Multiple gum recession treatment using tunnel technique by comparing two different graft harvesting methods

Phase 3

Recruiting

• Conditions: Other periodontal diseases,

• Registration Number: CTRI/2024/06/068416
• Lead Sponsor: Dr Snehal Pudke

Brief Summary

Gingival recession is the exposure of the root surface resulting from migration of the gingival margin apical to the cementoenamel junction (CEJ).Multiple adjacent gingival recession(MAGR) is common and various techniques have been described for the its treatment [e.g., coronally advanced flap (CAF), tunnel technique (TUN), flap designs (e.g., CAF with/without vertical releasing incisions, TUN with/without split-flap, etc.), adjuncts [e.g., free gingival graft (FGG), connective tissue graft (CTG), enamel matrix derivatives (EMD), soft tissue substitutes (STS) membranes for guided tissue regeneration (GTR), etc.], and combinations thereof have been tried. Most systematic reviews conclude that CAF + CTG should be considered as the ‘gold standard’ for single Miller class I and II GR, also coined as recession type (RT1). Recent literature indicate that tunnel technique (TUN) is a highly effective and predictable procedure in the treatment of multiple Gingival Recession (GR) defects. Positive outcomes of root coverage with TUN might be attributed to inherent advantage of this approach being a minimally invasive procedure with limited flap opening and lack of vertical releasing incisions, all of which contribute to decreased tissue trauma, enhanced wound healing, and greater blood supply to the graft. (Azzi & Etienne 1998, Zuhr et al. 2007, Aroca et al. 2010). Tunnel technique was first introduced by Allen in 1994, and its modifications by Zabalegui in 1999, Modified Coronally Advanced Tunnel (MCAT) by Azzi et al 2002 and Microsurgical CAT by Zuhr 2007. Over the following years, additional modifications of MCAT technique were proposed, such as introduction of the microsurgical approach, full-thickness flap preparation, papillae detachment and elevation, modified suturing technique, application of collagen porcine dermal matrix in lieu of SCTG , inclusion of biological factors such as enamel matrix derivative (EMD) or concentrated growth factor (CGF) , and site-specific application of Sub-epithelial connective tissue graft (SCTG). Various techniques have been proposed to obtain SCTG. Recently, de-epithelialized free gingival graft (FGG) has been used as another method to obtain SCTG. Therefore, the aim of this split mouth randomized controlled study is to evaluate and compare de-epithelialized FGG or SCTG in the treatment of multiple adjacent gingival recessions using MCAT.

Detailed Description

Not available

Study Timeline

• Study Start: 2024-02-07
• Last Update Posted: 2024-07-06

Recruitment & Eligibility

• Status: Open to Recruitment
• Sex: All
• Target Recruitment: 19

Inclusion Criteria

• Systemically healthy patients with age between 18 and 60 yrs.
• At least 20 natural teeth should be present.
• At least two adjacent Millers class I and II or Cairo’s RT1 recession defects from 2nd premolar right side to 2nd premolar left side in maxillary and mandibular arches.
• Minimum depth of gingival recession defect should be ≥ 2mm.
• Patients with healthy periodontal conditions.
• Patients with esthetic concerns.
• Patients willing to participate and willing to sign an informed consent.

Exclusion Criteria

• Systemic conditions and diseases that could affect the progression of periodontal disease.
• Patients those who underwent any subgingival periodontal therapy or antibiotic therapy in past 6 months.
• Patients using smokeless as well as smoking form of tobacco.
• Pregnant and lactating females.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
(CRC) percentage in multiple adjacent gingival recessions (Millers class I	Baseline and 6 months after surgery
To compare the complete/extent of root coverage	Baseline and 6 months after surgery
and II or Cairo’s RT1) at baseline and 6 months after surgery using MCAT	Baseline and 6 months after surgery
technique with de-epithelialized FGG and MCAT with SCTG	Baseline and 6 months after surgery

Secondary Outcome Measures

Name	Time	Method
To compare clinical parameters like Mean root	coverage (MRC) , Keratinized tissue width (KTW), Gingival recession depth

Trial Locations

Locations (1)

Sinhgad Dental College And Hospital, Pune; 🇮🇳 Pune, MAHARASHTRA, India

Sinhgad Dental College And Hospital, Pune

🇮🇳Pune, MAHARASHTRA, India

Dr Snehal Pudke

Principal investigator

8600696344

snehalpudke07@gmail.com