Abstract

COMPARE AND EVALUATE THE EFFICACY OF CORONALLY ADVANCED FLAP WITH AND WITHOUT CHORION MEMBRANE IN THE TREATMENT OF MILLER’S CLASS I OR CLASS II GINGIVAL RECESSION

Chandan Pal*

ABSTRACT

The periodontal tissue, comprises of the gingiva, periodontal ligament (PDL), cementum and alveolar bone which surrounds the tooth and play important role in supporting its function. Periodontal disease is a chronic inflammatory disorder that destroys these periodontal tissues resulting in soft and hard tissue loss which in turn leads to periodontal pocket formation, gingival recession and ultimately tooth loss.[1,2] Gingival recession is the term used for the exposure of root surface due to apical migration of gingival margins.[3] Gingival recession is relatively prevalent in the general population, can be localized or generalized and may be associated with unfavorable esthetics, dentin hypersensitivity, and susceptibility to root caries. The common factors contributing to gingival recession are periodontal disease, trauma from tooth-brushing, anatomic variation, smoking, oral habits, malpositioning and orthodontic tooth movement. Gingival recession can be seen in people with both poor and good oral hygiene.[4] Various classifications of gingival recession exist in the literature. However the most commonly used and widely accepted classification was given by P.D. Miller in 1985, who proposed four classes wherein Class I and Class II gingival recession is without interdental bone and soft tissue loss and Class III and Class IV gingival recession with interdental bone and soft tissue loss. It was also suggested that complete root coverage can be anticipated for Class I and Class II gingival recession.[5] The goal of treating gingival recession is to restore the gingival margin to the cementoenamel junction (CEJ) and create normal sulcus with a functional attachment. Different surgical techniques have been introduced to treat gingival recession, including the free gingival graft, the coronally advanced flap (CAF), the coronally advanced flap with connective tissue graft (CTG), nonresorbable membranes, resorbable membranes, enamel matrix derivative, and platelet containing gel.[6] The coronally advanced flap (CAF) for treatment of gingival recession was first introduced by Norberg.[7] Following which various modifications were introduced amongst these techniques CAF + CTG is considered as gold standard in treatment of gingival recession.[4] However, harvesting of CTG requires a additional surgical site. Various biomaterials have been used along with CAF in treatment of gingival recession. One of the new materials which have also been tried recently includes placental membranes.[8] The placental membrane includes Amnion and Chorion. Both have shown encouraging results in various periodontal surgical procedures.[9] The Amniotic membrane is an allograft that is derived from human amniotic tissue. It is the innermost layer of fetal membrane and has thin epithelial layer, thick basement membrane and avascular stroma consisting mainly of collagen.[10] The Chorion forms the outer limits of the sac that encloses the foetus and is composed of different types of collagen, cell-adhesion bioactive factors. These are known to aid in the formation of granulation tissue by stimulating fibroblast growth and neovascularization. These properties suggest that a Chorion membrane may have considerable potential for regeneration.[11] Hence, this prospective, randomized controlled trial is planned to evaluate the efficacy of Chorion membrane with coronally advanced flap in treatment of Miller’s class I or class II gingival recession.

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