A Modified Tunnel Approach in Treatment of Gingival Recession

Study Overview
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Brief Summary
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Objectives: To clinically evaluate the healing of Miller Class I and II isolated gingival recessions treated with the modified tunnel approach (mTA) versus the conventional tunnel technique (cTT) in conjunction with subepithelial connective tissue graft (SCTG). Material and Methods: In this split-mouth study, thirty healthy patients exhibiting two isolating anterior Miller Class I and II gingival recessions were treated with mTA + SCTG and cTT + SCTG. Treatment outcomes were assessed at baseline, 3-months and 6-months postoperatively. The primary outcome was root coverage esthetic scores (RES).

Detailed Description
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Various techniques have been suggested for the treatment of isolated mandibular recessions e.g., envelope, coronally advanced flaps double pedicle flap or tunneling procedures combined with laterally positioned pedicle flaps in conjunction with SCTG. Despite the fact that the mentioned techniques appear to improve root coverage, the success in terms of complete root coverage has high variability and thus it is still unknown which approach may lead to the most predictable outcomes. The limited evidence from the literature points clearly to the clinical importance of developing new concepts for predictable of isolated mandibular recessions. The MTA is a dual flap approach; that starts with full thickness flap (avoiding papilla incision) till the level of the mucogingival junction. On reaching the level of the vestibular mucosa, a partial thickness flap is applied to undermine the base of the flap. Using this dual approach carries two main advantages: avoidance of severing the gingival blood supply through the full thickness flap, in addition to minimizing the tension on the flap tissue through using the partial thickness flap at the above-mentioned site. In this trial, the mTA has been proposed for the surgical treatment of isolated mandibular recessions due to the following advantages: 1) it avoids vertical releasing incisions. 2) it doesn't incise the papilla, which may improve the vascularization of the area plus stabilizing the soft tissue flap. 3) it is suitable to patients with thin gingival biotype.

Official Title
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Evaluation of Root Coverage Outcome Using a Modified Tunnel Approach Versus Tunnel Technique: A Randomized Clinical Trial

Conditions
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Gingival Recession

Intervention / Treatment
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* Procedure: mTA + SCTG


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: except for chronic periodontitis, our patients were systemically free Two mandibular Miller Class I or II recession sites at least 2 mm attached gingiva. at least 3 mm depth of recession. Exclusion Criteria: Systemic diseases. Smokers or formal smokers Pregnant or lactating females History of antibiotic therapy at the last 6 months Patients who are not willing to follow the study protocol

Ages Eligible for Study
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Minimum Age: 29 Years
Maximum Age: 47 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

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: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: The test group<br>This group included 30 recession defects treated with mTA + SCTG | Procedure: mTA + SCTG<br>* These recession defects will be covered by modified tunnel approach; using a full thickness flap till the level of mucogingival junction then, partial thickness flap will be applied in the vestibular mucosa. SCTG will be harvested from the palate, put on the root surface then covered by the mTA and sutured.<br>* Other names: Dual approach + SCTG;|
| No Intervention: The control group<br>This group included 30 recession defects treated with cTT + SCTG | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The change in Root Coverage Esthetic Score | This score evaluates five variables: level of the gingival margin, marginal tissue contour, soft tissue texture, mucogingival junction alignment, and gingival color. It is calculated by expert operator. | Baseline, 3 months and 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The change in percentage of root coverage | The percentage of root coverage will be calculated at 3 months, then 6 months. | Baseline, 3 months and 6 months | 
| The change in depth of gingival recession | The change in depth of gingival recession will be calculated at baseline, 3 months and 6 months. | Baseline, 3 months and 6 months. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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gingival recession, tunnel technique, Miller Class I and II