J Periodontol • April 2007

Coronally Positioned Flap for Treatment

of Restored Root Surfaces: A 6-Month
Clinical Evaluation
Juliana Antico Lucchesi,* Vanessa Renata Santos,* Cristiane Mariote Amaral,†
Daiane Cristina Peruzzo,‡ and Poliana Mendes Duarte*

Background: The aim of this study was to evaluate clinically

the treatment of gingival recession associated with non-carious
cervical lesions (NCCLs) by resin modified glass ionomer ce-
ment (RMGI) or microfilled resin composite (MRC) and coro-

T
nally positioned flap (CPF) at 6 months following surgery. he exposure of root surfaces be-
Methods: Fifty-nine patients were assigned to one of three cause of gingival recession may
treatments: root exposure without NCCL treated with CPF result in tactile and thermal sensi-
(group 1); root exposure with NCCL treated with RMGI resto- tivity, esthetic complaints,1 and root
ration plus CPF (group 2); or root exposure with NCCL treated surface carious lesions.2 Numerous lon-
with MRC restoration plus CPF (group 3). Clinical measure- gitudinal human studies demonstrated
ments that were assessed at baseline and at 3 and 6 months the efficacy and predictability of different
after surgery included plaque index (PI), bleeding on probing techniques to correct gingival recession
(BOP); probing depth (PD), recession reduction (RR), clinical esthetically and functionally.3 Among
attachment level gain (CALG), keratinized tissue height (KTH), these techniques, the coronally posi-
keratinized tissue thickness (KTT), percentage of root cover- tioned flap (CPF), solely or combined
age (RC), and percentage of restored root coverage (RRC). with other procedures, e.g., subepithelial
Results: Intra- and intergroup analyses demonstrated no connective tissue graft (SCTG), has
significant differences in PI, BOP, PD, RR, CALG, KTH, or been one of the most widely used pro-
KTT (P >0.05) among the groups at any time. At 6 months, cedures in the treatment of Miller Class I
the mean RC was 80.83% – 21.08% for group 1; the mean gingival recessions.4-6
RRCs were 71.99% – 18.69% and 74.18% – 15.02% for groups Factors such as bone height, biotype
2 and 3, respectively. There were no statistically significant of gingival tissue, and anatomy of the ex-
differences in RRC between groups 2 and 3. posed root surface can have a negative
Conclusion: All treatments showed root coverage improve- impact on the degree of root coverage
ment without damage to periodontal tissues, supporting the after a periodontal plastic surgical proce-
use of CPF for treatment of root surfaces restored with RMGI dure.7 In some situations, the exposed
or MRC as being effective over the 6-month period. J Periodon- root surface can exhibit irregularities
tol 2007;78:615-623. and grooves, caries, resorption, or non-
carious cervical lesions (NCCLs).8 These
KEY WORDS
anatomical root surface presentations
Flap; glass ionomer; resin. can impair the mechanical planing that
is done prior to the surgical procedure
for root coverage; however, root planing
* Department of Periodontics, Dental Research Division, Guarulhos University, Guarulhos,
São Paulo, Brazil. is one of the fundamental steps in the root
† Department of Restorative Dentistry, Dental Research Division, Guarulhos University. coverage procedure to smooth irregular-
‡ Department of Prosthodontics and Periodontics, Division of Periodontics, School of
Dentistry at Piracicaba, State University of Campinas, São Paulo, Brazil. ities and grooves and to reduce the con-
vexity of the root.9
NCCLs, classically referred to as abra-
sion, erosion, or abfraction, frequently
can extend apically underneath the
free gingival margin. Based on its etiol-
ogy and severity, the most common

doi: 10.1902/jop.2007.060380

615
Coronally Positioned Flap for Restored Root Surfaces
therapies for an NCCL remain occlusal adjustment,
toothbrushing instructions, and/or restorative proce-
dures.10 Among the alternatives to NCCL restora-
tions, esthetic materials, such as resin ionomer
and composite resin, have become the most com-
monly used materials.11,12 These conventional re-
storative techniques result in protection against
further loss of tooth structure and sensitivity; however,
they may not meet the esthetic demands of the
patients (relative to the length of the tooth or teeth
involved).
In this context, an ideal therapeutic procedure for
the treatment of gingival recession associated with
an NCCL has presented a challenge to clinicians. The
high efficacy and predictability of the CPF were
demonstrated in the treatment of intact exposed roots
that were suitable for planing to achieve flattened
surfaces.4-6
Information regarding the outcome of mucogingi-
val procedures on carious or restored root surfaces
is scarce. Thus, the aim of this study was to evaluate
clinically the treatment of gingival recession associated
with NCCL with resin modified glass ionomer cement
(RMGI) or microfilled resin composite (MRC) plus
CPF at 6 months following surgery.
MATERIALS AND METHODS
Patient and Site Selection
Fifty-nine non-smoking, non-pregnant or -lactating,
periodontally and systemically healthy subjects from
the Periodontics Department of Guarulhos University
were enrolled in this study in 2005 and 2006. The fol-
lowing inclusion criteria were used: 1) 39 subjects
positive for the presence of one Miller Class I gingival
recession defect (‡2 and £5 mm) associated with
buccal NCCL (abfraction, erosion, or abrasion) in up-
per canines or premolars; 2) 20 subjects with one
Miller Class I gingival recession defect (‡2 and
£5 mm) with absence of buccal NCCL in upper
canines or premolars; 3) keratinized tissue height
(KTH) ‡2 mm; 4) probing depth (PD) £2 mm; 5) ab-
sence of caries or restorations in the area to be trea-
ted; 6) absence of pulpal pathology and severe
occlusal interferences in the teeth to be treated; 7) ra-
diographic evidence of sufficient interdental bone;
8) full-mouth plaque index (PI)13 and full-mouth
bleeding on probing (BOP) index scores £20%;13 9)
absence of previous mucogingival surgery at the
defect; and 10) dental hypersensitivity or impaired
esthetics associated with the recession.
Patients were informed of the nature of the study
and gave their written consent to the described proce-
dures. The study protocol was approved by the Insti-
tutional Committee of Ethics in Dental Research
(CAAE-0071.0.132.000-05).
616
Volume 78 • Number 4
Experimental Design
This study used a prospective, parallel, and random-
ized clinical design. Each subject was assigned to one
of the following three groups: group 1 (control group;
N = 20): root exposure without NCCL treated with
CPF; group 2 (test group; N = 20): root exposure as-
sociated with NCCL treated with RMGI plus CPF; and
group 3 (test group; N = 19): root exposure with NCCL
treated with MRC plus CPF.
Restorative Procedures
Initial therapy included dental scaling, polishing, and
occlusal adjustment as indicated. All patients were in-
structed to use a non-traumatic brushing technique
(coronally directed roll technique) with a soft tooth-
brush.
At the beginning of the restorative appointment, the
NCCLs were assigned randomly to one of the two test
groups by tossing a coin. Initially, isolation was car-
ried out using a rubber dam. For both test groups, den-
tin and enamel were etched using 35% phosphoric
acid gel§ for 15 seconds, rinsed for 10 seconds, and
the excess moisture blotted. Cavities in group 2 were
filled with RMGIi after primer application and light-
cured for 60 seconds. Lesions in group 3 were filled
with an adhesive,¶ applied according to the manufac-
turer’s instructions, and MRC# (Figs. 1 and 2). Each
restoration was finished grossly with a tapered, mul-
tifluted, carbide finishing bur under abundant water
irrigation. Final contouring and finishing were ac-
complished with progressively finer grit aluminum
oxide disks.** All restorative procedures were per-
formed by the same operator (operative dentist).
CPF
Two weeks after the restorative appointment, the
patients underwent CPF procedures performed by
a second operator (periodontist). A single dose of
dexamethasone (4 mg) was given 1 hour before sur-
gery. At the beginning of the surgical appointment,
the root surfaces of the control group were planed
thoroughly with periodontal manual curets, high-speed
fine carbide burs, and low-speed fine diamond burs
until a smooth surface was achieved.
After local anesthesia (2% lidocaine with 1:100,000
epinephrine), a sulcular incision was made at the buc-
cal aspect, and two horizontal incisions were made at
right angles to the adjacent papillae. Subsequently,
two divergent oblique incisions at the mesial and distal
aspects of the recession, extending apically beyond
the mucogingival junction (MGJ), completed a trape-
zoidal flap design. A periosteal elevator was used to
§ 3M ESPE, St. Paul, MN.
i Vitremer, 3M ESPE.
¶ Single Bond, 3M ESPE.
# Durafill VS, Heraeus Kulzar, Armonk, NY.
** Soflex Disks, 3M ESPE.
J Periodontol • April 2007 Lucchesi, Santos, Amaral, Peruzzo, Duarte

Figure 1. Figure 3.
Initial appearance of a gingival recession associated with an NCCL To perform CPF, an initial full-thickness flap was reflected and a
on the right maxillary canine. split-thickness flap was dissected to release any tissue tension.
The papillae adjacent to the involved tooth were deepithelialized.

Figure 2.
The exposed root with NCCL was treated with an MRC restoration.
Figure 4.
The flap was displaced coronally, covering the recessions, and fixed
carefully reflect an initial full-thickness flap. After this with non-resorbable sutures.
point, a split-thickness flap was dissected mesially,
distally, and apically, as necessary, to release any
tissue tension. The papillae adjacent to the involved
The following parameters were assessed on the
tooth were deepithelialized. The flap was displaced
buccal aspect of all study teeth at baseline (initial ther-
coronally, completely covering the recession (with
apy session) and 3 and 6 months after the surgeries:
or without restoration), and fixed with a non-resorb-
1) local PI: presence (1) or absence (0) assessed us-
able suture and a mattress sling suturing technique.
ing a manual periodontal probe;13 2) local BOP: pres-
Finally, interrupted sutures were placed at the vertical
ence (1) or absence (0) of bleeding up to 15 seconds
incisions to facilitate tissue stabilization (Figs. 3 and
after gentle probing;13 3) PD: distance between the
4). No periodontal dressing was used. Chlorhexidine
gingival margin (GM) and the bottom of the gingival
gluconate (0.12%) mouthwash was prescribed twice
sulcus; 4) relative recession height (rRH): distance
a day for 2 weeks, and analgesics were prescribed
between a fixed landmark (stent) and the most apical
to control postoperative discomfort. The sutures were
point of the GM; 5) relative clinical attachment level
removed after 10 days. Follow-up was monthly until
(rCAL): distance between a fixed landmark (stent)
6 months.
and the bottom of the gingival sulcus; 6) KTH: dis-
Clinical Parameters tance between the most apical extension of the GM
The clinical parameters were assessed by the same and the MGJ, chemically disclosed with a Schiller’s
second operator (periodontist), who was trained, cali- iodine solution; and 7) keratinized tissue thickness
brated (SE = 0.014), and blinded to the restorative (KTT): measured at a mid-point location between
material used in the test groups. the GM and MGJ by inserting a University of North

617
Coronally Positioned Flap for Restored Root Surfaces
Carolina (UNC)†† probe into the tissue and recording
to the nearest 0.5 mm. At the same visits, recession
height (RH), the distance between the cemento-
enamel junction and the most apical point of the
GM, was obtained only from the control group.
At baseline, the following measurements of the
NCCL were obtained by means of a digital gauge: le-
sion height (LH): distance between the most coronal
and the most apical points of the NCCL, always coin-
cident with the GM; NCCL depth (LD); and NCCL
width (LW).
The assessed clinical parameters were used to ob-
tain recession reduction (RR): calculated as preoper-
ative rRH - postoperative rRH for all experimental
groups; clinical attachment level gain (CALG): calcu-
lated as preoperative rCAL - postoperative rCAL for
all experimental groups; percentage of root coverage
(RC): calculated as ([preoperative RH - postoperative
RH]/preoperative RH) · 100 for the control group; and
percentage of restored root coverage (RRC): calcu-
lated as (100 · RR)/LH for test groups.
Periodontal measurements were performed with a
UNC manual probe.‡‡ An individual reference acrylic
stent was used as a reference point for clinical param-
eters because the cemento-enamel junction was
identifiable in the test groups. In addition, after the re-
storative procedures, the most coronal point of the
NCCL also became identifiable. Finally, the stents as-
sured reproducibility of probe positions and angula-
tions among evaluations.
Statistical Analysis
Data were analyzed using statistical software.§§ii
The significance level established for all analyses
was 5% (P <0.05).
First, the Kolmogorov-Smirnov test was used to
evaluate the normality of the data. The frequency of
detection of BOP (1) and PI (1) was determined for
each group. The statistical significance of the differ-
ences for BOP (1) and PI (1) over time within each
group and among the different groups within each
time point was evaluated by x2 test and Fisher test.
Intergroup analysis by Kruskal-Wallis test was used
to test the hypothesis that treatments had no influence
on RR, CALG, and KTT, and two-way analysis of
variance (ANOVA) was used to test the hypothesis
that the treatments did not influence PD and KTH. In
addition, an intragroup analysis by repeated mea-
sures ANOVA was performed to evaluate changes
in the mean PD, KTT, and KTH and the Mann-Whitney
test was used to evaluate changes in the mean RR
and CALG over time. Inter- and intragroup analyses
for RRC between test groups were evaluated by
Mann-Whitney and Wilcoxon tests. Finally, the t test
was performed to compare LH, LD, and LW at base-
line.
618
Volume 78 • Number 4
RESULTS
Fifty-nine patients, 44 females and 15 males aged 23
to 65 years (mean age, 44.66 – 13.01 years), were in-
cluded in the present study. Fifty-nine maxillary Miller
Class I gingival recession defects, one from each pa-
tient, were treated: four right canines, six left canines,
17 right first premolars, six right second premolars, 18
left first premolars, and eight left second premolars.
The means – SD for LH, LD, and LW were 2.9 –
0.36 mm, 1.2 – 0.38 mm, and 4.1 – 0.36 mm, respec-
tively for group 2 and 2.7 – 0.50 mm, 1.2 – 0.32 mm,
and 3.8 – 0.37 mm, respectively for group 3. No
statistically significant differences were detected be-
tween the dimensions of the lesions at baseline
(P >0.05).
The mean values (– SD) of the common clinical pa-
rameters for all three experimental groups at baseline
and 3 and 6 months are summarized in Table 1. No
statistically significant differences in PD, KTT, or KTH
(P >0.05) were observed among the groups. In addi-
tion, the mean RR and mean CALG at 3 months were
similar for all treatment groups and remained un-
changed at the 6-month follow-up (P >0.05).
Restorative procedures did not allow an increase in
tissue inflammation or plaque accumulation. No sig-
nificant changes (P >0.05) in the frequencies of PI (1)
and BOP (1) were observed among the groups at any
time. Table 2 shows the number of sites with PI (1) and
BOP (1) for each treatment at each time.
The mean RC for group 1 was 80.83% – 21.08% at 3
and 6 months. The mean RRCs for group 2 were
72.99% – 17.02% and 71.99% – 18.69% at 3 and 6
months, respectively. The mean RRCs for group 3
were 75.50% – 16.40% and 74.18% – 15.02% at 3
and 6 months, respectively. The difference between
test groups was not statistically significant at any
time. After 3 and 6 months, 11 sites (55%) in group
1 achieved complete RC. After 3 months, three sites
(15%) in group 2 and four sites (21%) in group 3
achieved complete RRC. After 6 months, three sites
(15%) in group 2 and three sites (15.8%) in group 3
achieved complete RRC. The percentages of reces-
sion or recession/filling coverage are given in Table
3. Figure 5 illustrates the clinical findings in group 3
at 6 months. Figures 6 and 7 illustrate, respectively,
the initial appearance of a gingival recession associ-
ated with NCCL on a left maxillary canine and its ap-
pearance 6 months after RMGI restoration plus CPF
(group 2). Figures 8 and 9 illustrate, respectively,
the initial appearance of a gingival recession without
NCCL on a left maxillary canine and its appearance 6
months after CPF (group 1).
†† Hu-Friedy, Chicago, IL.
‡‡ Hu-Friedy.
§§ SAS (Statistical Analysis Software), SAS Institute, Cary, NC.
ii BioEstat 4.0, Sociedade Civil Marirauá, BR.
J Periodontol • April 2007 Lucchesi, Santos, Amaral, Peruzzo, Duarte

Table 1.
Clinical Parameters at Baseline and at 3 and 6 Months Postoperatively

Group 1 Group 2 Group 3

Clinical Parameter 0 Months 3 Months 6 Months 0 Months 3 Months 6 Months 0 Months 3 Months 6 Months

PD (mm) 1.4 – 0.5 1.3 – 0.6 1.2 – 0.5 1.5 – 0.5 1.4 – 0.5 1.4 – 0.5 1.3 – 0.5 1.4 – 0.8 1.3 – 0.6

KTT (mm) 0.93 – 0.34 0.90 – 0.31 0.88 – 0.28 0.83 – 0.37 0.90 – 0.38 0.93 – 0.37 0.92 – 0.25 0.92 – 0.25 0.92 – 0.25
KTH (mm) 3.18 – 0.91 3.05 – 0.76 3.40 – 0.94 3.58 – 0.94 3.55 – 0.94 3.70 – 0.98 3.37 – 1.01 3.05 – 0.71 3.32 – 0.82
RR (mm) – 2.2 – 0.7 2.2 – 0.7 – 2.15 – 0.59 2.1 – 0.64 – 2.3 – 0.67 2.15 – 0.56

CALG (mm) – 2.4 – 1.0 2.4 – 1.0 – 2.2 – 1.0 2.2 – 1.0 – 2.3 – 0.8 2.2 – 0.7
– = no data available for this time.
No intergroup statistical differences for RR, CALG, or KTT determined by Kruskal-Wallis and Dunn tests (a = 0.05) and for PD and KTH determined by two-
way ANOVA (a = 0.05).
No intragroup statistical differences for PD, KTT, or KTH determined by repeated measures ANOVA and for RR and CALG determined by Mann-Whitney test
over time (a = 0.05).

Table 2.
Number of Sites With BOP or Plaque Accumulation Over Time

Group 1 (RC) (N = 20) Group 2 (RRC) (N = 20) Group 3 (RRC) (N = 19)

Clinical Parameter 0 Months 3 Months 6 Months 0 Months 3 Months 6 Months 0 Months 3 Months 6 Months

PI 12 7 8 12 12 11 12 13 10
BOP 7 0 0 4 0 1 3 0 2
2
No statistically significant differences, within each column or row, found by x and Fisher tests (a = 0.05).

Table 3.
Recession or Recession/Filling Coverage For All Experimental Groups at 3 and
6 Months Postoperatively

Group 1 (RC) (N = 20) Group 2 (RRC) (N = 20) Group 3 (RRC) (N = 19)

Root or Lesion Coverage (%) 3 Months 6 Months 3 Months 6 Months 3 Months 6 Months

100% 11 11 3 3 4 3
‡60% to <100% 6 6 11 10 11 12

<60% 3 3 6 7 4 4

DISCUSSION The percentage of coverage of a previously ex-

When a root exposure is associated with an NCCL, the
cosmetic component of the surgical or restorative
procedure may not be successful, especially in api-
cally extensive lesions. Therefore, to solve problems
of sensitivity and esthetics simultaneously, a com-
bined restorative-surgical therapy was proposed for
the treatment of gingival recession associated with
an NCCL. Treatment effectiveness was determined
as a function of RRC and periodontal tissue health
at 3 and 6 months after the surgical procedures.
posed root surface is the primary clinical outcome
used to evaluate the effectiveness of a mucogingival
procedure. The CPF is a predictable procedure to
achieve root coverage in Miller Class I mucogingival
defects.4,14,15 In the present study, the RC in the con-
trol group (80.83%) confirmed the predictability of
the CPF on the intact root surface. Recently, Goldstein
et al.16 demonstrated that CPF, combined with SCTG,
also was a very predictable procedure for the treat-
ment of previously carious root, with results similar

619
Coronally Positioned Flap for Restored Root Surfaces Volume 78 • Number 4

Figure 5.
MRC (group 3) at 6 months.

Figure 8.
Initial appearance of a gingival recession without NCCL on the left
maxillary canine. The mucogingival tissue was disclosed chemically
with a Schiller’s iodine solution.

Figure 6. In an NCCL, the enamel breaks away at the cervical

Initial appearance of a gingival recession associated with an NCCL
on the left maxillary canine.
Figure 7.
Clinical findings of group 2 (RMGI) at 6 months.
to those found in intact roots. However, this is the first
prospective and randomized clinical study in which
RMGI or MRC was placed over the root surface, before
grafting, to fill an NCCL.
margin, progressively exposing the dentine, extend-
ing to the root surface, and making the cemento-
enamel junction identifiable.10 In the present study,
based on the anatomical aspects of a root surface as-
sociated with an NCCL, RRC was considered for test
groups instead of RC. Therefore, it was not statistically
appropriate to compare the percentages of coverage
between control and test groups. Considering only
test groups, the healing patterns were quite similar.
After 3 and 6 months, although few sites achieved
total lesion coverage, the mean lesion coverage for
RMGI- or MRC-restored teeth was high (72.99%
and 75.5%, respectively). Because the most coronal
point of the NCCL probably is higher than the
cemento-enamel junction, a smaller percentage of
tooth/restoration coverage and a reduced number
of sites exhibiting complete coverage were expected
in test groups than the control group. However, con-
sidering the mean RR, the CPF effectiveness for cov-
erage of previously restored root surfaces was similar
to that of an intact root. Taken together, these findings
indicated that the presence of RMGI or MRC is not a
negative predictor for CPF success. Our RMGI data
are in agreement with Alkan et al.8 in a single case re-
port, in which SCTG was used successfully to treat

620
J Periodontol • April 2007
Figure 9.
Results of group 1 (control) at 6 months.
gingival recession associated with a glass ionomer–
restored root surface.
Because the periodontal flap was displaced coro-
nally, covering RMGI or MRC restorations, it can be as-
sumed that all fillings had their apical border placed
in a subgingival location. Although some studies re-
ported that subgingival restorations are harmful to
gingival health,17,18 data from this study revealed that
the fillings do not produce greater gingival inflam-
mation and plaque accumulation compared to the
control group. These contradictory findings prob-
ably are related to the fact that all patients performed
optimal plaque control, and the restorations were
carried out on the buccal aspects of the teeth, where
oral hygiene procedures are facilitated. Furthermore,
the restorative materials and technique variables
were controlled precisely, and restorations were con-
toured and finished accurately; these procedures are
essential to avoid gingival inflammation and plaque
accumulation.17-19 Finally, it is important to empha-
size that, in the current study, the most apical mar-
gin of the restored lesion was always ‡3 mm from
the alveolar crest (Fig. 3). Various investigators have
long proposed that 3.0 mm is the minimum distance
that restorative margins must be from the bone crest
to avoid deleterious effects to periodontal tissue.20,21
A periodontal plastic procedure is successful when
the gingival margin is at the cemento-enamel junc-
Lucchesi, Santos, Amaral, Peruzzo, Duarte
tion, it provides a sulcus depth £2 mm, there is the
presence of clinically attached gingiva, and no BOP
is present at the treated sites.22 In the present study,
shallow PDs were observed consistently in all groups
at 3 and 6 months. These data indicated that the CPF
was associated with CALG on the restored surfaces
during the observed periods. Dragoo23 demonstrated
histologic evidence that epithelium and connective
tissue can adhere to resin ionomer when placed in
a subgingival environment. However, at this stage,
caution should be used; further studies are required
to determine whether RMGI and MRC exhibit similar
histologic characteristics.
Initial KTT and KTH have been proposed as essen-
tial anatomical factors associated with complete root
coverage in a CPF procedure.14 Thus, KTT and KTH
also were evaluated at baseline and at 3 and 6 months.
At baseline, there were no significant differences in
KTH or KTT among the groups. This demonstrated
similar initial gingival tissue conditions among the
groups. In addition, KTH and KTT remained unchanged
at 3 and 6 months after surgery, suggesting that RMGI
or MRC may not jeopardize these gingival features.
It is important to emphasize that RMGI and MRC ex-
hibit some properties that are useful in addressing the
results found in the present study. For example, resin
ionomer materials have many properties that allow
them to be used in the subgingival location.23-25 RMGI
demonstrated biocompatibility with hard and soft tis-
sues,26,27 high marginal adaptation, reduced surface
roughness,27 and fluoride release.28 Therefore, when
taken together, RMGI’s properties may result in less
leakage and lower retention of microorganisms that
are able to cause periodontal injury and jeopardize
periodontal healing. Although the RMGI¶¶ used in the
present study demonstrated cytotoxicity in vitro be-
cause of the release of high amounts of 2-hydroxy-
ethyl-methacrylate,29,30 local irritation and damage
to the periodontal healing pattern were not observed.
Various factors can determine the biocompatibility
of a resin-based material, such as the amount and
nature of leachable components and the surface
structure of the final restoration.31 Textural character-
ization after finishing and polishing is the major ad-
vantage of MRC that could lead to a lower plaque
adherence and minimal soft tissue inflammation.32
In addition, monomer–polymer conversion is a very
important aspect of the biocompatibility of a resin
restoration, because it can influence the release of
toxic components significantly.33 Therefore, an opti-
mum polymerization is essential for the cytocompat-
ibility of resin materials. In the present study, the
control of restorative techniques, such as rubber
dam isolation, controlled light-curing time, and lesion
¶¶ Vitremer, 3M ESPE.
621
Coronally Positioned Flap for Restored Root Surfaces
depth (1.2 – 0.32 mm), may have favored an opti-
mum MRC polymerization and the absence of cyto-
toxicity.
In the present study, all treatments showed root
coverage improvement without damage to periodon-
tal tissues, supporting the use of CPF for treatment of
root surfaces restored with RMGI or MRC as being
effective over a 6-month period. Because the true
benefits for the patient are improved esthetics and
the stability of the results over time, it is relevant to
evaluate whether these successful outcomes remain
stable. It is important to consider the patient’s tooth-
brushing technique for the long-term maintenance
of the clinical outcomes achieved by any root cover-
age surgical procedure.34 In addition, a prospective
study17 of 26 years demonstrated that a pathogenic
periodontal process may develop slowly and take
1 to 3 years to be detected clinically. Therefore,
whether and to what extent these restorations will in-
fluence the periodontal tissue negatively, considering
the material deterioration, also must be observed in
longitudinal evaluations.
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Correspondence: Dr. Poliana Mendes Duarte, Rua Dr. Nilo
Pecxanha, n. 67 - Prédio U - 6! Andar - Centro, Guarulhos,
07.023-070 SP, Brazil. Fax: 55-11-64641758; e-mail:
poliduarte@yahoo.com or pduarte@ung.br.
Accepted for publication October 30, 2006.
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