Comparison of Two Flaps for Root Coverage
Condition: Gingival Recession
MeSH terms: Gingival Recession
Study type: Interventional

Summary: 
      The aim of this study was to compare clinical, esthetic and patient-centered outcomes of
      coronally advanced tunnel (TUN) and coronally advanced flap (CAF) both associated with
      connective tissue graft (CTG) in the treatment of gingival recession.
    

Detailed description: 
      This is a prospective, parallel and controlled clinical trial. The population evaluated in
      the study was selected at Institute of Science and Technology (ICT), São José dos Campos,
      College of Dentistry.

      Patients were assigned to one of the three treatment groups:

        -  Group TUN+CTG (21): Periodontal surgery for root coverage through tunnel flap technique
           plus connective tissue graft.

        -  Group CAF+CTG (21): Periodontal surgery for root coverage through trapezoidal flap plus
           connective tissue graft.

      All surgical procedures were performed by a single operator (MPS). The gingival recession
      defects were randomly treated by either the trapezoidal-type of coronally advanced flap plus
      connective tissue graft (CAF+CTG) or the coronally advanced tunnel technique with
      subepithelial connective tissue graft (TUN+CTG). In brief description, CAF treatment was
      performed by starting with two divergent releasing incisions lateral to the recessed area. A
      sulcular incision was made to unite the releasing incisions and the flap was raised beyond
      the mucogingival junction (MGJ) in split-full-split thickness. The connective tissue graft
      was removed from the palate and sutured in position. Sling sutures were placed to stabilize
      the flap in a coronal position 2 mm above the cement-enamel junction (CEJ), followed by
      interrupted sutures to close the releasing incisions. The tunnel flap was performed with
      initial sulcular incisions, spit thickness flap was prepared using specific tunneling knives
      beyond the mucogingival junction and until flap gain mobility. The flap was laterally
      extended to adjacent papillae that were carefully detached by means of a full-thickness
      preparation. The connective tissue graft was insert into the tunnel. Sling sutures were
      performed involving the flap and graft to coronally cover 2 mm above the CEJ. After the
      surgery, the participants were requested to take 500 mg of sodium dipyrone every 4 hours for
      3 days in case of pain, and to avoid brushing and flossing in the treated area for a period
      of 2 weeks. During this period, plaque control was performed using 0.12% chlorhexidine rinse
      used twice a day. The sutures were removed after 7 days, and all of the patients were
      recalled for prophylaxis and reinforcement of motivation and instruction for atraumatic tooth
      brushing during the study period.

      Clinical, esthetics, and comfort of patients parameters were assessed at 45 days, 2, 3 and 6
      months after the procedure.

      Quantitative data were recorded as mean ± standard deviation (SD), and normality was tested
      using Shapiro-Wilk tests. The probing depth (PD), relative gingival recession (RGR), clinical
      attachment level (CAL), keratinized tissue thickness (KTT), keratinized tissue width (KTW),
      and dentin hypersensitivity (DH) values were examined by two-way repeated measures ANOVA to
      evaluate the differences within and between groups, followed by a Tukey test for multiple
      comparisons when the Shapiro-Wilk p value was ≥ 0.05. Those presenting Shapiro-Wilk p values
      < 0.05 were analyzed using a Friedman test (for intragroup comparisons) and Mann-Whitney
      tests (for intergroup comparisons). Patients' esthetics and discomfort measures using visual
      analog scale (VAS) were analyzed by T-tests. The frequency of complete root coverage was
      compared using χ2 tests. Intergroup root coverage esthetic score (RES) comparisons were
      performed with a T-test. A significance level of 0.05 was adopted.
    

Intervention name(s): CAF plus connective tissue graft; Tunnel plus connective tissue graft; Sodium dipyrone; chlorhexidine rinse
Intervention type(s): Procedure; Procedure; Drug; Drug
Intervention description(s): Periodontal surgery for root coverage by the trapezoidal flap associated with connective tissue graft.; Periodontal surgery for root coverage by the tunnel flap associated with connective tissue graft.; All participants were instructed to take 500 mg sodium dipyrone just in case of pain.; All participants were instructed to perform 0.12% chlorhexidine rinse after the surgical procedures.
Other intervention name(s): Periodontal plastic surgery; Periodontal plastic surgery; Drug prescription; Drug prescription
Intervention MeSH terms: Dipyrone; Chlorhexidine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment