Healing of buccal gingival recessions following treatment with coronally advanced flap alone or combined with a cross-linked hyaluronic acid gel. An experimental study in dogs

Authors

• Yoshinori Shirakata ¹
• Toshiaki Nakamura ¹
• Yoshiko Kawakami ¹
• Takatomo Imafuji ¹
• Yukiya Shinohara ¹
• Kazuyuki Noguchi
• Anton Sculean ²

1. Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
2. Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland

Abstract

Aim. To clinically and histologically evaluate in dogs the healing of gingival recessions treated with coronally advanced flap (CAF) with or without cross-linked hyaluronic acid (HA).

Materials and Methods. Gingival recession defects were surgically created on the vestibular side of both maxillary canines in 8 dogs. After 8 weeks of plaque accumulation, the 16 chronic defects were randomly treated with either CAF alone or CAF and HA-gel (CAF/HA). Clinical and histological outcomes were evaluated at 10 weeks post-surgically

Results. Compared to baseline, the clinical measurements at 10 weeks revealed a statistically significant decrease in gingival recession for both CAF (p < 0.01) and CAF/HA (p < 0.001) groups. Statistically significant differences were found in clinical attachment level (p < 0.05) and width of gingival recession (p < 0.01) favouring the CAF/HA group. Bone formation was statistically significantly greater in the CAF/HA group than in the CAF group (1.84 ± 1.16 mm vs., 0.72 ± 0.62 mm, respectively, p < 0.05). Formation of cementum and connective tissue attachment were statistically significantly higher in the CAF/HA group compared with the CAF group (i.e. 4.31 ± 1.78 mm versus 2.40 ± 1.35 mm and 1.69 ± 0.98 mm versus 0.74 ± 0.68 mm, respectively (p < 0.05)).

Conclusions. The present data have for the first time provided histologic evidence for periodontal regeneration of gingival recession defects following treatment with CAF and HA.

Clinical relevance. The use of HA in conjunction with CAF may represent a novel modality for treating gingival recession defects.

Keywords: coronally advanced flap, gingival recession, histological investigation, hyaluronic acid, periodontal regeneration, root coverage