Combined Bilaminar Tunnel Technique in Treating Difficult Gingival Recessions

Choying Lin12 enrolled

Overview

The goal of this clinical trial is to learn if the combined bilaminar tunnel technique works to treat anatomically difficult gingival recessions. It will also explore whether anatomical factors are associated with root coverage outcomes. The main questions it aims to answer are: Does the combined bilaminar tunnel technique improve root coverage outcomes in patients with anatomically difficult gingival recessions? Are specific anatomical factors associated with root coverage outcomes after the combined bilaminar tunnel technique? Participants will: Receive root coverage surgery using the combined bilaminar tunnel technique Visit the clinic for follow-up evaluations after surgery Receive clinical measurements to assess gingival recession and root coverage outcomes Receive radiographic evaluation to assess anatomical characteristics, if clinically indicated or available

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Gingival Recession, Mucogingival Surgery Gingival Recession Root Coverage

Interventions

mucogingival surgeryPROCEDURE

Participants will receive root coverage surgery using the combined bilaminar tunnel technique for the treatment of gingival recession. The procedure initiates with a partial-thickness flap at the sites with the most severe recession with tunnelled coronally advanced flap(tCAF), extending from the coronal margin to the mucogingival junction (MGJ). For adjacent teeth, intrasulcular incisions are made to prepare a full-thickness flap using a tunnel knife. A de-epithelialized connective tissue graft is harvested and stabilized at the coronal portion of the recipient site to facilitate root coverage. Simultaneously, a volume-stable collagen matrix (VSCM) is placed apically within the partial-thickness flap to fill bone concavities and reduce tissue retraction forces during healing.

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: * Orthodontic patients who were going to be treated with cTUN approach for soft tissue modification. * Healthy periodontal condition or well controlled periodontitis with periodontal probing depth ≦ 3mm, and absence of bleeding on probing. * Thin gingival phenotype, determined with visible metal shade\[27\] * Intact clinical and pre-surgery radiographic data (CBCT) was available, and the patient followed the recommended supportive post-surgery treatment at least 6 month after the surgery. * Informed consent had been obtained prior to the mucogingival surgery. Exclusion Criteria: * Uncontrolled systemic disease, such as hypertension, diabetes. * Untreated periodontitis * History of radiation therapy on head and neck regions. * Heavy smokers (more than 0.5 pack per day). * Patient with pregnancy or breastfeeding. * History of mucogingival surgery performed on the same site. * Patient who did not comply to the recommended supportive treatment was regarded as erratic complier.

Outcomes

Primary Outcomes

mean root coverage and complete root coverage rate

Mean root coverage will be calculated as the percentage reduction in gingival recession depth from baseline to the 6 month after receiving the treatment. Gingival recession depth will be measured as the distance from the cemento-enamel junction to the gingival margin.

Time frame: From enrollment to six month after receiving the treatment

Secondary Outcomes

Correlation Between Clinical and Anatomical Factors and Baseline Recession Depth

The correlation between clinical and anatomical factors and baseline recession depth will be assessed. Clinical and anatomical factors will include baseline keratinized tissue width, tooth angulation, depth of alveolar bone concavity, angulation of alveolar bone concavity, root prominence, buccal bone dehiscence, and buccal bone thickness. Baseline keratinized tissue width and recession depth will be measured clinically in millimeters using a periodontal probe. Tooth angulation and angulation of alveolar bone concavity will be measured in degrees on CBCT images. Depth of alveolar bone concavity, root prominence, buccal bone dehiscence, and buccal bone thickness will be measured in millimeters on CBCT images. The correlation will be evaluated using linear regression analysis.

Time frame: perioperative

Correlation Between Clinical and Anatomical Factors and Mean Root Coverage After Treatment with the Combined Bilaminar Tunnel Technique

The correlation between clinical and anatomical factors and mean root coverage after treatment will be assessed. Clinical and anatomical factors will include baseline keratinized tissue width, tooth angulation, depth of alveolar bone concavity, angulation of alveolar bone concavity, root prominence, buccal bone dehiscence, and buccal bone thickness. Baseline keratinized tissue width will be measured clinically in millimeters using a periodontal probe. Tooth angulation and angulation of alveolar bone concavity will be measured in degrees on CBCT images. Depth of alveolar bone concavity, root prominence, buccal bone dehiscence, and buccal bone thickness will be measured in millimeters on CBCT images. Mean root coverage will be calculated as the percentage reduction in recession depth from baseline to 6 months after treatment. The correlation will be evaluated using linear regression analysis.

Time frame: From baseline to 6 month after treatment.

Association Between Clinical and Anatomical Factors and Complete Root Coverage After Treatment

The association between clinical and anatomical factors and complete root coverage after treatment will be assessed. Clinical and anatomical factors will include baseline keratinized tissue width, tooth angulation, depth of alveolar bone concavity, angulation of alveolar bone concavity, root prominence, buccal bone dehiscence, and buccal bone thickness. Baseline keratinized tissue width will be measured clinically in millimeters using a periodontal probe. Tooth angulation and angulation of alveolar bone concavity will be measured in degrees on CBCT images. Depth of alveolar bone concavity, root prominence, buccal bone dehiscence, and buccal bone thickness will be measured in millimeters on CBCT images. Complete root coverage will be recorded as a binary outcome, defined as the presence or absence of complete coverage of the previously exposed root surface at 6 months after treatment. The association will be evaluated using logistic regression analysis.

Time frame: From baseline to 6 month after treatment