Compare gingival thickness following CAF With SCTG and Vitamin C Versus SCTG Alone in Management of RT1 Gingival Recession.
Control group (coronally advanced flap and subepithelial connective tissue graft alone) Test group (coronally advanced flap and subepithelial connective tissue graft using microsurgical approach) Same procedure will be executed but with the addition of vitamin C injection. Intraepidermal injection (oral mesotherapy technique) of 1-1.5 ml (200-300 mg concentration) of L-ascorbic acid will be done. It will be locally introduced in relation to the keratinized gingival tissues with extension to the whole target region successively using special syringes (30 gauge). The needle will be introduced parallel to the gingival tissues with the bevel facing upwards. Vitamin C will then be delivered through the attached gingival tissues at the epithelium-connective tissue junction (equivalent to epidermal- dermal junction) till the tissues blanch. Vitamin C will be injected first time immediately postsurgical and then repeated once per week for 3 consecutive weeks for a total of 4 injections.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
22
Injection of vitamin C after CAF with SCTG aiming to increase gingival thickness in patients with RT1 gingival recession.
Coronally advanced flap with subepithelial connective tissue graft.
Faculty of Oral and Dental Medicine - CU
Cairo, Egypt
RECRUITINGGinigval thickness
Determined 2 mm apical to the gingival margin with a short needle for anesthesia and a 3 mm diameter silicon disk stop. The needle is inserted perpendicular to the mucosal surface, through the soft tissues with light pressure until a hard surface is felt. The silicon disk stop is then placed in tight contact with the soft tissue surface with the coronal border overlapping the soft tissue margin. As the needle is located in the center of the silicon disk, measurement of GT is performed 2 mm apical from the gingival margin. Once in the correct position, the disk is fixed with a drop of cyanocrylic adhesive; after careful removal of the needle, the penetration depth is measured with a caliper accurate to the nearest 0.1 mm.
Time frame: 6 months
Root Coverage Esthetic Score
A system proposed for evaluating esthetic outcomes of root coverage procedures. The RES system evaluated five variables at 6-months after surgery: the level of the gingival margin, marginal tissue contour, soft tissue texture, MGJ alignment, and gingival color.
Time frame: 6 months
Early Healing Index
A system proposed for the clinical assessment of the early wound events by using a differentiated early wound healing index (EHI) (Wachtel et al., 2003).
Time frame: 6 months
Gingival Recession Depth (RD)
Measured from the CEJ to the most apical extension of the gingival margin.
Time frame: 6 months
Gingival Recession Width (RW)
Measured horizontally between the borders of the recession at the level of CEJ.
Time frame: 6 months
Percentage of root coverage
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(Preoperative vertical recession - Postoperative vertical recession/preoperative vertical recession) x 100.
Time frame: 6 months
Probing Depth (PD)
Measured from the gingival margin to the bottom of the gingival sulcus.
Time frame: 6 months
Clinical Attachment Level (CAL)
Measured from the CEJ to the bottom of the gingival sulcus.
Time frame: 6 months
Height of Keratinized Tissue (KTH)
Measured as the distance between the gingival margin and the mucogingival junction (MGJ). All measurements will be performed by means of the UNC periodontal probe and will be rounded up to the nearest millimeter.
Time frame: 6 months
Post-Operative Pain
Visual Analogue Scale (VAS) with numbers from 0 to 10 ('no pain' to 'worst pain imaginable') measured daily for the first 2 weeks postoperatively.
Time frame: 2 weeks
Post-Surgical Patient Satisfaction
A 3-item questionnaire is asked and the patients shall use a 7-point answer scale.
Time frame: 6 months