The goal of this clinical trial is to evaluate gingival recession depth reduction using tunneled coronally advanced flap compared to coronally advanced flap, both combined with connective tissue graft in patients with isolated RT2 gingival recession sites.
Gingival recession can cause clinical conditions that could be of main concern for patients. Techniques aiming for coverage of the gingival recession aim to address dentin hypersensitivity, non-carious cervical lesions (NCCLs) and enhance patient's esthetics (Cortellini \& Bissada, 2018). Mid-buccal gingival recessions have been associated with patient's esthetic discomfort (Zucchelli \& Mounssif, 2015). Most of the studies in the literature focus on the treatment of RT1 recession as they have the most favorable prognosis of full root coverage (Barootchi et al., 2020). Despite most studies focusing their attention on RT1 cases, RT2 defects are found to be the most prevalent type with 88.8% among patients according to (Romandini et al., 2020). The coronally advanced flap and the tunneling technique are the most commonly performed surgical approaches for treating gingival recessions. However, these two approaches have commonly been regarded as alternatives to each other, with clinicians choosing to perform only one of them during root coverage procedures. (Barootchi \& Tavelli, 2022) aimed in his conducted case series to designate a surgical technique to treat isolated RT2 gingival recession defects in which he was trying to achieve and combine the advantage of both better access and graft stabilization in CAF and the preservation of the integrity of the papilla and better blood supply to the graft present in tunneling technique. The study concluded that the combination of both techniques in the same surgical design can have the potential to enhance flap and graft vascularization and improve clinical, esthetic, and patient-reported outcomes. To our knowledge, there is no conducted randomized clinical trials comparing the tunneled coronally advanced flap technique to the coronally advanced flap for gingival depth reduction. So, this clinical trial aims to address this gap of the literature.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
22
Tunneled coronal advanced flap with connective tissue graft to treat isolated RT2 gingival recession sites.
Coronally advanced flap with connective tissue graft to treat isolated RT2 gingival recession sites
Faculty of Dentistry, Cairo University
Cairo, Egypt
RECRUITINGGingival Recession Depth
It's measured as the distance between cemento-enamel junction (CEJ), and gingival margin (GM) using periodontal probe.
Time frame: 6 months
Percentage of mean root coverage (MRC%)
(Preoperative vertical recession depth - Postoperative vertical recession/preoperative vertical recession) x 100 \[%\]
Time frame: 6 months
Percentage of complete root coverage (CRC%)
Number of defect sites with complete root coverage/ Total number of recession sites treated x 100 \[%\]
Time frame: 6 months
Gingival Recession Width
Measured at the widest point (it is the distance between the mesial gingival margin and the distal gingival margin of the tooth)
Time frame: 6 months
Gingival Thickness
Measured using transgingival needle probing using anesthesic needle a rubber stopper
Time frame: 6 months
Keratinized Tissue Width
Measured as the distance between the gingival margin and the mucogingival junction (MGJ).
Time frame: 6 months
Clinical Attachment Level
Measured from the CEJ to the bottom of the gingival sulcus.
Time frame: 6 months
Probing Pocket Depth
Measured from the gingival margin to the bottom of the gingival sulcus.
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Time frame: 6 months
Pink Esthetic Score
It's a score by (Fürhauser et al., 2005) based on seven variables: mesial papilla, distal papilla, soft-tissue level, soft tissue contour, alveolar process deficiency, soft-tissue color and texture. Each variable is assessed with a 0-1-2 score, with 2 being the best and 0 being the poorest score.
Time frame: 6 months
Post-operative pain
Visual Analogue Scale (VAS) with numerical scale from 0 to 10 ('no pain' to 'worst pain imaginable') measured daily for the first 2 weeks postoperatively.
Time frame: 2 weeks
Post-operative patient satisfaction
A 3-item questionnaire will be given to the patients to be answered using a 7-point answer scale for assessing their satisfaction with the whole surgical procedure and the achieved results of the procedure performed.
Time frame: 2 weeks, 6 months
Root coverage esthetic score
(Cairo et al., 2009) This score evaluates five variables: level of the gingival margin (GM) , marginal tissue contour (MTC), soft tissue texture (STT) , mucogingival junction (MGJ) alignment , and gingival color (GC). * GM: Zero point for failure of root coverage (gingival margin apical or equal to the baseline recession); 3 points partial root coverage; 6 points CRC. * MTC: Zero point irregular gingival margin (does not follow the CEJ); 1 point -proper marginal contour/ scalloped gingival margin (follows the CEJ). * STT: Zero point for scar formation and/or keloid-like appearance; I point absence of scar or keloid formation. * MGJ: Zero point -MGJ not aligned with the MGJ of adjacent teeth; 1 point if the MGJ aligned with the MGJ of adjacent teeth. * GC: Zero point color of tissue varies from gingival color at adjacent teeth; 1 point normal color and integration with the adjacent soft tissues. 10 is the ideal esthetic score
Time frame: 6 months