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ePaper created 2016-03-07, 22:38:59 | version 1.38.0
Journal of Oral Science & Rehabilitation 60 Volume 2 | Issue 1/2016 initial REC = 2.3 ± 0.9 mm) and 75 (mean initial REC = 2.3 ± 1.1 mm) RECswere analyzedforeach treatment group. The mean final REC at 12 months was 0.3±0.5mmforthetestgroupand0.4±0.6mm for the control, with a RECred of 2.1 ± 0.9 mm (89.1% of the initial REC) and 1.9 ± 0.9 mm (84.3% ofthe initial REC), respectively. The Stu dent’s t-test for unpaired data did not find a sta tistically significant difference in RECred bet ween the two groups (p = 0.9692; Table 1). Forty-three out of 56 (76.8%) RECs in the test group and 53 out of 75 (70.7%) in the control groupachievedCRC.Thechi-squaredtestdidnot demonstrate a statisticallysignificant difference in the CRC rate between the two groups (p = 0.4336; Table 2). Table 3 shows the data of the RECs at the central incisors adjacent to the tunneled or not tunneled papilla.The initialmean REC atthe cen tral incisors was 2.3 ± 0.9 mm and 2.7 ± 1.2 mm, respectively, forthe test and control groups. The mean final REC after 12 months for the test and controlgroupswas0.3±0.6mmand0.4±0.6mm, respectively, with a RECred from the baseline of 2.0 ± 0.9 mm (87%)forthetest and 2.3 ± 1.0 mm (87%)forthecontrolgroups.TheMann–Whitney U test did not show a statistically significant dif ference in RECred between the two groups (p = 0.27572; Table 3). Fifteen out of 20 (75%) RECs in the test group and 14 out of 20 (70%) in the control achieved CRC. The Fisher exact test did notfindastatisticallysignificantdifferenceinthe CRC rate between the two groups (p = 0.7401; Table 4). Discussion The results of CAF performed with a tunneling procedure underneath the maxillary midline papillawerebetterintermsofRECredthanthose ofthe controlgroup, althoughthe differences did not achieve statistical significance. They were 89.6% alignedwiththe outcomes ofoverallperi odontalplasticproceduresfromarecentsystem atic review of the literature (86.27%)6 and with those from another publication on CAF with no releasing incisions in the same esthetic area (89.1%).13 However, limited to the same esthetic area, they were slightly inferior to those of both CAF improved with an orthodontic device for a sling suture and flap securing in a more coronal position (96.2%)13 and CAFalone (95.0%),14 even on monolateral RECs (97.0%)7 or in a limited number of patients and RECs (97.0%).9 In this study, CRC too (76.8%) was comprised in the upper level of the range of outcomes of overall periodontal plastic procedures (23.8–89.3%)6 and showed better results than CRC obtained withconventionalCAFwithnoreleasingincisions in the same esthetic area (61.0%)13 but worse thanthe outcomes obtained bothwith improved CAF (84.6%)13 and CAF alone (84.0%; 88.0%; 89.0%)14, 7, 9 even within the above-mentioned limits of these last two studies. It is important to emphasize that no previous investigation has evaluated either cases of bila teral root exposures exclusively or such a large number of consecutive RECs per patient (mean of6.55) as in the present study. In the previously mentioned clinical studies,7, 9, 14 the number of consecutive RECs that underwent treatment varied with a mean of between 3.3 and 4.1 per patient. Even considering only the central incisors, the results of CAF with the tunneling procedure were better in terms of RECred and CRC than those of the control group were, al though such a difference did not achieve stati stical significance in this case. No comparison is possible with other investigations concerning specific data on these teeth, since the key role of thismethodinthesymmetryandestheticsofthe smile has not been reported in literature prior to this study. Conclusion CAF performed with tunneling of the maxillary midline papilla can be considered a minimally invasive,safeandpredictablesurgicalprocedure, but failed to demonstrate significant additional benefits in terms of RECred and CRC compared with a conventionalapproach inthis randomized clinical trial. Competing interests The authorsdeclarethattheyhave nocompeting interests. The study was self-funded by the au thors. C o r o n a l l y a d v a n c e d f l a p i n t h e t r e a t m e n t o f b i l a t e r a l m u l t i p l e g i n g i v a l r e c e s s i o n s