluronan and hyaluronan fragments. Int J Pharm 420:84–92CrossRefPubMed
39.
go back to reference Wikesjö UM, Selvig KA (1999) Periodontal wound healing and regeneration. Periodontol 2000 19:21–39 Wikesjö UM, Selvig KA (1999) Periodontal wound healing and regeneration. Periodontol 2000 19:21–39
40.
go back to reference Calvin M (1998) Cutaneous wound repair. Wounds 10:12–32 Calvin M (1998) Cutaneous wound repair. Wounds 10:12–32
41.
go back to reference Chen WY, Abatangelo G (1999) Functions of hyaluronan in wound repair. Wound Repair Regen 17:79–89CrossRef Chen WY, Abatangelo G (1999) Functions of hyaluronan in wound repair. Wound Repair Regen 17:79–89CrossRef
42.
go back to reference Weigel PH, Frost SJ, McGary CT, Leboeuf RD (1988) The role of hyaluronic acid in inflammation and wound healing. Int J Tiss Reac 10:355–365 Weigel PH, Frost SJ, McGary CT, Leboeuf RD (1988) The role of hyaluronic acid in inflammation and wound healing. Int J Tiss Reac 10:355–365
43.
go back to reference Bevilacqua L, Eriani J, Serroni I et al (2012) Effectiveness of adjunctive subgingival administration of amino acids and sodium hyaluronate gel on clinical and immunological parameters in the treatment of chronic periodontitis. Annali di Stomatologgia 3:75–81 Bevilacqua L, Eriani J, Serroni I et al (2012) Effectiveness of adjunctive subgingival administration of amino acids and sodium hyaluronate gel on clinical and immunological parameters in the treatment of chronic periodontitis. Annali di Stomatologgia 3:75–81
44.
go back to reference Romeo U, Libotte F, Palaia G, Galanakis A, Gaimari G, Tenore G, del Vecchio A, Polimeni A (2014) Oral soft tissue wound healing after laser surgery with or without a pool of amino acids and sodium hyaluronate: a randomized clinical study. Photomed Laser Surg 32:10–16CrossRefPubMed Romeo U, Libotte F, Palaia G, Galanakis A, Gaimari G, Tenore G, del Vecchio A, Polimeni A (2014) Oral soft tissue wound healing after laser surgery with or without a pool of amino acids and sodium hyaluronate: a randomized clinical study. Photomed Laser Surg 32:10–16CrossRefPubMed
45.
go back to reference Rajan P, Rao NM, Nera M, Rahaman SM (2015) Hyaluronon as an adjunct to coronally advanced flap for the treatment of gingival recession defects. Natl J Integr Res Med 6:94–100 Rajan P, Rao NM, Nera M, Rahaman SM (2015) Hyaluronon as an adjunct to coronally advanced flap for the treatment of gingival recession defects. Natl J Integr Res Med 6:94–100
46.
go back to reference Kumar R, Srinivas M, Pai J, Suragimath G, Prasd K, Polepalle T (2014) Efficacy of hyaluronic acid (hyaluronan) in root coverage procedures as an adjunct to coronally advanced flap in Miller class I recession: a clinical study. J Indian Soc Periodontol 18:746–750PubMedPubMedCentral Kumar R, Srinivas M, Pai J, Suragimath G, Prasd K, Polepalle T (2014) Efficacy of hyaluronic acid (hyaluronan) in root coverage procedures as an adjunct to coronally advanced flap in Miller class I recession: a clinical study. J Indian Soc Periodontol 18:746–750PubMedPubMedCentral
47.
go back to reference Mc Guire M, Nunn M (2003) Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivate or connective tissue. Part 1: comparison on clinical parameters. J Periodontol 74:1110–1125CrossRef Mc Guire M, Nunn M (2003) Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivate or connective tissue. Part 1: comparison on clinical parameters. J Periodontol 74:1110–1125CrossRef
48.
go back to reference Young EE, Lariviere WR, Belfer I (2012) Genetic basis of pain variability: recent advances. J Med Genet 49:1–9CrossRefPubMed Young EE, Lariviere WR, Belfer I (2012) Genetic basis of pain variability: recent advances. J Med Genet 49:1–9CrossRefPubMed
Metadata
Title
Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial
Authors
Andrea Pilloni
Patrick R. Schmidlin
Philipp Sahrmann
Anton Sculean
Mariana A. Rojas
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
Clinical Oral Investigations / Issue 3/2019
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI
https://doi.org/10.1007/s00784-018-2537-4

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