Joint Treatment of Non-Carious Cervical Lesions and Gingival Recessions (RCT)

Objectives: Gingival recession (GR) and concomitant non-carious cervical lesion (NCCL) inflict not only aesthetic concerns but also dentin hypersensitivity (DH). We aimed to evaluate a novel cervical filling combined with two types of periodontal plastic surgeries as a joint restorative and surgical therapy.
Methods: 20 patients (40 sites) of the Department of Periodontology, Semmelweis University Budapest were recruited with no signs of periodontitis but with split-mouth GR, NCCL, along with DH. Baseline parameters were recorded and following electronic randomisation the test sides (T) received a nanofilled resin-coated GIC (Fuji IX extra^®, G-Coat Plus^®) while the NCCL left unfilled at the controls (C). After second randomisation modified coronally advanced flap technique either with autologous connective tissue graft (MCAF-CTG), or with enamel matrix derivative (MCAF-EMD) were carried out on both sides. After the healing period of one year the following parameters were evaluated: DH; absolute GR height (AGRH); absolute GR width (AGRW); probing pocket depth (PPD); bleeding on probing (BOP); gingival crevicular fluid (GCF), etc.

Results: Every patient finished the trial without serious side effects. Both surgical techniques resulted in statistically significant (p<0.05) improvement on both T/C sides regarding AGRH and AGRW. In MCAF-CTG significantly increased BOP and PPD at T vs. C sites were detected gradually in 0-6-12 months. Significantly increased BOP and decreased DH at T vs. C sites were measured in MCAF-EMD group in 0-6 and 0-12 month interval. In addition MCAF-CTG showed significantly higher AGRH decrease, PPD increase at T and DH decrease at C, furthermore GCF increase at T/C sites compared to MCAF-EMD.

Conclusions: Both surgical techniques appear to be suitable for reducing GR with/without restorative therapy. MCAF-EMD alone may not be sufficient to alleviate DH. GIC covered by the nanofilled resin sealer seems to reduce DH but may cause increased risk of gingival inflammation, therefore subgingival extension is not recommended.