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This study aims to assess the effect of tunneling technique with subepithelial connective tissue graft versus tunneling technique with laterally closed tunnel in treatment of recession type 2 defect.Few randomized clinical trial has been involved with recession type 2 defects treated with tunneling technique and coronal advanced flap.
Tunneling with subepithelial connective tissue graft:
At the recipient site (recession defect):
After scaling and root planning. A sulcular incision is made through the gingival margin and extends post the mucogingival line leaving the interdental papilla intact.
At donor site (palate):
A connective tissue graft is harvested from the palate after administration of local anesthesia using a partial thickness flap which will be raised with single incision.
Then the graft is placed and secured in the recipient site using suture. The flap is displaced to be in a coronal position using a suture.
Tunneling technique with the laterally closed tunnel):
After local anesthesia, root planing of the exposed root surface will be performed. An intrasulcular incisions will be made creating a tunnel extending to the mucogingival line and mesial and distal recession defects while keeping the interdental papilla intact as well as not perforating the flap.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group A : Lateral closed Tunnel | Active Comparator | Laterally closed tunnel procedure with subepithelial connective tissue graft (sCTG) After local anesthesia, root planing will be performed. Recession defect - a tunneling technique will be prepared using sulcular incision is made through the gingival margin and extends post the mucogingival line leaving the interdental papilla intact. • Recipient site; Using either single or mattress sutures, the graft will be pulled and fixed mesially and distally at the inner aspect of the pouch. The graft will be adapted to the CEJ by means of a sling suture. Margins of the pouch will be pulled together over the graft and sutured with interrupted sutures to accomplish tension-free complete or partial coverage of the graft as well as the denuded root surface. |
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| Group B : Tunneling | Active Comparator | Tunnel procedure with subepithelial connective tissue graft (sCTG) - Control: At the recipient site (recession defect): a tunneling technique will be prepared using sulcular incision is made through the gingival margin and extends post the mucogingival line leaving the interdental papilla intact. Then the graft is placed and secured in the recipient site. The flap is displaced to be in a coronal position using a sling suture with no suturing to approximate the margins together. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Group A (Lateral closed tunnel subepithelial CT graft) | Procedure | Subepithelial connective tissue graft (autogenous graft) will be harvested from the palate by Single incision technique to be used with the adjacent teeth to treating gingival recession with edges of the recession sutured together after placing connective tissue graft |
| Measure | Description | Time Frame |
|---|---|---|
| Reduction Recession Depth | recession depth measured from CEJ to the gingival margin in a cross-section at the central buccal site. | 6 month |
| Measure | Description | Time Frame |
|---|---|---|
| Gingival recession depth. | Measured as the distance between the gingival margin and the mucogingival junction | 6 month |
| Gingival recession width | Measured as the distance between the gingival margin adjacent to the defect |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Manal Hosny, PhD | Cairo University | Study Chair |
| Hani El-Nahass, PhD | Cairo University | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cairo University | Cairo | Almanyal , Cairo | 12613 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18380550 | Background | Agudio G, Nieri M, Rotundo R, Cortellini P, Pini Prato G. Free gingival grafts to increase keratinized tissue: a retrospective long-term evaluation (10 to 25 years) of outcomes. J Periodontol. 2008 Apr;79(4):587-94. doi: 10.1902/jop.2008.070414. | |
| 19968743 | Background | Aroca S, Keglevich T, Nikolidakis D, Gera I, Nagy K, Azzi R, Etienne D. Treatment of class III multiple gingival recessions: a randomized-clinical trial. J Clin Periodontol. 2010 Jan;37(1):88-97. doi: 10.1111/j.1600-051X.2009.01492.x. Epub 2009 Nov 30. |
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I will check with my Study Chair
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| ID | Term |
|---|---|
| D005889 | Gingival Recession |
| ID | Term |
|---|---|
| D005882 | Gingival Diseases |
| D010510 | Periodontal Diseases |
| D009059 | Mouth Diseases |
| D009057 | Stomatognathic Diseases |
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Its a randomised clinical trial
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|
| Group B (Tunnel procedure with subepithelial CT graft) | Procedure | Subepithelial connective tissue graft (autogenous graft) will be harvested from the palate by Single incision technique to be used with the prepared tunnel to treating gingival recession |
|
|
| 6 month |
| Root coverage esthetic score (RES) | system used to evaluated five variables 6 months gingival margin (GM), marginal tissue contour (MTC), soft tissue texture (STT), MGJ alignment, and gingival color (GC). | 6 month |
| Probing depth | Measured from the gingival margin to the bottom of the gingival sulcus | 6 month |
| Clinical attachment level | Measured from the CEJ to the bottom of the gingival sulcus. | 6 month |
| Width of keratinized tissue | Measured as the distance between the gingival margin and the mucogingival junction | 6 month |
| Gingival thickness | The measurement of Gingival tissue thickness is performed 2 mm apical from the gingival margin. | 6 month |
| Post-operative pain | Visual Analogue Scale (VAS) with numbers from 0 to 10 ('no pain' to 'worst' pain imaginable) | 2 weeks |
| Post-Surgical Patient Satisfaction Questionnaire | A 3-item questionnaire is asked and the patients shall use a 7-point answer scale. The answers were given on a 7-point scale ranging from 1 ''not at all'' to 7 ''very likely'' | 6 month |
| Percentage complete root coverage | (Preoperative vertical recession -- Postoperative vertical recession/preoperative vertical recession) x 100 | 6 month |
| 10505811 | Background | Baldi C, Pini-Prato G, Pagliaro U, Nieri M, Saletta D, Muzzi L, Cortellini P. Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol. 1999 Sep;70(9):1077-84. doi: 10.1902/jop.1999.70.9.1077. |
| 21507033 | Background | Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol. 2011 Jul;38(7):661-6. doi: 10.1111/j.1600-051X.2011.01732.x. Epub 2011 Apr 20. |
| 19335093 | Background | Cairo F, Rotundo R, Miller PD, Pini Prato GP. Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol. 2009 Apr;80(4):705-10. doi: 10.1902/jop.2009.080565. |
| 19046326 | Background | Cortellini P, Tonetti M, Baldi C, Francetti L, Rasperini G, Rotundo R, Nieri M, Franceschi D, Labriola A, Prato GP. Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? A multi-centre, randomized, double-blind, clinical trial. J Clin Periodontol. 2009 Jan;36(1):68-79. doi: 10.1111/j.1600-051X.2008.01346.x. Epub 2008 Nov 20. |
| 25618109 | Background | Dominiak M, Gedrange T. New perspectives in the diagnostic of gingival recession. Adv Clin Exp Med. 2014 Nov-Dec;23(6):857-63. doi: 10.17219/acem/27907. |
| 9663118 | Background | Edel A. Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. 1974. Periodontal Clin Investig. 1998 Spring;20(1):12-20. No abstract available. |
| 21837295 | Background | Esteibar JR, Zorzano LA, Cundin EE, Blanco JD, Medina JR. Complete root coverage of Miller Class III recessions. Int J Periodontics Restorative Dent. 2011 Jul-Aug;31(4):e1-7. |
| 12636127 | Background | Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003 Feb;134(2):220-5. doi: 10.14219/jada.archive.2003.0137. |
| 20407659 | Background | Khuller N. Coverage of gingival recession using tunnel connective tissue graft technique. J Indian Soc Periodontol. 2009 May;13(2):101-5. doi: 10.4103/0972-124X.55838. |
| 3866056 | Background | Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol. 1985 Dec;56(12):715-20. doi: 10.1902/jop.1985.56.12.715. |
| 3858267 | Background | Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985;5(2):8-13. No abstract available. |
| 9802711 | Background | Nordland WP, Tarnow DP. A classification system for loss of papillary height. J Periodontol. 1998 Oct;69(10):1124-6. doi: 10.1902/jop.1998.69.10.1124. |
| 3894614 | Background | Raetzke PB. Covering localized areas of root exposure employing the "envelope" technique. J Periodontol. 1985 Jul;56(7):397-402. doi: 10.1902/jop.1985.56.7.397. |
| 29889911 | Background | Sculean A, Allen EP. The Laterally Closed Tunnel for the Treatment of Deep Isolated Mandibular Recessions: Surgical Technique and a Report of 24 Cases. Int J Periodontics Restorative Dent. 2018 Jul/Aug;38(4):479-487. doi: 10.11607/prd.3680. |
| 26321849 | Background | Shah R, Thomas R, Mehta DS. Recent modifications of free gingival graft: A case series. Contemp Clin Dent. 2015 Jul-Sep;6(3):425-7. doi: 10.4103/0976-237X.161910. |
| 9083906 | Background | Smith RG. Gingival recession. Reappraisal of an enigmatic condition and a new index for monitoring. J Clin Periodontol. 1997 Mar;24(3):201-5. doi: 10.1111/j.1600-051x.1997.tb00492.x. |
| 5240496 | Background | Sullivan HC, Atkins JH. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics. 1968 Jun;6(3):121-9. No abstract available. |
| 10635186 | Background | Zabalegui I, Sicilia A, Cambra J, Gil J, Sanz M. Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report. Int J Periodontics Restorative Dent. 1999 Apr;19(2):199-206. |
| 25867992 | Background | Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000. 2015 Jun;68(1):333-68. doi: 10.1111/prd.12059. |
| D055093 |
| Periodontal Atrophy |