Tunnel vs. CAF for the Treatment of Multiple Gingival Recessions
Condition: Gingival Recession
MeSH terms: Gingival Recession
Study type: Interventional

Summary: 
      Many studies have compared the tunnel technique and coronally advanced flap in the treatment
      of single and multiple recessions. However, there is a lack of evidence that compared both
      techniques in combination with a connective tissue graft, for just multiple adjacent
      recessions. No technique is clearly superior to another in terms of complete root coverage
      (CRC), mean root coverage (MRC) and the gain of keratinized tissue height (KTH) when multiple
      recession coverage was evaluated. Moreover, as a connective tissue graft supposed to offer
      more stability in terms of complete root coverage in long-term basis, the main question
      should be aimed at the role of the sub-epithelial connective tissue graft, when it is used in
      combination with one technique or another. Hence, the hypothesis is focused on if the use of
      a connective tissue graft in combination with a tunnel technique would provide higher
      clinical outcomes and similar patient-based outcomes than its use in combination with the
      Coronally Advanced flap technique.
    

Detailed description: 
      Parallel group, clinical evaluator- and statistician-blinded, randomized clinical trial.
    

Intervention name(s): Connective tissue Harvest and CAF; Connective tissue Harvest and Tunnel
Intervention type(s): Procedure; Procedure
Intervention description(s): A connective tissue graft will be harvested from the palate as a free gingival graft, which will be de-epithelialized with a 15-c blade(Zucchelli et al. 2010) before opening of the opaque envelopes, which contains the allocation concealment. The dimensions of the graft achieve 3 to 5 mm mesial and distal from the lateral teeth with an ideal thickness about 1 to 1.5 mm. Donor tissue will be taken at premolar and molar level. In control sites, the graft will be adapted to cover each exposed root to the CEJ, and stabilized with either 6-0 resorbable sutures (with the knot placed under the papillary area) or a non-resorbable suture with the knot on the palatal side. For suturing of the graft, interrupted sutures or sling sutures (anchored to periosteum apical to the graft and hanging around the neck of the experimental teeth) may be used.; A connective tissue graft will be harvested from the palate as a free gingival graft, which will be de-epithelialized with a 15-c blade(Zucchelli et al. 2010) before opening of the opaque envelopes, which contains the allocation concealment. The dimensions of the graft achieve 3 to 5 mm mesial and distal from the lateral teeth with an ideal thickness about 1 to 1.5 mm. Donor tissue will be taken at premolar and molar level.
In test sites, the graft should be slid through the tunnel. To accomplish the adequate position of the graft into the tunnel, 2 sutures are first placed, 1 at the most mesial and the other at the most distal aspect of the tunnel. The needles should pass underneath the tunnel and exit through the largest or most central gingival recession, the one through which the grafting tissue will be introduced. With these 2 sutures already inside the tunnel, the graft is bitten on both ends with vertical mattress sutures.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The two intervention groups will be the CAF group (standard of care control) and Tunnel group (TUN, Test group). Two experienced clinicians (ML, or JG) will deliver treatment consisting of root coverage surgery using a coronally advanced flap in combination with a connective tissue graft (Control group), or a tunnel technique (Test group) in combination with a connective tissue graft.
Follow-up of individual patients will be 6 months (to be extended to 3 years to observe differences in a long-term basis)
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment