In this randomized comparative controlled clinical trial, 50 patients with single recession defects with thin phenotype were treated with coronally advanced flap. The connective tissue graft was obtained by removing the keratinized layer of the tissue. Removal of the epithelium was achieved by to different approach. At first group epithelium and remnants were removed extraorally whereas others were intraorally. After the removal, obtained graft laid on a lamella, and residual keratinocytes were observed under the microscope. Amount of recession reduction recorded at the 6th week, 6th month, 12th month, and keratinized tissue height, gingival thickness, recession depth, recession width, probing depth, and clinical attachment level, were also evaluated. Keratinized tissue change, Gingival thickness change, root coverage, clinical attachment gain, and complete root coverage were calculated. Wound healing index, tissue appearance, patient expectations, aesthetics, and dentine hypersensitivity were assessed at baseline and 6th week.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
50
In this group, the grafts were de-epithelialized at the donor site before harvesting. The calibrated surgeon removed the epithelium with a sharp Kirkland knife under magnification. To be sure of the elimination whole epithelial layer, bleeding was observed. Recipient site was prepared as follows; A after sulculer incision had done (blade 15c) two vertical incions were made from the gingival margin to 3 mm beyond the mucogingival junction A partial-thickness flap was elevated under the recession area and full thickness flap elevated adjacent flap portions. then relasing incisions were made apically from the mucogingival junction. After the preparation of the recipient site, obtained graft was sutured 1 mm apically to the cemento-enamel junction. Finally flap was positioned without tension and stabilized at least 2mm coronally from the cemento-enamel margin with the single interrupted sutures.
In this group, the grafts were de-epithelialized after graft harvesting. The calibrated surgeon removed the epithelium with 15 c knife under magnification. all remnants were removed under magnification. Same recipient site procedure was conducted in this group.
Hacettepe University
Ankara, Turkey (Türkiye)
Recession reduction
RD, measured from the cemento-enamel junction (CEJ) to the most apical extension of the gingival margin.
Time frame: 3rd month
Recession reduction
RD, measured from the cemento-enamel junction (CEJ) to the most apical extension of the gingival margin.
Time frame: 6th month
Recession reduction
RD, measured from the cemento-enamel junction (CEJ) to the most apical extension of the gingival margin.
Time frame: 12th month
amount of deciduous cells
Amount of deciduous cells was measured with computerized microscope via histomorfometric methods.
Time frame: at the day of the surgery.
percentage of deciduous cells
amount of deciduous cells Amount of deciduous cells was measured with computerized microscope via histomorfometric methods.
Time frame: at the day of the surgery
Recession Depth (RD)
RD, was measured from the cemento-enamel junction (CEJ) to the most apical extension of the gingival margin.
Time frame: Baseline.
Recession Depth (RD)
RD, was measured from the cemento-enamel junction (CEJ) to the most apical extension of the gingival margin.
Time frame: 3rd month
Recession Depth (RD)
RD, was measured from the cemento-enamel junction (CEJ) to the most apical extension of the gingival margin.
Time frame: 6th month
Recession Depth (RD)
RD, was measured from the cemento-enamel junction (CEJ) to the most apical extension of the gingival margin.
Time frame: 12th month
Keratinized Tissue Height (KTH)
TH, was measured from gingival margin to the mucogingival junction (MGJ).
Time frame: baseline
Keratinized Tissue Height (KTH)
TH, was measured from gingival margin to the mucogingival junction (MGJ).
Time frame: 3rd month
Keratinized Tissue Height (KTH)
TH, was measured from gingival margin to the mucogingival junction (MGJ).
Time frame: 6th month
Keratinized Tissue Height (KTH)
TH, was measured from gingival margin to the mucogingival junction (MGJ).
Time frame: 12th month
Gingival Thickness (GT)
GT, was measured at the midpoint location between the gingival margin and mucogingival junction, using an endodontic spreader (#25 endodontic spreader, 25 mm; D-perfect, Shenzhen, China).
Time frame: baseline
Gingival Thickness (GT)
GT, was measured at the midpoint location between the gingival margin and mucogingival junction, using an endodontic spreader (#25 endodontic spreader, 25 mm; D-perfect, Shenzhen, China).
Time frame: 3rd month
Gingival Thickness (GT)
GT, was measured at the midpoint location between the gingival margin and mucogingival junction, using an endodontic spreader (#25 endodontic spreader, 25 mm; D-perfect, Shenzhen, China).
Time frame: 6th month
Gingival Thickness (GT)
GT, was measured at the midpoint location between the gingival margin and mucogingival junction, using an endodontic spreader (#25 endodontic spreader, 25 mm; D-perfect, Shenzhen, China).
Time frame: 12th month
Recession width (RW)
Recession width (RW), the distance between the mesial gingival margin and the distal gingival margin of the tooth measured from the widest point of the recession.
Time frame: baseline
Recession width (RW)
Recession width (RW), the distance between the mesial gingival margin and the distal gingival margin of the tooth measured from the widest point of the recession.
Time frame: 3rd month
Recession width (RW)
Recession width (RW), the distance between the mesial gingival margin and the distal gingival margin of the tooth measured from the widest point of the recession.
Time frame: 6th month
Recession width (RW)
Recession width (RW), the distance between the mesial gingival margin and the distal gingival margin of the tooth measured from the widest point of the recession.
Time frame: 12th month
Probing pocket depth (PD)
Probing pocket depth (PD), measured from the gingival margin to the bottom of the gingival sulcus.
Time frame: baseline
Probing pocket depth (PD)
Probing pocket depth (PD), measured from the gingival margin to the bottom of the gingival sulcus.
Time frame: 3rd month
Probing pocket depth (PD)
Probing pocket depth (PD), measured from the gingival margin to the bottom of the gingival sulcus.
Time frame: 6th month
Probing pocket depth (PD)
Probing pocket depth (PD), measured from the gingival margin to the bottom of the gingival sulcus.
Time frame: 12th month
Clinical attachment level (CAL)
Clinical attachment level (CAL), measured from the cementoenamel junction to the bottom of the gingival sulcus.
Time frame: Baseline
Clinical attachment level (CAL)
Clinical attachment level (CAL), measured from the cementoenamel junction to the bottom of the gingival sulcus.
Time frame: 3rd month
Clinical attachment level (CAL)
Clinical attachment level (CAL), measured from the cementoenamel junction to the bottom of the gingival sulcus.
Time frame: 6th month
Clinical attachment level (CAL)
Clinical attachment level (CAL), measured from the cementoenamel junction to the bottom of the gingival sulcus.
Time frame: 12th month
Keratinized tissue change (KTC)
Keratinized tissue change (KTC), GT change (GTC), root coverage, clinical attachment gain (CAG) were calculated in millimeters and percentages.
Time frame: 3rd month
Keratinized tissue change (KTC)
Keratinized tissue change (KTC), GT change (GTC), root coverage, clinical attachment gain (CAG) were calculated in millimeters and percentages.
Time frame: 6th month
Keratinized tissue change (KTC)
Keratinized tissue change (KTC), GT change (GTC), root coverage, clinical attachment gain (CAG) were calculated in millimeters and percentages.
Time frame: 12th month
Wound healing index (WHI)
Wound healing index (WHI) was recorded two-weeks after surgery. The wound surface was visually inspected and the soft tissue healing was defined as 'uneventful' (score 1), 'slightly disturbed' (score 2) or 'poor' (score 3) based on the presence and severity of the items including patient discomfort, erythema, edema, suppuration and flap dehiscence.
Time frame: 3rd month
Wound healing index (WHI)
Wound healing index (WHI) was recorded two-weeks after surgery. The wound surface was visually inspected and the soft tissue healing was defined as 'uneventful' (score 1), 'slightly disturbed' (score 2) or 'poor' (score 3) based on the presence and severity of the items including patient discomfort, erythema, edema, suppuration and flap dehiscence.
Time frame: 6th month
Wound healing index (WHI)
Wound healing index (WHI) was recorded two-weeks after surgery. The wound surface was visually inspected and the soft tissue healing was defined as 'uneventful' (score 1), 'slightly disturbed' (score 2) or 'poor' (score 3) based on the presence and severity of the items including patient discomfort, erythema, edema, suppuration and flap dehiscence.
Time frame: 12th month
Tissue appearance (TA)
Tissue appearance (TA) was evaluated by asking the patients to score the consistency, contour, color match, keloid formation degree and contiguity of their treated sites at T2. The scores were collected as points, shown in parentheses, by asking the consistency as firm (1p) or spongy (0p); contour as presence (2p) or absence (0p) of knife-edged and scalloped gingival margin; color match as excellent (3p), good (2p), adequate (1p) or unsatisfactory (0p); keloid formation degree as absent (1p) or present (0p); contiguity as the presence (-1p) or absence (0p) of each perceptible incision mark.
Time frame: 3rd month
Tissue appearance (TA)
Tissue appearance (TA) was evaluated by asking the patients to score the consistency, contour, color match, keloid formation degree and contiguity of their treated sites at T2. The scores were collected as points, shown in parentheses, by asking the consistency as firm (1p) or spongy (0p); contour as presence (2p) or absence (0p) of knife-edged and scalloped gingival margin; color match as excellent (3p), good (2p), adequate (1p) or unsatisfactory (0p); keloid formation degree as absent (1p) or present (0p); contiguity as the presence (-1p) or absence (0p) of each perceptible incision mark.
Time frame: 6th month
Tissue appearance (TA)
Tissue appearance (TA) was evaluated by asking the patients to score the consistency, contour, color match, keloid formation degree and contiguity of their treated sites at T2. The scores were collected as points, shown in parentheses, by asking the consistency as firm (1p) or spongy (0p); contour as presence (2p) or absence (0p) of knife-edged and scalloped gingival margin; color match as excellent (3p), good (2p), adequate (1p) or unsatisfactory (0p); keloid formation degree as absent (1p) or present (0p); contiguity as the presence (-1p) or absence (0p) of each perceptible incision mark.
Time frame: 12th month
Dentine hypersensitivity (DH)
Dentine hypersensitivity (DH) was evaluated with air evaporative stimulus method at baseline and T2. After placement of finger(s) for preserving the nearby teeth, the recession sites were subjected to evaporative stimulus comprised of 1-second air blast from 1 to 3 mm distance by using the air spray at 40-65 psi pressure and 19±50C. After application, the patients were requested to give a score to their DH between 0 (=no pain) and 10 (=extreme pain).
Time frame: 3rd month
Dentine hypersensitivity (DH)
Dentine hypersensitivity (DH) was evaluated with air evaporative stimulus method at baseline and T2. After placement of finger(s) for preserving the nearby teeth, the recession sites were subjected to evaporative stimulus comprised of 1-second air blast from 1 to 3 mm distance by using the air spray at 40-65 psi pressure and 19±50C. After application, the patients were requested to give a score to their DH between 0 (=no pain) and 10 (=extreme pain).
Time frame: 6th month
Dentine hypersensitivity (DH)
Dentine hypersensitivity (DH) was evaluated with air evaporative stimulus method at baseline and T2. After placement of finger(s) for preserving the nearby teeth, the recession sites were subjected to evaporative stimulus comprised of 1-second air blast from 1 to 3 mm distance by using the air spray at 40-65 psi pressure and 19±50C. After application, the patients were requested to give a score to their DH between 0 (=no pain) and 10 (=extreme pain).
Time frame: 12th month
Aesthetics (A)
Aesthetics (A) was evaluated by the patient at T1 by rating its level as excellent, good, fair or poor.
Time frame: 3rd month
Aesthetics (A)
Aesthetics (A) was evaluated by the patient at T1 by rating its level as excellent, good, fair or poor.
Time frame: 6th month
Aesthetics (A)
Aesthetics (A) was evaluated by the patient at T1 by rating its level as excellent, good, fair or poor.
Time frame: 12th month
Vestibuler Depth
VD was measured from the gingival margin to the deepest point of to vestibule sulcus.
Time frame: baseline
Vestibuler Depth
VD was measured from the gingival margin to the deepest point of to vestibule sulcus.
Time frame: 3rd month
Vestibuler Depth
VD was measured from the gingival margin to the deepest point of to vestibule sulcus.
Time frame: 6th month
Vestibuler Depth
VD was measured from the gingival margin to the deepest point of to vestibule sulcus.
Time frame: 12th month
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