Reliability and accuracy analysis of root coverage esthetic score

doi:10.3969/j.issn.1674-8115.2022.05.007

Abstract

Abstract: Objective

· To evaluate the reliability and accuracy of the root coverage esthetic score (RES) in clinical applications by comparing RES and the visual analogue scale (VAS) results after root coverage procedures.

Methods

· Thirty-two patients who visited the Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January to December 2020 with a total of 105 gingiva recessions were enrolled in this study. All gingiva recessions were treated with envelope technique combined with connective tissue graft (CTG). The patients' periodontal conditions were examined 6 months after surgery and the esthetic results were scored by 2 periodontists through RES and patients themselves through VAS. Intraclass correlation coefficient (ICC) and 95% confidence interval (95% CI) were used to represent the consistency of physician RES results. The differences of keratinized gingiva (KG) and gingival recession (GR) at baseline and 6 months after surgery were compared by using t-test. Analysis of variance was used to test the differences of each index among different VAS grades. Linear regression analysis was used to evaluate the relationship between percentage of root coverage (PRC) and VAS, RES and VAS. Multiple linear regression analysis was carried out with VAS as the outcome variable and 5 indexes of RES as independent variables. All tests were bilateral tests. The difference was statistically significant when P<0.05.

Results

·In this study, KG increased by (1.19 ± 1.28) mm and GR decreased by (1.77±1.21) mm 6 months after surgery. The average PRC was 81.4%±39.9%, and the percentage of complete root coverage (PCRC) was 69.5%. There was no significant difference between the RES scores of the 2 periodontists (ICC=0.95, 95%CI 0.92?0.96). KG (P=0.008), PRC(P=0.000) and PCRC (P=0.000) varied significantly between different VAS grades. The RES and VAS scores were linearly correlated (P=0.000). Multiple linear regression analysis showed that VAS scores were linearly correlated with gingival margin (GM), soft tissue texture (STT) and muco-gingival junction (MGJ) (P=0.000, P=0.000,P=0.006).

Conclusion

· To a certain extent, the results of RES are consistent with the patient's esthetic judgment.

Key words: root coverage procedure, envelop technique, connective tissue graft, root coverage esthetic score, visual analogue scale

CLC Number:

R781.4

SUN Wentao, XIE Yufeng, SHU Rong. Reliability and accuracy analysis of root coverage esthetic score[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(5): 602-608.

Figures/Tables 7

TrendMD

References 20

1	AGUSTÍN Z J. Glossary of periodontal terms[J]. Rev ADM, 1990, 47(6): 350-358.
2	GRAZIANI F, GENNAI S, ROLDÁN S, et al. Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions[J]. J Clin Periodontol, 2014, 41: S63-S76.
3	CAIRO F, ROTUNDO R, MILLER P D, et al. Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases[J]. J Periodontol, 2009, 80(4): 705-710.
4	FÜRHAUSER R, FLORESCU D, BENESCH T, et al. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score[J]. Clin Oral Implants Res, 2005, 16(6): 639-644.
5	WESSELS R, DE ROOSE S, DE BRUYCKERE T, et al. The Mucosal Scarring Index: reliability of a new composite index for assessing scarring following oral surgery[J]. Clin Oral Investig, 2019, 23(3): 1209-1215.
6	U.S. Department of Health and Human Services FDA Center for Drug Evaluation and Research; U.S. Department of Health and Human Services FDA Center for Biologics Evaluation and Research; U.S. Department of Health and Human Services FDA Center for Devices and Radiological Health. Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance[J]. Health Qual Life Outcomes. 2006, 11(4):79.
7	ISAIA F, GYURKO R, ROOMIAN TC, et al. The root coverage esthetic score: intra-examiner reliability among dental students and dental faculty[J]. J Periodontol, 2018, 89(7): 833-839.
8	MILLER P D, A classification of marginal tissue recession[J]. Int J Periodont Rest, 1985, 5(2): 8-13.
9	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]. J Periodontol, 2009, 80(7): 1083-1094.
10	LANDIS J R, KOCH G G. The measurement of observer agreement for categorical data[J]. Biometrics, 1977, 33(1): 159-174.
11	CAIRO F, CORTELLINI P, PILLONI A, et al. Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial[J]. J Clin Periodontol, 2016, 43(10): 849-856.
12	ZUCCHELLI G, MARZADORI M, MOUNSSIF I, et al. Coronally advanced flap + connective tissue graft techniques for the treatment of deep gingival recession in the lower incisors. A controlled randomized clinical trial[J]. J Clin Periodontol, 2014, 41(8): 806-813.
13	MOUNSSIF I, STEFANINI M, MAZZOTTI C, et al. Esthetic evaluation and patient-centered outcomes in root-coverage procedures[J]. Periodontol 2000, 2018, 77(1): 19-53.
14	SRIVIDYA I, PENMETSA G S, SUBBAREDDY B V, et al. Analysis of root coverage esthetic score in patients treated for gingival recession: an interexaminer reliability[J]. J Indian Soc Periodontol, 2021, 25(2): 133-137.
15	CAIRO F, NIERI M, CATTABRIGA M, et al. Root coverage esthetic score after treatment of gingival recession: an interrater agreement multicenter study[J]. J Periodontol, 2010, 81(12): 1752-1758.
16	STEFANINI M, JEPSEN K, DE SANCTIS M, et al. Patient-reported outcomes and aesthetic evaluation of root coverage procedures: a 12-month follow-up of a randomized controlled clinical trial[J]. J Clin Periodontol, 2016, 43(12): 1132-1141.
17	SACHDEVA S, SALUJA H, MANI A, et al. Aesthetic root coverage with acellular dermal matrix allograft: a shield for gingival recession[J]. BMJ Case Rep, 2021, 14(12): e243895.
18	ROTUNDO R, NIERI M, MORI M, et al. Aesthetic perception after root coverage procedure[J]. J Clin Periodontol, 2008, 35(8): 705-712.
19	KERNER S, ETIENNE D, MALET J, et al. Root coverage assessment: validity and reproducibility of an image analysis system[J]. J Clin Periodontol, 2007, 34(11): 969-976.
20	KIM S M, CHOI Y H, KIM Y G, et al. Analysis of the esthetic outcome after root coverage procedures using a comprehensive approach[J]. J Esthet Restor Dent, 2014, 26(2): 107-118.

Indicator	Baseline	6 months post-surgery	Difference	P value
KG/mm	2.16±1.09	3.04±0.97	1.19±1.28	0.000
GR/mm	2.21±1.15	0.44±0.85	-（1.77±1.21）	0.000

Indicator	Baseline	6 months post-surgery	Difference	P value
KG/mm	2.16±1.09	3.04±0.97	1.19±1.28	0.000
GR/mm	2.21±1.15	0.44±0.85	-（1.77±1.21）	0.000

Indicator		VAS				P value
Indicator		Excellent （n=53）	Good （n=37）	Fair （n=15）	Poor （n=0）	P value
KG /mm	Baseline	2.16±1.09	2.38±0.89	1.97±1.39	‒	0.412
	6 months post-surgery	3.67±0.94	3.05±0.74	3.27±1.28	‒	0.008
	Difference	1.52±1.35	0.68±0.81	1.30±1.62	‒	0.008
GR /mm	Baseline	2.20±1.10	2.01±0.31	2.79±1.61	‒	0.077
	6 months post-surgery	0.20±0.89	0.31±0.68	1.50±1.28	‒	0.000
	Difference	-（1.97±1.06）	-（1.79±1.17）	-（1.29±1.24）	‒	0.061
PRC/%	‒	92.6±15.8	80.4±53.2	44.4±41.0	‒	0.000
PCRC/%	‒	81.1	75.7	20.0	‒	0.000
RES/score	‒	9.12±1.52	8.31±1.91	‒	‒	0.000

Indicator		VAS				P value
Indicator		Excellent （n=53）	Good （n=37）	Fair （n=15）	Poor （n=0）	P value
KG /mm	Baseline	2.16±1.09	2.38±0.89	1.97±1.39	‒	0.412
	6 months post-surgery	3.67±0.94	3.05±0.74	3.27±1.28	‒	0.008
	Difference	1.52±1.35	0.68±0.81	1.30±1.62	‒	0.008
GR /mm	Baseline	2.20±1.10	2.01±0.31	2.79±1.61	‒	0.077
	6 months post-surgery	0.20±0.89	0.31±0.68	1.50±1.28	‒	0.000
	Difference	-（1.97±1.06）	-（1.79±1.17）	-（1.29±1.24）	‒	0.061
PRC/%	‒	92.6±15.8	80.4±53.2	44.4±41.0	‒	0.000
PCRC/%	‒	81.1	75.7	20.0	‒	0.000
RES/score	‒	9.12±1.52	8.31±1.91	‒	‒	0.000

Indicator	VAS
Indicator	Excellent （n=53）	Good （n=37）	Fair （n=15）	Poor （n=0）	P value
GM/score	5.35±1.23	5.11±1.71	2.40±2.32	‒	0.000
MTC/score	0.95±0.18	0.81±0.34	0.90±0.28	‒	0.043
STT/score	0.94±0.23	0.72±0.40	0.33±0.36	‒	0.000
MGJ/score	0.95±0.20	0.89±0.24	0.72±0.47	‒	0.015
GC/score	0.92±0.25	0.78±0.36	0.42±0.48	‒	0.000