Introduction

Periodontal diseases that have evolved over the years and have transformed from periodontitis being considered an almost ubiquitous condition (Ramamurthy & Visha, 2018). Periodontal disease is a chronic inflammatory disease which is one of the major causes for tooth loss in adults (Avinash, Malaippan, & Dooraiswamy, 2017; Khalid, 2016; Mootha, Malaiappan, Jayakumar, Varghese, & Thomas, 2016; Ramesh, Ravi, & Kaarthikeyan, 2017; Varghese, 2015).

Periodontitis is characterised by a bacterial infection which leads to inflammation of the gums thereby destroying periodontal tissues and alveolar bone (Kumar & Varghese, 2019; Murthykumar, Arjunkumar, & Jayaseelan, 2019; Priyanka, 2017; Ramesh, Varghese, & Jayakumar, 2016). It also results in the breakdown of the collagen fibres of the periodontal ligament, resulting in the periodontal pocket between the gingiva and tooth (Khalid, 2016; Panda, 2014). Periodontal disease is as such a slowly progressing disease, but the tissue destruction is irreversible (Ravi, Malaiappan, Varghese, Jayakumar, & Prakasam, 2017). Historically treatment of periodontitis has been primarily directed at the elimination of causative factors and maintenance of a functional and healthy dentition (Kavarthapu & Thamaraiselvan, 2018; Ramesh, 2019; Thamaraiselvan, Elavarasu, Thangakumaran, Gadagi, & Arthie, 2015). Periodontal therapy includes both surgical and nonsurgical management of disease processes (Ramesh, 2016). Anatomical landmark consideration is essential during periodontal therapy (Kavarthapu et al., 2018).

Figure 1 X axis represents the Gingival Colour Score in the scale of 0, 1 and Y axis represents the number of cases; Blue Colour represents FGG (Free Gingival Graft); Green Colour represents CTG + Pouch and Tunnel Technique; Cream colour represents CTG (Connective tissue graft) and purple colour represents Laterally Displaced Flap). FGG had better Gingival Colour Score than other treatment modalities, however it is not statistically significant. Chi-square test- Pearson Chi-square value: 3.789, p value: 0.285 (p>0.05).

Figure 2 (X axis represents the Mucogingival Junction Alignment Score in the scale of 0,1; Y axis represents the number of cases; Blue Colour represents FGG(Free Gingival Graft); Green Colour represents CTG + Pouch and Tunnel Technique; Cream colour represents CTG (Connective tissue graft) and purple colour represents Laterally Displaced Flap).FGG had better Mucogingival Junction Alignment Score than other treatment modalities, however it is not statistically significant. Chi-square test, Pearson Chi-square value 0.883, p value 0.830 (p>0.05).

Figure 3 (X axis represents the Marginal Tissue Contour Score in the scale of 0,1; Y axis represents the number of cases; Blue Colour represents FGG( Free Gingival Graft); Green Colour represents CTG + Pouch and Tunnel Technique; Cream colour represents CTG (Connective tissue graft) and purple colour represents Laterally displaced flap). FGG had better Marginal Tissue Contour Score than other treatment modalities, however it is not statistically significant. Chi-square test,Pearson Chi-square value 1.587, p value 0.662(p>0.05).

Figure 4 (X axis represents the Soft Tissue Texture Score in the scale of 0,1; Y axis represents the number of cases; Blue Colour represents FGG (Free Gingival Graft); Green Colour represents CTG + Pouch and Tunnel Technique; Cream colour represents CTG (Connective tissue graft) and purple colour represents Laterally displaced flap). FGG had better Soft Tissue Texture Score than other treatment modalities, however it is not statistically significant. Chi-square test, Pearson Chi-square value 1.587, p value 0.662 (p>0.05).

Figure 5 (X axis represents the Gingival Margin Score in the scale of 0,3 and 6; Y axis represents the number of cases; Blue Colour represents FGG(Free Gingival Graft); Green Colour represents CTG + Pouch and Tunnel Technique; Cream colour represents CTG (Connective tissue graft) and purple colour represents Laterally displaced flap).FGG had better Gingival Margin Score than other treatment modalities, however it is not statistically significant. Chi-square test, Pearson Chi-square value 4.887, p value 0.558(p>0.05).

Figure 6 (X axis represents the Root Coverage % ranging 30%-100% ; Y axis represents the number of cases; Blue Colour represents FGG( Free Gingival Graft); Green Colour represents CTG + Pouch and Tunnel Technique; Cream colour represents CTG (Connective tissue graft) and purple colour represents Laterally displaced flap).FGG had better root coverage than other treatment modalities, however it is not statistically significant. Chi-square test, Pearson Chi-square value 4.887, p value 0.558(p>0.05).

The gingival recession defect is a primary esthetic concern. Management of recession defects is indicated for esthetic purposes, to overcome dentin sensitivity caused due to the root exposure and to increase the amount of keratinised tissue (‘Consensus report. Mucogingival therapy’, 1996). Most often the clinical outcomes following the management of recession defects are generally expressed in terms of percentage of root coverage and at times in terms of complete root coverage (Cairo, Pagliaro, & Nieri, 2008). Patients demand esthetic management has increased over the days; thus, the gingival recession coverage procedure should provide a soft tissue component which is comparable and indistinguishable from adjacent tissue .

Materials and Methods

In this retrospective study, 17 patients who had undergone root coverage for isolated gingival recession defects in the Department of Periodontics, Saveetha Dental College from June 2019 to March 2020 were assessed. Scores were given based on the RES to evaluate the esthetic outcome following recession coverage.

Inclusion Criteria

• Patient with an age group of 18-30 years.

• Patient with single tooth recession defects.

Exclusion Criteria

• Patients who did not report for follow up were excluded.

• Patients above the age of 30 or below 18 years were excluded.

• Patients with systemic diseases like diabetes, hypertension, cardiovascular diseases.

• Patients who are current and former smokers.

• Patients who underwent any dental treatments in the past six months.

Statistical Analysis

All the data were included in SPSS software IBM version 23.0. The chi-square test was used to analyse the association between RES and various surgical procedures for recession defect. Also, the association between recession coverage and different recession coverage procedures was analysed. A P-value of less than 0.05 was considered statistically significant.

Results and Discussion

The current study showed no statistical difference (p>0.05) between RES score and various treatment modality available for recession coverage (Table 1). There was no significant(p>0.005) association among postoperative gingival colour score, mucogingival junction alignment score, marginal tissue contour score, soft tissue texture score, gingival margin score and root coverage in percentage and various treatment modalities available for recession coverage as shown in Figure 6; Figure 5; Figure 4; Figure 3; Figure 2; Figure 1.

Esthetic satisfaction following root coverage procedure is most often seldom investigated in clinical trials (Aichelmann-Reidy, Yukna, Evans, Nasr, & Mayer, 2001; Wang, 2001). Esthetic evaluation is more subjective. Thus, esthetic assessment can be useful in the evaluation of recession coverage outcomes.

Present study results showed no statistical significance between RES, Root coverage vs various treatment modalities used for recession coverage. Evidence (Cairo, 2009) report that coronally advanced flap for recession coverage had better root coverage and RES compared to other treatment modalities which were contradictory to the present study were Free Gingival Graft had better root coverage and RES score this would be because of the difference in the ethnic group as well due to less sample size in the present study.

(Prato, Baldi, Nieri, & Franseschi, 2005) showed that there was 100% recession coverage with coronally advanced flap. In contrast, the same results were not obtained in the present study; this could be because of the clinical case selection as well as surgical techniques used.

(Wennstrom & Zucchelli, 1996) in their study also showed that free gingival graft had lower recession coverage among all the recession coverage procedures whereas in our present study free gingival graft showed to have better results though it was statistically not significant.

The limitation of the present study was that it had a limited sample size, short term follow up. Hence extensive research should be done with long term follow up and by including other parameters that assess the effectiveness of various treatment modalities of isolated recession defects.

Conclusion

Free Gingival Graft showed better root coverage and recession esthetic score (RES); however, there was no significant association among root coverage, RES and various treatment modalities used for recession coverage (p>0.05). Thus, future studies need to be assessed in larger sample size as well as standardized esthetic outcome measures are required to evaluate recession esthetic scores.

Conflict of Interest

The authors declare that they have no conflict of interest for this study.

Funding Support

The authors declare that they have no funding support for this study.