Clinical efficacy of tunnelled coronally advanced flap and amnion chorion membrane with the adjunct use of hyaluronic acid and low-level laser therapy for multiple gingival recession: randomized controlled trial

Gingival recession (GR) or soft tissue recession is defined as the displacement of the gingival margin apical to the cemento-enamel junction (CEJ) of a tooth or the platform of a dental implant. It is associated with poor aesthetics, dentinal hypersensitivity, and a negative impact on the oral health- related quality of life of an individual. 

Coronally advanced flap has several disadvantages, hence to overcome these challlenges,, Barootchi and et.al (2022) introduced a technique, tunnelled coronally advanced flap (TCAF) that combined the advantage of CAF and tunnelling technique (TUN) to gain access and improve graft stabilization while preserving the integrity of the papilla, for treatment.

Autograft tissue currently remains the “gold standard” of periodontal plastic surgery but significantly increases patient morbidity.

Amnion chorion membrane (ACM) exert anti-inflammatory, angiogenic, antifibrotic, antimicrobial effects low immunogenicity.

In recent years, low-level lasers have also been evaluated regarding their efficacy in wound healing‑ process in both medical and dental fields. Tissue repair phase in wound healing begins on the third day and lasts about two weeks, involves fibroblast proliferation and collagen genesis. The supplementation of LLLT at this point leads to expedited wound-healing events can be used as adjunct in promoting the healing and improve the outcome of periodontal flap procedures.

Hyaluronic acid (HA) is a major component of the extra cellular matrix in almost all tissues and suppresses tissue break down activating metalloproteinase inhibitors. HA is a promising adjunct for promoting faster wound healing when used in post periodontal flap surgery.

Combination of photobiomodulation therapy (PBMT) and HA gel application has proven to show significant clinical results by improving the healing outcome and decreases the time required for wound healing and re-epithelialization.

Patients with multiple maxillary gingival recession with cairos RT1/RT2 will be treated . 

Group A : patients will be treated with Tunnelled coronally advanced flap technique followed by placement of amnion chorion membrane.

Group B: patients will be treated with Tunnelled coronally advanced flap technique followed by placement of amnion chorion membrane followed by low level laser therapy prior to pack placement

Group C: : patients will be treated with Tunnelled coronally advanced flap technique and 0.2% hyaluronic acid gel will be applied in the root surface and amnion chorion membrane. post suturing patients are subjected to low level laser therapy followed by pack placement.

Thus, this study aims to evaluate the efficacy of TCAF and ACM with LLLT and HA.