A Comparative Study of Modified Semilunar Coronally Advanced Flap and Coronally Advanced Flap in Clinical Practice for the Management of Multiple Gingival Recessions
Abstract
The objective of the present study was to compare the clinical outcomes between Coronally Advanced Flap (CAF) without Vertical Releasing Incisions (VRIs) and Modified Semilunar Coronally Advanced Flap (MSCAF) and to evaluate the patient centered outcome for CAF without VRIs and MSCAF using Visual Analog Scale (VAS). Ten systemically healthy patients (8 males and 2 female) with a mean age of 41.9 years (range 24-54 years) presented with 47 labial/buccal Miller class I gingival recession defects, were randomly assigned to CAF without VRIs or MSCAF. Clinical parameters assessed included recession height, recession width, probing depth, clinical attachment level, width of keratinized tissue, gingival thickness, full mouth plaque and gingival score. Clinical recordings were performed at baseline and 6 months later. Inter-measurements differences were analysed with a paired t-test, with significance set at α<0.05. Both techniques were effective in obtaining and maintaining a coronal displacement of the gingival margin. The CAF without VRIs resulted in significant clinical improvements better than MSCAF for percentage of root coverage (RC). A statistically significant difference between groups was demonstrated in terms of overall aesthetic result (P=0.01; S), root coverage (P=0.04; S) on visual analog scale. Six months results showed both techniques can be successfully used to treat Class I gingival recession. However, patient-centered outcomes, such as overall esthetic result and root coverage favoured CAF without VRIs therapy.
1. American Academy of Periodontology. Consensus report: mucogingival therapy. Ann Periodontol 1996;1:702-6.
2. Haghighat K. Modified semilunar coronally advanced flap. J Periodontol 2006;77:1274-9.
3. Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. II. Clinical results. Int J Periodontics Restorative Dent 1994;14:302-15.
4. Zucchelli G, de Sanctis M. Treatment of multiple gingival recession-type defects in patients with esthetic demands. J Periodontol 2000;71:1506-14.
5. Ozcelik O, Haytac MC, Seydaoglu G. Treatment of multiple gingival recessions using a coronally advanced flap procedure combined with button application. J Clin Periodontol 2011;38:572-80.
6. Zucchelli G, Mele M, Mazzotti C, et al. Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol 2009;80:1083-94.
7. Bernimoulin JP, Luscher B, Mühlemann HR. Coronally repositioned periodontal flap: clinical evaluation after one year. J Clin Periodontol 1975;2:1-13.
8. Wennström JL, Zucchelli G. Increased gingival dimensions: a significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study. J Clin Periodontol 1996;23:770-7.
9. Trombelli L, Scabbia A, Wikesjö UM, et al. Fibrin glue application in conjunction with tetracycline root conditioning and coronally positioned flap procedure in the treatment of human gingival recession defects. J Clin Periodontol 1996;23:861-7.
10. Harris RJ, Harris AW. The coronally positioned pedicle graft with inlaid margins: a predictable method of obtaining root coverage of shallow defects. Int J Periodontics Restorative Dent 1994;14:228-41.
11. Cetiner D, Aysen B, Ahu U. Expanded mesh connective tissue graft for the treatment of multiple gingival recessions. J Periodontol 2004;75:1167-72.
12. Rotundo R, Nieri M, Mori M, et al. Aesthetic perception after root coverage procedure. J Clin Periodontol 2008;35:705-12.
13. Modica F, Del Pizzo M, Roccuzzo M, et al. Coronally advanced flap for the treatment of buccal gingival recessions with and without enamel matrix derivative: a split-mouth study. J Periodontol 2000;71:1693-8.
14. Huang LH, Neiva RE, Soehren SE, et al. The effect of platelet-rich plasma on the coronally advanced flap root coverage procedure: a pilot human trial. J Periodontol 2005;76:1768-77.
15. Huang LH, Neiva RE, Wang HL. Factors affecting outcome of coronally advanced flap root coverage procedure. J Periodontol 2005;76:1729-34.
16. Wennström JL, Pini Prato GP. Mucogingival therapy. In: Lindhe J, Karring T, Lang NP, editors. Clinical periodontology and implant dentistry. Copenhagen: Munksgaard; 1997. p. 550-96.
17. Lins LH, de Lima AF, Sallum AW. Root coverage: comparison of coronally positioned flap with and without titanium-reinforced barrier membrane. J Periodontol 2003;74:168-74.
18. Santana RB, Mattos CML, Dibart S. A clinical comparison of two flap designs for coronal advancement of the gingival margin: semilunar versus coronally advanced flap. J Clin Periodontol 2010;37:651-8.
19. Marggraf E. A direct technique with a double lateral bridging flap for coverage of denuded root surface and gingival extension: clinical evaluation after 2 years. J Clin Periodontol 1985;12:69-76.
20. Bittencourt S, Ribeiro Edel P, Sallum EA, et al. Comparative 6-month clinical study of a semilunar coronally positioned flap and subepithelial connective tissue graft for the treatment of gingival recession. J Periodontol 2006;77:174-81.
21. Bittencourt S, Ribeiro Edel P, Sallum EA, et al. Root surface biomodification with EDTA for the treatment of gingival recession with a semilunar coronally repositioned flap. J Periodontol 2007;78:1695-701.
22. Spahr A, Haegewald S, Tsoulfidou F, et al. Coverage of Miller Class I and II recession defects using enamel matrix protein versus coronally advanced flap techniques: a 2-year report. J Periodontol 2005;76:1871-80.
23. Zucchelli G, de Sanctis M. Long-term outcome following treatment of multiple Miller Class I and II recession defects in esthetic areas of the mouth. J Periodontol 2005;76:2286-92.
24. Ainamo A, Bergenholtz A, Hugoson A, et al. Location of the mucogingival junction 18 years after apically repositioned flap surgery. J Clin Periodontol 1982;9:49-52.
25. Gartrell JR, Mathews D. Gingival recession: the condition, process, and treatment. Dent Clin North Am 1976;20:199-213.
26. Pini Prato G, Clauser C, Cortellini P, et al. Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal recessions: a 4-year follow-up study. J Periodontol 1996;67:1216-23.
27. Pini Prato G, Rotundo R, Franceschi D, et al. Fourteen-year outcomes of coronally advanced flap for root coverage: follow-up from a randomized trial. J Clin Periodontol 2011;38:715-20.
28. Baldi C, Pini Prato G, Pagliaro U, et al. Coronally advanced flap procedure for root coverage: is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol 1999;70:1077-84.
29. Hwang D, Wang HL. Flap thickness as a predictor of root coverage. J Periodontol 2006;77:1625-34.
30. Wood DL, Hoag PM, Donnenfeld OW, et al. Alveolar crest reduction following full and partial thickness flaps. J Periodontol 1972;43:141-4.
31. Santamaria MP, Feitosa DS, Nociti FH Jr, et al. Cervical restoration and the amount of soft tissue coverage achieved by coronally advanced flap: a 2-year follow-up randomized controlled clinical trial. J Clin Periodontol 2009;36:434-41.
32. Cairo F, Rotundo R, Miller PD, et al. Root coverage esthetic score: a system to evaluate the esthetic outcomes of the treatment of gingival recession through evaluation of clinical cases. J Periodontol 2009;80:705-10.
33. Dawn M, et al. Adaptive visual scale (AVAS): a modifiable software program for the creation, administration, and scoring of visual analog scales. Behav Res Methods 2009;41:91-106.
34. Kerner S, Borghetti A, Katsahian S, et al. A retrospective study of root coverage procedures using an image analysis system. J Clin Periodontol 2008;35:346-55.
2. Haghighat K. Modified semilunar coronally advanced flap. J Periodontol 2006;77:1274-9.
3. Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. II. Clinical results. Int J Periodontics Restorative Dent 1994;14:302-15.
4. Zucchelli G, de Sanctis M. Treatment of multiple gingival recession-type defects in patients with esthetic demands. J Periodontol 2000;71:1506-14.
5. Ozcelik O, Haytac MC, Seydaoglu G. Treatment of multiple gingival recessions using a coronally advanced flap procedure combined with button application. J Clin Periodontol 2011;38:572-80.
6. Zucchelli G, Mele M, Mazzotti C, et al. Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol 2009;80:1083-94.
7. Bernimoulin JP, Luscher B, Mühlemann HR. Coronally repositioned periodontal flap: clinical evaluation after one year. J Clin Periodontol 1975;2:1-13.
8. Wennström JL, Zucchelli G. Increased gingival dimensions: a significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study. J Clin Periodontol 1996;23:770-7.
9. Trombelli L, Scabbia A, Wikesjö UM, et al. Fibrin glue application in conjunction with tetracycline root conditioning and coronally positioned flap procedure in the treatment of human gingival recession defects. J Clin Periodontol 1996;23:861-7.
10. Harris RJ, Harris AW. The coronally positioned pedicle graft with inlaid margins: a predictable method of obtaining root coverage of shallow defects. Int J Periodontics Restorative Dent 1994;14:228-41.
11. Cetiner D, Aysen B, Ahu U. Expanded mesh connective tissue graft for the treatment of multiple gingival recessions. J Periodontol 2004;75:1167-72.
12. Rotundo R, Nieri M, Mori M, et al. Aesthetic perception after root coverage procedure. J Clin Periodontol 2008;35:705-12.
13. Modica F, Del Pizzo M, Roccuzzo M, et al. Coronally advanced flap for the treatment of buccal gingival recessions with and without enamel matrix derivative: a split-mouth study. J Periodontol 2000;71:1693-8.
14. Huang LH, Neiva RE, Soehren SE, et al. The effect of platelet-rich plasma on the coronally advanced flap root coverage procedure: a pilot human trial. J Periodontol 2005;76:1768-77.
15. Huang LH, Neiva RE, Wang HL. Factors affecting outcome of coronally advanced flap root coverage procedure. J Periodontol 2005;76:1729-34.
16. Wennström JL, Pini Prato GP. Mucogingival therapy. In: Lindhe J, Karring T, Lang NP, editors. Clinical periodontology and implant dentistry. Copenhagen: Munksgaard; 1997. p. 550-96.
17. Lins LH, de Lima AF, Sallum AW. Root coverage: comparison of coronally positioned flap with and without titanium-reinforced barrier membrane. J Periodontol 2003;74:168-74.
18. Santana RB, Mattos CML, Dibart S. A clinical comparison of two flap designs for coronal advancement of the gingival margin: semilunar versus coronally advanced flap. J Clin Periodontol 2010;37:651-8.
19. Marggraf E. A direct technique with a double lateral bridging flap for coverage of denuded root surface and gingival extension: clinical evaluation after 2 years. J Clin Periodontol 1985;12:69-76.
20. Bittencourt S, Ribeiro Edel P, Sallum EA, et al. Comparative 6-month clinical study of a semilunar coronally positioned flap and subepithelial connective tissue graft for the treatment of gingival recession. J Periodontol 2006;77:174-81.
21. Bittencourt S, Ribeiro Edel P, Sallum EA, et al. Root surface biomodification with EDTA for the treatment of gingival recession with a semilunar coronally repositioned flap. J Periodontol 2007;78:1695-701.
22. Spahr A, Haegewald S, Tsoulfidou F, et al. Coverage of Miller Class I and II recession defects using enamel matrix protein versus coronally advanced flap techniques: a 2-year report. J Periodontol 2005;76:1871-80.
23. Zucchelli G, de Sanctis M. Long-term outcome following treatment of multiple Miller Class I and II recession defects in esthetic areas of the mouth. J Periodontol 2005;76:2286-92.
24. Ainamo A, Bergenholtz A, Hugoson A, et al. Location of the mucogingival junction 18 years after apically repositioned flap surgery. J Clin Periodontol 1982;9:49-52.
25. Gartrell JR, Mathews D. Gingival recession: the condition, process, and treatment. Dent Clin North Am 1976;20:199-213.
26. Pini Prato G, Clauser C, Cortellini P, et al. Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal recessions: a 4-year follow-up study. J Periodontol 1996;67:1216-23.
27. Pini Prato G, Rotundo R, Franceschi D, et al. Fourteen-year outcomes of coronally advanced flap for root coverage: follow-up from a randomized trial. J Clin Periodontol 2011;38:715-20.
28. Baldi C, Pini Prato G, Pagliaro U, et al. Coronally advanced flap procedure for root coverage: is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol 1999;70:1077-84.
29. Hwang D, Wang HL. Flap thickness as a predictor of root coverage. J Periodontol 2006;77:1625-34.
30. Wood DL, Hoag PM, Donnenfeld OW, et al. Alveolar crest reduction following full and partial thickness flaps. J Periodontol 1972;43:141-4.
31. Santamaria MP, Feitosa DS, Nociti FH Jr, et al. Cervical restoration and the amount of soft tissue coverage achieved by coronally advanced flap: a 2-year follow-up randomized controlled clinical trial. J Clin Periodontol 2009;36:434-41.
32. Cairo F, Rotundo R, Miller PD, et al. Root coverage esthetic score: a system to evaluate the esthetic outcomes of the treatment of gingival recession through evaluation of clinical cases. J Periodontol 2009;80:705-10.
33. Dawn M, et al. Adaptive visual scale (AVAS): a modifiable software program for the creation, administration, and scoring of visual analog scales. Behav Res Methods 2009;41:91-106.
34. Kerner S, Borghetti A, Katsahian S, et al. A retrospective study of root coverage procedures using an image analysis system. J Clin Periodontol 2008;35:346-55.
| Files | ||
| Issue | Vol 64 No 8 (2026) | |
| Section | Original Articles | |
| Keywords | ||
| Gingival recession Multiple adjacent gingival recessions Coronally advanced flap Modified semilunar coronally advanced flap Root coverage Patient satisfaction. | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ram V, Uppor A, Kadakampally D. A Comparative Study of Modified Semilunar Coronally Advanced Flap and Coronally Advanced Flap in Clinical Practice for the Management of Multiple Gingival Recessions. Acta Med Iran. 2026;64(8):521-530.
