Evaluation of Esthetic Root Coverage Using Platelet-Rich Fibrin Versus Subepithelial Connective Tissue Graft With Vestibular Incision Subperiosteal Tunnel Access Technique in Patients With Multiple Gingival Recessions: A Randomized Controlled Clinical Trial
Trial Snapshot
- Phase
- Not Applicable
- Sponsor
- Cairo University
- Enrollment
- 28
- Primary Endpoint
- Amount of root coverage
Study Overview
Brief Summary
Patients with gingival recession, complain of excessive tooth length that affects their appearance during smiling or functioning. The main goal of plastic periodontal surgeries is to restore patient's esthetic demands with the regeneration of gingival and periodontal tissues.
Although SCTG is considered a gold standard, it has its own limitations like patient morbidity and graft availability. Consequently, PRF has been introduced in an attempt to overcome the drawbacks of SCTG and achieve optimum results in root coverage.
The minimally invasive VISTA technique allows better access with coronal positioning and stabilization of gingival margin to achieve complete root coverage. In addition to platelets-rich fibrin that gives a predictable and reproducible result in restoring the amount of keratinized tissue, root coverage and better esthetic outcome. The use Vestibular incision subperiosteal tunneling access (VISTA) with platelet-rich fibrin will be used to achieve complete root coverage.
Detailed Description
Gingival recession is defined as apical displacement of gingival margin beyond the cementoenamel junction leading to the exposure of root surface. There are various etiologic factors for gingival recession like trauma, infection and other anatomical factors.
Nowadays, periodontal plastic surgeries for treatment of gingival recession have become an important array due to increase in patient's esthetic demands and other conditions such as dentin hypersensitivity, root caries or abrasion, keratinized tissue augmentation and gingival margin discrepancy.
Subepithelial connective tissue grafts (SCTG) are considered the gold standard to obtain maximum root coverage due to its characteristics of quick keratinization and periodontal connective tissue adherence, in addition to its good blood supply to the graft and high degree of gingival color match and esthetics. However, the application of this technique is limited by the thickness of the donor tissue, anatomical factors, limited quantity compromising their use in multiple recession, tissue morbidity, and technique sensitive with postoperative pain, bleeding and swelling.
Accordingly, alternative membranes and new biomaterials have been introduced to overcome the limitations of SCTG.
Platelet rich fibrin (PRF) was introduced; a second generation platelet concentrate. PRF contains growth factors that play an essential role in soft and hard tissue regeneration; they promote fibroblastic proliferation, increase tissue vascularization, enhance soft tissue healing potential and accelerate bone regeneration. These growth factors include (PDGFs), epidermal growth factor (EGF), transforming growth factor beta (TGF-β), vascular endothelial growth factor (VEGF).
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Eligibility Criteria
- Ages
- 20 Years to 50 Years (Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Multiple adjacent maxillary or mandibular gingival recessions Miller class І or II
- •Good oral hygiene with full mouth plaque score (FMPS) ≤ 20% (O'Leary et al. 1972)
Exclusion Criteria
- •Any systemic condition that may contraindicate periodontal surgery
- •Individuals taking medications that interfere with periodontal tissue health or healing
- •Previous periodontal plastic surgery in the selected sites for at least 6 months before the study
- •Pregnancy or lactating women
- •Former or current smokers
- •Active periodontal disease
- •Non-compliant patients.
- •Any restorations found in the selected sites
Arms & Interventions
VISTA using PRF
Vestibular incision subperiosteal tunnel access combined with Platelets-Rich Fibrin
An intravenous blood will be drawn from the patient in a glass-coated plastic tubes, centrifuged at 3000 rpm for 10-12 min. A Platelets rich fibrin membrane will then be obtained
Intervention: VISTA using PRF (Procedure)
VISTA using SCTG
vestibular incision subperiosteal tunnel access combined with subepithelial connective tissue graft
Subepithelial connective tissue graft will be harvested from the palate, secured in the tunnel to cover the root dehiscence then sutured
Intervention: VISTA using SCTG (Procedure)
Outcomes
Primary Outcomes
Amount of root coverage
Time Frame: 6 months
complete root coverage after surgical correction measured in millimeters by using periodontal probe
Secondary Outcomes
- Root Coverage Esthetic score a numbering score(6 months)
- Keratinized Tissue Width in millimeters(6 months)
- Post-Operative Pain a numerical rating scale(14 days)
- Post-Surgical Patient Satisfaction numerical rating scale(14 days)
- Post-Operative Swelling verbal rating scale(7 days)
- Probing depth in millimeters(6 months)
- Clinical Attachment level gain in millimeters(6 months)
- Gingival Thickness in millimeters(6 months)
Investigators
Yasmin Medhat Sery
B.Sc. in Oral and Dental Medicine
Cairo University