effect of microneedling with coronally advanced flap for management of rt1 gingival recession in thin gingival phenotype

Conditions: Gingival Recession

Summary: the goal of this clinical trial is to explore the effect of microneedling to increase the gingival tissue thickness which could improve the outcome of root coverage in coronally advanced flap procedure in thin gingival phenotype. the main question it aims to answer is that : does the use of microneedling procedure followed by coronally advanced flap has similar outcomes of root coverage in recession type 1 (rt1) gingival recession i.e. buccal gingival recessions without interdental clinical attachment loss in thin gingival phenotype as compared to coronally advanced flaps with connective tissue graft. systemically healthy patients having isolated upper rt1 gingival recession will be assigned into two groups. microneedling will be performed in one group (4 sessions each at a 10 days interval) followed by coronally advanced flap operation (at an interval of 2 months) and coronally advanced flap with connective tissue graft will be performed in the other group. follow-up will be done at 1 month, 3 months and 6 months for evaluation of primary and secondary outcomes.

the gingival phenotype affects the choice of mucogingival surgical technique for coverage of the root surface in gingival recession. it has been reported that a flap thickness of \> 0.8 mm results in a covered root surface of 100%, whereas a flap thickness of \< 0.8 mm results in partial root coverage in coronally advanced flap procedure for miller class i or ii root coverage. thus connective tissue graft (ctg) use is advocated in thin phenotype cases, for improved clinical and esthetic outcomes. connective tissue graft increases the predictability of coronally advanced flap. treatment by addition of connective tissue graft has some drawbacks like creation of a second surgical site, postoperative discomfort and long chair side time, leading the researchers to explore techniques less invasive in nature. microneedling (mn), also known as "percutaneous collagen induction therapy." it creates microinjuries that result in minimal superficial bleedings and create a wound-healing cascade from which various growth factors, such as platelet-derived growth factors, transforming growth factors, connective tissue growth factor and fibroblast growth factors, are released. in microneedling, the tissue responds as if experiencing minor trauma and the body's own collagen production is induced to preserve skin integrity. microneedling as opposed to connective tissue grafts is a non-surgical approach to increase gingival thickness, that results in significant changes in the gingival thickness and keratinized tissue width of individuals with thin gingival phenotype. it is associated with higher patient acceptance, lesser surgical site co-morbidities and is a minimally invasive yet an effective approach to augment the gingiva. the histological analysis performed one year post microneedling sessions, showed increased collagen and elastic fiber accumulation in the reticular dermis, a thickened epidermis and a normal stratum corneum, showing its greater effect on gingival thickness. the present study aims to increase the gingival thickness by microneedling procedures to enhance root coverage by coronally advanced flap procedures in thin gingival phenotype. this technique is proposed to improve thin gingival phenotype by minimally invasive and non-surgical means.

Eligibility criteria:
inclusion criteria: * presence of isolated rt1 buccal maxillary gingival recessions in esthetic zone with thin gingival phenotype (gingival thickness≤1mm) associated with esthetic complaints and/or dental sensitivity and otherwise systemically healthy. * gingival recession ≥2mm , keratinized tissue width≥2mm and clinically identifiable cementoenamel junction * age 20years-50 years * patient demonstrating compliance for maintaining good oral hygiene after phase 1 therapy plaque index (pi) \<1, gingival index (gi) \<1 * providing a written and verbal informed consent. exclusion criteria: * patient with systemic disease that can influence the outcome of therapy. * pregnant females or on oral contraceptive pills or hormone replacement therapy. * smokers and patients undergoing orthodontic therapy * physically and mentally impaired patients. * non vital, malpositioned tooth * presence of cervical abrasions or restorations in the area * previous history of periodontal surgery on the involved sites.

Keywords: gingival recession percutaneous collagen induction root coverage connective tissue graft microneedle