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Multiple techniques can be used for recession coverage. The most common techniques for single recessions are : tunnel technique (T) and coronally advanced flap (CAF) both combined with a palatal graft to provide sufficient gingival thickness. Recently two modifications have been described in literature, namely the tunneled coronally advanced flap and the modified tunnel. MTUN will function as the control group while people treated with the TCAF technique will function as the test group.
This randomized controlled trial compares MTUN and TCAF to determine which technique provides better root coverage for receding gums at single recession in the premandible. The main question it aims to answer is:
- What is the average root coverage achieved with each technique in the short and long term? This may be clinically relevant because covering gum recession can reduce tooth sensitivity, improve aesthetics and make oral hygiene easier.
Researchers will compare the modified tunnel technique (MTUN = the gum is undermined) with the tunneled coronally advanced flap (TCAF = the gum is undermined, only partially detached and repositioned higher). In both techniques, a small piece of tissue is removed from the palate, which is used to cover the recession. The purpose of the connective tissue graft under the flap/tunnel, is to increase thickness and provide support. Pain associated to the material used to cover the donorsite will be seen as the secondary research question. The site will either be covered by spongostan and multiple stitches or a palatal stent.
Participants will:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| TCAF + CTG | Active Comparator | Tunneled coronally advanced flap with a connective tissue graft. |
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| MTUN + CTG | Active Comparator | Modified tunnel with connective tissue graft. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| tunneled coronally advanced flap with connective tissue graft | Procedure | The gum at the recession site is undermined, only partially detached and reattached higher (combined withh a connective tissue graft). |
| Measure | Description | Time Frame |
|---|---|---|
| mean root coverage | The average percentage of previously exposed tooth root surface that becomes covered by gingival tissue following a root coverage procedure. | From enrollment up to ten years after surgical treatment. |
| Measure | Description | Time Frame |
|---|---|---|
| complete root coverage | The percentage of teeth for which the previously exposed root surface is completely covered by gingival tissue following the surgical procedure. These teeth show no visible recession after healing. | From enrollment up to ten years after surgical treatment. |
| pocket depth |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Véronique Prof. Dr. Christiaens | Contact | +32 332 40 17 | vchristi.christiaens@ugent.be |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Periodontology and Implantology of Ghent University | Recruiting | Ghent | Oost-Vlaanderen | 9000 | Belgium |
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| modified tunnel with connective tissue graft | Procedure | At the recession site, the gingiva is undermined to create a tunnel, and a connective tissue graft is inserted through the sulcus into this space before advancing the flap coronally. |
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The distance from the gingival margin to the bottom of the sulcus by use of a periodontal probe. |
| From enrollment up to ten years after surgical treatment. |
| recession reduction | The change in the amount of exposed root surface after the root coverage procedure. | From enrollment up to ten years after surgical treatment. |
| width of keratinized tissue | The distance from the mucogingival junction to the free gingival margin. It includes free and attached gingival tissue, measured by use of a periodontal probe. | From enrollment up to ten years after surgical treatment. |
| gingival thickness | Thickness of the gingival tissue measured 1-2 mm apical to the gingival margin. | From enrollment up to ten years after surgical treatment. |
| phenotype | Gingival phenotype is classified as thin, thick or combined. | From enrollment up to ten years after surgical treatment. |
| treatment time | Time in minutes from the first incision up to the last suture | Only measured during surgery in minutes. |
| post-operative pain at the donor site | Post-operative pain at the donor site will be assessed by the patient using the Visual Analogue Scale (VAS), ranging from 0 (no pain) to 10 (worst imaginable pain). A higher score indicates greater pain experienced by the patient. | From one week post-operative up to three months post-operative. |
| post-operative pain at the recession site | Post-operative pain at the recession site will be assessed by the patient using the Visual Analogue Scale (VAS), ranging from 0 (no pain) to 10 (worst imaginable pain). A higher score indicates greater pain experienced by the patient. | From one week post-operative up to three months post-operative. |
| number of analgesics | The number of pain medication tablets consumed by the patient to manage post-operative pain. | From one week post-operative up to two weeks post-operative. |
| score of aesthetic result | Aesthetic satisfaction will be based on root coverage and color match. Aesthetic satisfaction at the recession site will be assessed by use of the Visual Analogue Scale (VAS), ranging from 0 (aesthetic satisfaction not achieved) to 10 (aesthetic satisfaction fully achieved). A higher score indicates greater satisfaction. | From six months post-operative up to ten years post-operative. |
| root sensitivity | Root sensitivity is assessed using the Visual Analogue Scale (VAS), raging from 0 (no sensitivity) to 10 (extreme sensitivity), based on a tactile test with controlled air flow. A higher score indicates that the patient experiences greater sensitivity. | From one week pre-operative up to ten years post-operative. |
| willingness to retreat | A patient's willingness to undergo retreatment based on their previous experience with the procedure. It is assessed by use of the Visual Analogue Scale (VAS) ranging from 0 (not willing at all) to 10 (extremely willing). A patient reporting a higher score indicates greater willingness. | From three months post-operative up to two years post-operative. |
| 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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