Management of Miller Class I & II Gingival Recession

Study Overview
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Brief Summary
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Management of Miller class I & II gingival recession using coronally advanced flap combined with conventional de-epithelialized free gingival graft versus coronally advanced flap combined with abrasive de-epithelized connective tissue graft Null hypothesis: In patients with Miller class I and II gingival recession, there is no difference between coronally advanced flap with conventional de-epithelialized free gingival graft and coronally advanced flap with abrasive de-epithelized connective tissue graft in recession depth reduction.

Official Title
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Management of Miller Class I & II Gingival Recession Using Conventional Versus Abrasive De-epithelization of Palatal Graft

Conditions
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Gingival Recession

Intervention / Treatment
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* Procedure: coronally advanced flap with abrasive de-epithelized graft.
* Procedure: coronally advanced flap with de-epithelized graft.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years. Systemically healthy patients. Miller's Class I and II recession defects with recession depth ≥ 2mm. Presence of identifiable cemento-enamel junction (CEJ). Clinical indication and/or patient request for recession coverage. Smoking ≤ 10 cigarettes/day. Cooperative patients able and accept to come for follow up appointments. Exclusion Criteria: Pregnant females. Smoking ˃ 10 cigarettes/day. Contraindication for periodontal surgery. Patients with poor oral hygiene. Recession defects associated with caries or restoration as well as Teeth with evidence of a pulpal pathology Molar teeth

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Test group<br>SCTG will be harvested from the palate in the intervention group (coronally advanced flap and abrasively de-epithelialized free gingival graft) | Procedure: coronally advanced flap with abrasive de-epithelized graft.<br>* SCTG will be harvested from the palate by abrasive de-epithelialization of palatal graft involves removing the epithelium of the selected area with a high-speed hand piece and diamond bur<br>|
| Active Comparator: Control group<br>SCTG will be harvested from the palate using Zucchilli's technique (zucchelli, 2010) in the control group (coronally advanced flap and conventionally de-epithelialized free gingival graft) | Procedure: coronally advanced flap with de-epithelized graft.<br>* SCTG will be harvested from the palate by abrasive de-epithelialization of palatal graft involves removing the epithelium of the selected area with a blade<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Direct Post-operative pain | Directly will be evaluated post-surgically with Visual Analogue Scale with numbers from 0 to 10 that given to the patients at 7 days follow-up visits. | 7 days | 
| Indirect Post-operative pain | Indirectly will be evaluated on the basis of the mean consumption of analgesics | 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complete Root Coverage | CRC evaluated in patients by single operator clinically using a periodontal probe. Root coverage was deemed complete when the gingival margin is at or above the level of CEJ | 6 months | 
| Recession depth. | Measured from the CEJ to the most apical extension of the gingival margin | 6 months | 
| Gingival Recession Width | measured at the level of the CEJ. | 6 months | 
| Width Of Keratinized Gingiva | Measured from the gingival margin to the mucogingival line | 6 months | 
| Root Coverage Esthetic Score | The RES system evaluates five variables 6 months following surgery | 6 months | 
| Gingival thickness | It will be measured by penetrating the gingiva mid-buccally in the attached gingiva, half way between mucogingival junction and free gingival groove with the periodontal probe after giving local anesthesia to measure the thickness of gingival tissues. | 6 months | 
| Surgical chair time | measured by Stop watch | at the time of surgery |