De‐epithelialized gingival graft versus subepithelial connective tissue graft in the treatment of multiple adjacent gingival recessions using the tunnel technique: 1‐year results of a randomized clinical trial

Abstract

Aim To compare the clinical efficacy and postoperative morbidity of de‐epithelialized gingival graft (DGG) with subepithelial connective tissue graft (SCTG) on treatment of multiple adjacent gingival recessions (MAGRs) with tunnel technique (TUN) and to evaluate histological characteristics of the palatal grafts. Materials and methods Twenty‐seven patients with MAGRs affecting at least 2 adjacent teeth were treated with either DGG + TUN or SCTG + TUN. Recession depth(RD) and width(RW), probing depth(PD), clinical attachment level(CAL), keratinized tissue height(KTH), gingival thickness(GT), and complete and mean root coverage(CRC, MRC) were evaluated at 6 and 12 months postoperatively. Multilevel analysis was performed to identify patient‐ and tooth/site‐related predictors for the 12‐month MRC outcomes. Postoperative patient morbidity and histological characteristics of palatal graft samples obtained during harvesting were investigated. Results At the 12‐month follow‐up, MRC was 91.72% ± 16.59% and 84.72% ± 19.72% in DGG + TUN and SCTG + TUN groups (p = .001). Multilevel regression analysis identified RD, KTH and GT as variables associated with MRC. No significant difference between the groups was observed regarding postoperative patient morbidity parameters. Cellularity was found significantly higher in the SCTG samples compared to the DGG samples (p < .05). Conclusions Although DGG + TUN presented higher MRC and CRC compared to SCTG + TUN in the treatment of MAGRs, treatment method was not a significant predictive factor for the amount of MRC outcomes while RD, KTH and GT were significant predictive factors.

Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes

“…Nonetheless, single linear measurements (recession height and width) did not emerge as potential prognostic parameters of statistically significant importance in our report. The findings of the present study are not in line with results from a recently published study by Bakhishov et al [ 39 ] who found in multilevel regression analysis that GR height at baseline was a significant negative prognostic factor in the amount of 12-month ARC after MCAT + SCTG (p = 0.02). The mentioned model revealed no significant effect of initial RW on ARC though, which was in accordance with our findings.…”

Intraoral De-Epithelialized Gingival Graft in the Treatment of Multiple Adjacent Gingival Recessions: Case Report with a 1-Year Follow-Up

“…Azar et al [31] reported that, DGG could be considered as "dense CTG", included minimum adipose and epithelial tissue. Despite epithelial remnant cells during de-epithelialization [32], DGG was unique graft for root coverage [18].…”

“…Using DGG has minimized chair time during operation was recorded [17]. Implementation DGG with tunnel technique in the treatment of gingival recessions was successfull [18], many alternative products as connective tissue grafts (CTG), collagen matrix [19], acelular dermal allo-and xenografts [20] have been studied. In spite of many articles, few articles have discussed using DGG for multiple recessions, especially when associated with the tunnel technique [18,21].…”

“…Implementation DGG with tunnel technique in the treatment of gingival recessions was successfull [18], many alternative products as connective tissue grafts (CTG), collagen matrix [19], acelular dermal allo-and xenografts [20] have been studied. In spite of many articles, few articles have discussed using DGG for multiple recessions, especially when associated with the tunnel technique [18,21]. The subepithelial connective tissue graft is a predictable and versatile technique in treatment of gingival recessions [10,22].…”

Effect of 24% EDTA root conditioning on the outcome of modified coronally advanced tunnel technique with subepithelial connective tissue graft for the treatment of multiple gingival recessions: a randomized clinical trial

“…Distinct modifications to the original tunnel technique have been described over time by several authors to improve clinical outcomes [6][7][8]. Although the efficacy of the tunnel technique was dependent on the application of subepithelial connective tissue graft (SCTG), which was regarded as the gold standard [9], attempts have been made to search for materials alternative to SCTG, such as collagen porcine dermal matrix [10], enamel matrix derivatives [11], and concentrated growth factors [12]. In order to achieve good esthetic results, the understanding how to apply scientific evidence for a given case is crucial [13].…”