Clinical Evaluation of (TCAF) Versus (CAF) Combined With Connective Tissue Graft in the Treatment of Multiple RT2 Gingival Recession Sites

Clinical Evaluation of Tunneled Coronally Advanced Flap (TCAF) Versus Coronally Advanced Flap (CAF) Combined With Connective Tissue Graft in the Treatment of Multiple RT2 Gingival Recession Sites: A Randomized Controlled Clinical Trial

the aim of the study is to evaluate the changes in gingival recession depth reduction following, treatment of multiple RT2 recession with tunnel coronal advanced flap in comparison to coronal advanced flap, both combined with connective tissue graft

Several techniques for gingival recession defects have been developed for treatment such as are pedicle soft-tissue graft (rotational flap procedures, advanced flap procedure and tunneling), free soft-tissue graft (epithelialized and subepithelial connective tissue graft) and regenerative procedures (barrier membrane or biologic mediators.

The coronally advanced flap and the tunneling technique are the most commonly performed surgical approaches for treating gingival recessions. Barootchi et al. 2024 conducted a clinical study using tunnel coronal advanced flap technique(TCAF) for treating multiple RT2 gingival recession defects ,in order to combine the advantage of both better access and graft stabilization in CAF and the preservation of the integrity of the papilla and better blood supply to the graft present in tunneling technique. From the previous study it was concluded that the combination of both techniques in the same surgical design can improve both the flap and graft vascularization and enhance clinical, esthetic, and patient-reported outcomes. To our knowledge, there is no conducted randomized clinical trials comparing the tunneled coronally advanced flap technique to the coronally advanced flap for gingival depth reduction in multiple RT2 recessions.

So, this clinical trial aims to address this gap of the literature.

Inclusion Criteria:

• Patients age 18 years or older.
• Multiple adjacent recession defect classified as RT2.
• Patients with healthy systemic condition (Mazzotti et al., 2023).
• An esthetic concern or hypersensitivity associated with GR
• The gingival recessions must have at least 1.5 mm of KTW.
• Presence of an identified CEJ (A step ≤ 1mm of the CEJ level)

Exclusion Criteria:

• Full-mouth plaque and bleeding scores >20 (O'Leary et al., 1972)
• Patients with active periodontal disease;
• Intake of any medications known to affect gingival homeostasis or to interfere with wound healing
• Pregnancy and nursing women
• Smokers: a contraindication for any plastic periodontal surgery (Khuller, 2009).
• Absence of cervical restorations, crowding or malalignment