Effect of Botulinum Toxin a Injection in Treatment of Recession RT1 and RT2

Effect of Botulinum Toxin -A Injection in Mentalis Muscle with Coronally Advanced Flap and De-epithelized Free Gingival Graft in Treatment of RT1 , RT2 Gingival Recession _Randomized Control Trial

The goal of this study type: clinical trial] is to learn the effect of Botulinum Toxin _A injection in treatment of RT1andRT2 Gingival recession in lower anterior teeth .

Primary outcome is keratinzed tissue width. Researchers will compare Coronally Advanced flap with De-epithelized free gingival graft and Botulinum toxin-A injection in Mentalis muscle with coronally advanced flap with De-epithelized free gingival graft alone .

The outcome will be measured at baseline, after 3 months and after 6 mobths _medical history

• 3 mm horizontal incisions, then two vertical incisions
• deepitheliztion of anatomical papillae
• superficial and deep incisions
• harvesting DFGG
• Suturing
• BOTOX injection

Inclusion Criteria:

• Single or multiple RT1, RT2 GR patient
• patients ≥18 years
• systemically healthy, full mouth plaque score, full mouth bleeding score ≤ 15% after phase I therapy
• clinical indication and/or patient request for recession coverage
• well motivated patients, maintaining oral hygiene throughout study

Exclusion Criteria:

• Pregnant or lactating women
• Smokers' patients
• Teeth with cervical restorations/abrasion.
• Patients had a systemic condition affect blood components and healing