CREEPING ATTACHMENT PHENOMENON AND ITS SIGNIFICANCE IN DENTAL PRACTICE: ANALYSIS OF DATA OBSERVED IN CLINICAL STUDIES

Abstract

Introduction. The data noted in the literature regarding the clinical significance of the phenomenon of creeping attachment characterized by significant variability in relation to the frequency of its development, the conditions that determine the nature of its course, the expressiveness of clinical changes associated with late coronal migration of soft tissues, and the probability of predicting certain clinical outcomes. Objective. Conduct analytical processing and systematization of clinical research data to clarify the conditions, parameters and consequences of the development of the phenomenon of creeping attachment during the realization of various dental interventions. Methods. In order to form the primary cohort of publications associated with the purpose of the study, the search was conducted within the PubMed Central database (https://www.ncbi.nlm.nih.gov/pmc/) and through the Google Scholar search engine (https://scholar. google.com/). Results. Most of the studies devoted to the study of the creeping attachment phenomenon are presented in the form of individual clinical cases or their series, while there is a shortage of randomized controlled studies and studies of a histological nature. Most often, the development of creeping attachment is observed in the period from 2 weeks to 1 year after the corresponding surgical manipulations, although this period may vary depending on the specifics of the clinical situation. Additional coronal migration of the soft gingival tissues due to the phenomenon of creeping attachment can amount to 0,4–2,8 mm, and such can be registered in 95,5% of the analyzed cases. The factors that determine the level of creeping attachment are: the initial parameters of the recession width, the position of the graft used, the level of resorption of the surrounding bone tissue, the position of the tooth, the state of oral hygiene. Conclusions. The development of the creeping attachment phenomenon is possible both after carrying out various types of periodontal interventions with or without the additional use of grafts, and as a result of the orthodontic treatment, which helps to reduce the level of tension and overstretching in the structure of the surrounding soft tissues. A higher likelihood of creeping attachment development can be expected when soft tissue grafts containing living cells are used, while the likelihood of creeping attachment development is minimal or at least unpredictable when using acellular dermal matrices. Despite the significant frequency of the creeping attachment development in cases of gingival recession treatment, the fact of its presence should not be used as a reliable predictor in relation to the possibility of achieving complete restoration of the soft tissue covering over the exposed root surface.