Comparative evaluation of efficacy of tunneled coronally advanced flap versus coronally advanced flap with collagen matrix for management of isolated gingival recession: A randomized clinical trial

Gingival recession (GR) is defined as the exposure of the root surface due to apical migration of junctional epithelium apical to the cementoenamel junction (CEJ). GR is usually associated with dentinal hypersensitivity, susceptibility to root caries, and aesthetic concern. Therefore, obtaining root coverage (RC) becomes an integral part in the treatment of GR. Hence, the goal of root coverage is to restore the gingival structure functionally and esthetically.

Several surgical treatment modalities, such as free gingival autograft, free connective tissue autograft, pedicle autografts, laterally positioned pedicle flap, coronally advanced flap (CAF), subepithelial connective graft, guided tissue regeneration and pouch and tunnel technique have been used for gingival recession treatment.

Coronally advanced flap (CAF) with connective tissue graft (CTG) remains the gold standard till date. One of the recent technique is Tunneled coronally advanced flap (TCAF) which minimizes incisions and reflection of flaps and provide abundant blood supply and intimate contact of the donor tissue with the recipient site.

The efficacy of the tunnel technique with a CTG from the tuberosity for the treatment of multiple gingival recession has been investigated. The rationale behind using TCAF relies on the fact that the Tunnel technique can detach the buccal papillae from the interproximal bone, allowing for a coronal repositioning of the midfacial soft tissues.

Several soft tissue substitutes have been utilized as alternatives to CTG to avoid increased post-operative morbidity due to second surgical site. Collagen matrix (CM) was employed to treat recession deformities without the discomfort of second surgical sites, as was the case with CTGs. CM possesses hemostatic qualities, biocompatible and function as a scaffold for fibroblasts and promote tissue remodeling. When combined with tissue augmentation techniques, the CM has demonstrated the ability to increase the width of keratinized tissue surrounding teeth.

Gain in the root coverage is an advantage of the CAF at the papilla without attachment loss and tunneling minimizes the incisions and flap reflection thereby providing abundant blood supply to the tissues and intimate contact with recipient site. Therefore to take advantage of both coronally advanced flap and tunneling simultaneously, TCAF was introduced. TCAF is a recent novel technique and has not been compared with coronally advanced flap (the gold standard technique).

The aim of this study is to compare the effectiveness of tunneled coronally advanced flap (TCAF) versus coronally advanced flap (CAF) with collagen matrix (CM) for the management of isolated Cairo’s recession type 1 gingival recession.