Treatment of Gingival Recessions With Connective Tissue or Concentrated Growth Factor Membrane Using Tunnel Technique

Study Overview
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Brief Summary
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This randomized controlled clinical study aimed to evaluate the success of the combination of tunnel technique and concentrated growth factor membrane for root coverage in treating multiple gingival recessions and compare with the gold standard connective tissue graft.

Detailed Description
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The study included 108 defects in 40 patients with Miller Class I and II gingival recession. Gingival recession defects were randomly divided into two groups. Tunnel technique + connective tissue graft was applied to 20 patients in the control group (51 defects) and tunnel technique + concentrated growth factor membrane was applied to 20 patients in the test group (57 defects). The results at baseline and 6 months were evaluated for the following clinical parameters: Mean root coverage, complete root coverage, probing depth, clinical attachment level, gingival recession depth, gingival recession width, keratinized tissue width and gingival thickness.

Official Title
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Clinical Evaluation of the Treatment of Multiple Gingival Recessions With Connective Tissue Graft or Concentrated Growth Factor Membrane Using Tunnel Technique: A Randomized Controlled Clinical Trial

Conditions
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Gingival Recession

Intervention / Treatment
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* Procedure: Tunnel technique
* Procedure: Connective tissue graft
* Other: Concentrated growth factor membrane


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age ≥18 years periodontally and systemically healthy presence of Miller I or II class gingival recession defect in at least two teeth on the buccal aspect of incisors, canine and premolar teeth (≥ 2 mm in depth) gingival thickness ≥ 0.8 mm 2 mm apical to the gingival margin presence of identifiable cementoenamel junction (CEJ) (step ≤1 mm at the CEJ level and/or presence of a root irregularity/abrasion with identifiable CEJ was accepted full-mouth plaque score (FMPS) ≤20%. Exclusion Criteria: smoking contraindications for surgical periodontal treatment presence of recession defects associated caries, restoration and furcation problems use of systemic antibiotics for any reason in the last 3 months.

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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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 |
| --- | --- |
| Active Comparator: TT+CTG<br>The combined connective tissue graft (CTG) with tunnel technique (TT) | Procedure: Tunnel technique<br>* After local anesthesia, the exposed root surfaces were mechanically treated with curettes. A tunnelling knives were used to prepare a split-thickness flap and create a continuous tunnel in the buccal soft tissues, following the intrasulcular incision with a #69 microblade. Split-thickness flap preparation was performed to beyond the mucogingival junction with supraperiosteal dissection by placing the tunneling knives to the soft tissue. This process was repeated by entering through the sulcus of each tooth. After the elevation of the flap, a papilla elevator placed under the flap was entered through the sulcus to mobilize the papilla, the periosteum at the base of the papilla was cut, and the full-thickness flap was elevated.<br>Procedure: Connective tissue graft<br>* CTG was harvested using the de-epithelialized connective tissue graft technique. The epithelial tissue on the outer surface of the graft was removed with a 15 blade and a 1-mm-thick graft was obtained.<br>|
| Experimental: TT+CGF<br>The combined concentrated growth factor (CGF) membrane with tunnel technique (TT) | Procedure: Tunnel technique<br>* After local anesthesia, the exposed root surfaces were mechanically treated with curettes. A tunnelling knives were used to prepare a split-thickness flap and create a continuous tunnel in the buccal soft tissues, following the intrasulcular incision with a #69 microblade. Split-thickness flap preparation was performed to beyond the mucogingival junction with supraperiosteal dissection by placing the tunneling knives to the soft tissue. This process was repeated by entering through the sulcus of each tooth. After the elevation of the flap, a papilla elevator placed under the flap was entered through the sulcus to mobilize the papilla, the periosteum at the base of the papilla was cut, and the full-thickness flap was elevated.<br>Other: Concentrated growth factor membrane<br>* Intravenous blood samples were collected in without anticoagulant 10-mL tubes and immediately centrifuged in a CGF centrifuge machine using a program with the following features: 30 ̋ acceleration, 2 min at 2700 rpm, 4 min at 2400 rpm, 4 min at 2700 rpm, 3 min at 3000 rpm, and 36 ̋ deceleration and stop. After centrifugation, four layers were formed in the tube: the serum layer at the top, the second buffy coat layer, the third CGF layer containing GF and unipotent stem cells, and the red blood cell layer at the bottom. The resulting CGF was removed from the tube and separated from the red blood cell layer using microsurgical scissors.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complete root coverage | Change from baseline in percentage of complete root coverage at 6th months. | Six months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean root coverage | Change from baseline in percentage of root coverage at 6th months. | Six months | 
| Probing depth | Change from baseline in probing depth at 6th months. The distance between the sulcus base and the gingival margin the midbuccal aspect of the teeth | Six months | 
| Clinical attachment level | The changes in clinical attachment level after 6th months. Distance between the sulcus base and the CEJ in the midbuccal aspect of the teeth | Six months | 
| Gingival recession depth | The changes in gingival recession depth after 6th months. Distance between the gingival margin at the deepest point of recession | Six months | 
| Gingival recession width | The changes in gingival recession width after 6th months. Horizontal distance between the mesial and distal margin of the recession defect at the CEJ | Six months | 
| Keratinized tissue width | The changes in keratinized tissue width after 6th months. Distance between the gingival margin and the mucogingival junction | Six months | 
| Gingival thickness | The changes in gingival thickness after 6th months. Measured midbuccally from 2 mm apical to the gingival margin with a No: 20 endodontic spreader | Six months |