Titanium Prepared Platelet Rich Fibrin for Multiple Gingival Recessions
Condition: Gingival Recession
MeSH terms: Gingival Recession
Study type: Interventional

Summary: 
      Objective: Titanium-prepared platelet-rich fibrin (T-PRF) is activated with titanium, which
      results in a more mature and aggregated form than PRF. In our previous studies, we
      established that the fibrin carpet formed with titanium had a firmer network structure, and
      longer resorption time in the tissue than the fibrin carpet formed with glass. The purpose of
      this randomized controlled clinical trial is to compare the effects of autogenous T-PRF and
      CTG.

      Materials and methods: A total 114 Miller Class I/II gingival recessions with abrasion
      defects will be treated either T-PRF (63 teeth) or CTG (51 teeth) using a modified tunnel
      technique. Clinical periodontal indexes, keratinized tissue (KTW), gingival thickness (GT)
      and recession depth (RD) will be recorded before surgery and at 6 and 12-month follow-up
      examinations. The Visual Analog Scale and healing index scores will be assessed.
    

Detailed description: 
      A total of 34 patients will be informed in detail about the risks and benefits of each step
      of the study, and their signed consents will be obtained.

      These clinical assessments will be done:

        1. Plaque Index and Gingival Index In case of multiple gingival recessions, plaque index
           and gingival index will be obtained from the three dental points as mesial, distal and
           vestibule midpoints; plaque index will be calculated according to Sillnes&Löe criteria,
           whereas gingival index will be calculated according to Löe&Silness criteria.

        2. Periodontal Pocket Depth In case of multiple gingival recessions, the distance between
           the pocket base and free gingival margin will be measured separately for each tooth with
           the assistance of periodontal Williams probe through the midpoint of vestibule.

        3. Recession Width Periodontal probe will be horizontally placed on the enamel-cement
           border and the measurement will be recorded.

        4. Recession Depth The defect distance will be measured vertically from the enamel-cement
           conjunction of the tooth to the very apical aspect of the gingival margin using
           periodontal probe and recorded in millimeters.

        5. Clinical Attachment Level The clinical attachment level (CAL) will be measured by
           periodontal probe through the midpoint of vestibule as the distance between gingiva base
           and enamel-cement border and recorded in millimeters.

        6. Keratinized Tissue Width The distance between gingival margin and alveolar mucosa will
           be measured in millimeters. A solution consisted of 10% potassium iodide and 5% iodine
           will be applied onto the gingiva and alveolar mucosa with a cotton pellet. This solution
           stains the glycogen-rich alveolar mucosa darker than the keratinized tissue and allows
           keratinized gingival mucosa to be exposed more clearly.

        7. Gingival Thickness This measurement will be performed in the relevant area by No. 15
           endodontic spreader under topical anesthesia. The spreader will be placed perpendicular
           to the gingiva through approximately 1.5 mm apical aspect of the gingival margin, pushed
           forward until obtaining bone support, and fixed with a disc. The distance between the
           disc and the tip of endochuck will be measured by a digital caliper with a sensitivity
           of 0.1 mm.

        8. Measurement of CTG Thickness Fat and glandular tissue and band-shape epithelium on the
           CTG, which will be derived from the maxillary palate, will be removed by a scissor. The
           graft, which will be placed onto a sterile, metal smooth surface, will be fixed through
           its mesial, distal and middle aspects by a No. 15 endodontic spreader with the
           assistance of a disc and then measured by digital caliper. The mean graft thickness will
           be calculated as the arithmetic mean of the values measured.

        9. Measurement of T-TRF Membrane Thickness Two thrombocyte rich platelets taken from the
           tubes that have been centrifuged will be separated from the serum at room temperature in
           sterile gauze and will be turned into membranes. They will be measured by digital
           caliper as two-layer similar to the measurement of connective tissue thickness, and the
           values will be recorded..

      VAS Assessment On the postoperative Day 1, 3 and 7, the patients will be asked to complete a
      chart where they can rate subjective complaints of pain, burning sensation and discomfort in
      the surgery site between 0 (none) and 100 (very severe).

      Wound Healing Index While removing the sutures two weeks after surgery, the physician will
      evaluate wound healing according to the Huang criteria separately for each tooth; Score 1:
      Problem-free wound healing without gingival edema, erythema, suppuration, or dehiscence of
      the flap margins.

      Score 2. Problem-free wound healing with mild gingival edema, erythema, patient discomfort
      and flap dehiscence without suppuration.

      Score 3. Poor wound healing with severe gingival edema, erythema, suppuration, patient
      discomfort and flap dehiscence.

      Calculation of Root Surface Coverage Ratio This ratio is presented as percentage (%) and
      evaluated in the 6th and 12th months.

      Preoperative recession depth - Postoperative recession depth X 100 % Preoperative recession
      depth
    

Intervention name(s): Root Coverage Surgery with T-PRF; Root Coverage Surgery with CTG
Intervention type(s): Procedure; Procedure
Intervention description(s): Root surfaces in the multiple gingival recession regions were made smooth using Gracey curettes. To remove the smear layer, 24% EDTA solution was applied to the tooth surfaces for approximately 2 minutes and then washed with physiological saline. The receiver region was prepared using the modified tunnel method. After passive stabilization of the flap in the coronal aspect, the preparation of the donor region was initiated; Root surfaces in the multiple gingival recession regions were made smooth using Gracey curettes. To remove the smear layer, 24% EDTA solution was applied to the tooth surfaces for approximately 2 minutes and then washed with physiological saline. The receiver region was prepared using the modified tunnel method. After passive stabilization of the flap in the coronal aspect, the preparation of the donor region was initiated
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: In this randomized controlled clinical trial, multiple gingival recessions were treated by T-PRF in 16 patients and by CTG in 18 patients selected by the coin-toss method. All surgical procedures, measurements and follow-up were performed by the same clinician
Masking: None (Open Label)
Primary purpose: Treatment