Comparing TCAF and MTUN With Soft Tissue Grafting for Treating Single Recessions in the Premandible

An RCT Comparing Tunneled Coronally Advanced Flap (TCAF) and Modified Tunnel Technique (MTUN) in Combination With a Soft Tissue Graft for Single Recession Coverage

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:

• Undergo surgery (MTUN or TCAF, randomly assigned) to cover recessions
• Attend regular check-ups for up to 10 years after surgery
• Keep a postoperative journal (recording medication use, pain levels, tooth sensitivity, etc.)

Inclusion Criteria:

• at least 18 years old
• good oral hygiene
• presence of one recession in the premandible
• good general health

Exclusion Criteria:

• smoker
• pregnant women (assessed at each visit; if the patient appears pregnant during follow-up, x-rays will not be taken)