Coronally Advanced Flap With Alloderm Versus Coronally Advanced Flap With Micro-needling on RT1 Gingival Recession

The Effect of Coronally Advanced Flap With Acellular Dermal Matrix (Alloderm) Versus Coronally Advanced Flap With Micro-needling on RT1 Gingival Recession: A Pilot Study

This study aims to assess the effect of micro-needling together with coronally advanced flap procedure on the gain of gingival thickness (GT) and keratinized tissue width (KTW) and compare it to Alloderm with coronally advanced flap procedure in the management of thin periodontal phenotype associated with recession type 1 (RT1)

Gingival or periodontal diseases were found to occur more likely in patients with a thin gingival biotype. The periodontal phenotype was also found to show stronger correlation with gingival thickness rather than keratinized tissue width and papilla height. Moreover, the thin gingiva was usually found to be associated with thin bony plate with potential for dehiscence and fenestration and hence was thought to be at risk for recession after trauma.

Several techniques have been recommended for the treatment of gingival recession. One of the most predictable outcome is associated with the use of a coronally advanced flap and acellular dermal matrix graft.

Treatment of thin periodontal phenotype through the conjunction of i-PRF and micro-needling may be a first move of the non-surgical approach for improving the gingival thickness. Micro-needling was proved to be generally an effective and safe therapeutic option for numerous dermatologic conditions as clinical improvement of scars, striae, and rhytids with appropriate recovery and limited side effects. The controlled dermal wounding and stimulation of the wound healing cascade through Micro-needling was found to enhance collagen production and thus was responsible for the clinical results obtained.

Therefore, this study will be aiming to compare the effect of micro-needling on the gingival thickness in root coverage procedures. It will also provide an insight of its effect on the patient related factors and the root coverage parameters.

Inclusion Criteria:

• Patient consulting in the outpatient clinic.

  • Able to tolerate the study procedures.
  • Patient ready to perform oral hygiene instructions.
  • Compliance with the maintenance program.
  • Provide informed consent.
  • Accepts the 6 months follow-up period

• Mature permanent tooth.

• Full-mouth plaque index (PI) and full-mouth bleeding on probing (BOP) score of ≤ 15%.

• Presence of identifiable Cemento-enamel Junction.

• RT1 facial recession defect of ≥3 mm.

• Clinical indication and/or patient request for recession coverage

Exclusion Criteria:

• Medically compromised patients.

  • use of any drugs that might lead to gingival enlargement
  • Pregnant or nursing women.
  • Uncooperative patients.
  • Smokers.

• Teeth with malocclusion, crowding, fillings, missing or supernumerary mandibular anterior teeth.

  • Cairo Recession Type 3 (RT3) recession defects.
  • Teeth with active orthodontic treatment.
  • Previous periodontal surgery.