Randomized clinical trial evaluating single maxillary gingival recession treatment with connective tissue graft and tunnel or trapezoidal flap: 2‐year follow‐up

Abstract

Background: The literature lacks long-term evidence regarding outcomes of the coronally advanced tunnel flap (TUN) combined with connective tissue graft (CTG) when compared to the trapezoidal coronally advanced flap (CAF) and CTG combination. This study presents 2-year results of a randomized clinical trial comparing CTG combined with either CAF or TUN in the treatment of single maxillary gingival recession (GR) defects. Methods: Thirty-nine patients, each contributing a single Miller Class I or II GR defect, were treated by CAF+CTG (control; n = 19) or TUN+CTG (test; n = 20) and completed the 2-year follow up. Clinical, patient centered, and esthetic evaluations were performed and differences among groups were analyzed. Results: At 2 years, mean root coverage for control and test group was 89.5% ± 14.6% and 87.7% ± 18.4%, respectively (P = 0.5). The corresponding complete root coverage prevalence was 68.4% and 50% (P = 0.4). Dentin hypersensitivity significantly decreased for both groups. The two groups showed improvement in esthetics, as assessed by both professionals and patients, without significant intergroup differences (P > 0.5). TUN+CTG sites were much more likely to present improvement in root coverage between 6 months and 2 years, exhibiting creeping attachment of 0.7 ± 0.6 mm. Conclusions: At 2 years of follow up, both CAF+CTG and TUN+CTG resulted in significant clinical and esthetic improvements and provided similar results in the treatment of single maxillary GRs.

Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 5‐year results of an RCT using 3D digital measurement technology for volumetric comparison of soft tissue changes

“…Therefore, it is conclusive that RECred and RC were significantly better at CT‐grafted sites (TUN+CTG: 1.75 mm and 82.2%) compared to non‐augmented sites (CAF+EMD: 0.50 mm and 32.0%) confirming other long‐term evaluations (Barootchi et al, 2019; Tavelli, Barootchi, Di Gianfilippo, et al, 2019). In contradiction to our findings, a recently published 2‐year follow‐up RCT on gingival recession treatment revealed stable THK with a tendency for increased HKT and RECred values from 1 to 2 years (Neves et al, 2019). A possible explanation might consist of the fact that the composition of the applied CTGs differs substantially from the ones used in our study.…”

“…The use of three‐dimensional measuring methods makes a comparison with other studies using rigid millimetre‐scaled periodontal probes difficult (Leknes et al, 2005; Cordaro et al, 2012; McGuire et al, 2012; Garces‐McIntyre et al, 2017; Barootchi et al, 2019; Neves et al, 2019; Petsos, Eickholz, Raetzke, et al, 2020; Salem et al, 2020). The applied measuring technique has demonstrated accuracy and high reproducibility to record in vitro imitated gingival recessions to the nearest 0.01 mm (Lehmann et al, 2012).…”

Iatrogenic acid‐induced gingival recession during crown cementation: A case report

“…In our case, creeping attachment was evident 9 months following the procedure. This coronal gingival migration following the use of subepithelial connective tissue graft has been previously documented in the literature 12,13 . Additional creeping attachment may occur up to 2 years after the graft procedure with a tunnel flap, 13 resulting in further gingival approximation or coverage of the apical margin of the crown.…”

“…This coronal gingival migration following the use of subepithelial connective tissue graft has been previously documented in the literature 12,13 . Additional creeping attachment may occur up to 2 years after the graft procedure with a tunnel flap, 13 resulting in further gingival approximation or coverage of the apical margin of the crown. This case report is the first to describe creeping attachment at a site that had suffered a chemical injury, indicating that such sites may respond similarly to non‐traumatized tissues.…”

On the value of the 2017 classification of phenotype and gingival recessions

“…For the first time, a single classification integrated recession‐related factors, phenotype‐related factors, and tooth‐related factors. Despite the significant advantages that the 2017 classification on phenotype and gingival recession provided compared with previous classifications, its use seems to have been accepted more slowly within the literature on periodontal plastic surgery which still often reports on previous classifications 11,12 …”