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Microsurgical tunneling flap procedures using connective tissue grafts (CTG) are predictable for treating teeth with gingival recessions. Cross-linked hyaluronic acid can be used in conjunction with subepithelial palatal connective tissue grafts to improve postsurgical results. The aim of this study is to evaluate clinically the use of tunnel technique with CTG and cross-linked hyaluronic acid in addition to CTG alone for the treatment of multiple gingival recessions.
The treatment of multiple adjacent recession appears to be challenging for the clinician due to large surgical field, variation in teeth position in the dental arch (prominent roots), variation in recession size, thin phenotype and insufficient keratinized tissue in many teeth. Surgical treatment of all multiple recession in one dental arch during one session appears to be optimum. Surgical treatment time is longer, however patient doesn't need to undergo multiple surgeries, pharmacological therapies and postsurgical instructions. Esthetic concern seems to be one of the most common complaints from patients. Among utilized surgical techniques tunneling flap procedures using connective tissue grafts (CTG) with or without biologics such as an enamel matrix derivative (EMD) or hyaluronic acid (HA) provided the most successful outcomes for the treatment. Cross-linked hyaluronic acid can be used in conjunction with subepithelial palatal connective tissue grafts to improve postsurgical results and improving healing process. The aim of this study is to evaluate clinically the use of tunnel technique with CTG and cross-linked hyaluronic acid in addition to CTG alone for the treatment of multiple gingival recessions.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Modified Coronally Advanced Tunnel With Connective Tissue Graft | Experimental | Procedure: A modified microsurgical tunnel technique by Zuhr et al. (2007). Initial sulcular incisions with a microsurgical blade are followed by a split-thickness buccal flap preparations using the tunneling knives. The preparation is extended into the mucosal tissue to gain sufficient flap mobility. The papillary regions are detached in their buccal aspects with the periosteum. The graft is inserted into the tunnel and stabilized with absorbable suspensory sutures. The buccal flap is advanced coronally and stabilized with non-absorbable suspensory sutures. |
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| MCAT With Cross-linked Hyaluronic Acid in Addition to CTG | Active Comparator | Procedure: A modified microsurgical tunnel technique by Zuhr et al. (2007). Initial sulcular incisions with a microsurgical blade are followed by a split-thickness buccal flap preparations using the tunneling knives. The preparation is extended into the mucosal tissue to gain sufficient flap mobility. The papillary regions are detached in their buccal aspects with the periosteum. The root surfaces are applied with cross-linked hyaluronic acid. The graft is inserted into the tunnel and stabilized with absorbable suspensory sutures. The buccal flap is advanced coronally and stabilized with non-absorbable suspensory sutures. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| The tunnel technique for root coverage with CTG without Cross-linked Hyaluronic Acid | Device | The tunnel technique for root coverage with CTG without Cross-linked Hyaluronic Acid |
| Measure | Description | Time Frame |
|---|---|---|
| Periodontal parameters measured before surgery. |
| 1-7 days before surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Periodontal parameters measured after surgery. |
ALL ABOVE PARAMETERS ARE MEASURED IN MILIMETERS |
| Measure | Description | Time Frame |
|---|---|---|
| Patient-reported outcomes based on VAS scales | Questionnaires: Scale 1: Pain after surgery (during recent 2 weeks) from 0 (no pain) to 10 (very big pain) | 2 weeks after surgery |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Beata Wyrębek, PhD | Contact | +48692013589 | beatawyrebek@gmail.com | |
| Bartłomiej Górski, PhD | Contact | 00 48 22 116 64 31 | gorskibartlomiej04@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Batlomiej Górski, PhD | Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw | Recruiting | Warsaw | Mazowsze | 00-246 | Poland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40137366 | Derived | Gorski B, Skierska IM, Gelemanovic A, Roguljic M, Bozic D. Multiple Recessions Coverage Using the Modified Tunnel Technique and Connective Tissue Graft with or Without Cross-Linked Hyaluronic Acid: 2-Year Outcomes of RCT. J Funct Biomater. 2025 Mar 4;16(3):87. doi: 10.3390/jfb16030087. | |
| 39597902 | Derived | Gorski B, Skierska IM, Nijakowski K, Brodzikowska A. Tunnel Technique and Subepithelial Connective Tissue Graft, With or Without Cross-Linked Hyaluronic Acid, in the Treatment of Multiple Gingival Recessions: Prognostic Parameters for Clinical Treatment Outcomes of Randomized Controlled Trial. J Clin Med. 2024 Nov 10;13(22):6758. doi: 10.3390/jcm13226758. |
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| Type | Date | Date Unknown |
|---|---|---|
| Release | May 11, 2025 | |
| Reset | May 30, 2025 |
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| The tunnel technique for root coverage with CTG andCross-linked Hyaluronic Acid | Device | The tunnel technique for root coverage with CTG andCross-linked Hyaluronic Acid |
|
| 12 months after surgery |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| May 11, 2025 | May 30, 2025 |
| ID | Term |
|---|---|
| D005889 | Gingival Recession |
| ID | Term |
|---|---|
| D005882 | Gingival Diseases |
| D010510 | Periodontal Diseases |
| D009059 | Mouth Diseases |
| D009057 | Stomatognathic Diseases |
| D055093 | Periodontal Atrophy |
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