Gingival Recessions
Conditions
Keywords
Laser Therapy, Gingival Recession, autografts
Brief summary
The aim of this study is to evaluate the clinical effectiveness of three techniques used in combination with the tunnel method for the treatment of multiple gingival recessions: subepithelial connective tissue graft (SCTG Group), scalpel-de-epithelialized free gingival graft (Scalpel Group), and Erbium, Chromium: Yttrium-Scandium-Gallium-Garnet (Er,Cr:YSGG) laser-de-epithelialized free gingival graft (Laser Group).
Detailed description
Gingival recession is not only one of the most common aesthetic and functional problems of the periodontium, but also one of the most complex conditions in terms of etiology and treatment modalities. Subepithelial connective tissue grafts (SCTG), applied in combination with various techniques, are considered the gold standard in the treatment of gingival recession. In cases where a surgical approach is indicated, coronally advanced flap (CAF) or graft-based subepithelial connective tissue procedures in combination with the tunnel technique (TT) have been reported to be successfully utilized. The use of de-epithelialized free gingival graft (De-epFGG) as a connective tissue graft (CTG) represents another treatment option for managing gingival recession. With advancements in laser technology, lasers with various wavelengths are increasingly being used as alternatives to scalpels in numerous intraoral surgical procedures. Considering the advantageous properties of erbium lasers, which are among the most prominent dental lasers, their use has also been demonstrated for preparing recipient sites for free gingival grafts (FGG). There are only a limited number of studies in the literature investigating the combination of De-epithelialized Free Gingival Graft (De-epFGG) with the Tunnel Technique (TT). The aim of this study is to evaluate the clinical effectiveness of SCTG, scalpel-based De-epFGG, and Er,Cr:YSGG laser-based De-epFGG techniques, all applied in combination with the tunnel technique, in the treatment of Miller Class I and II multiple gingival recessions. The study hypothesis is that the percentage of root coverage achieved using De-epFGG (scalpel and laser methods) would be comparable and that these methods could serve as strong alternatives to SCTG.
Interventions
PROCEDUREUsing the tunnel technique in the treatment of gingival recession
Microsurgical periodontal instruments were used during surgical procedures. In this study, specially developed tunnel instruments (Helmunt Zepf, Seitingen-Oberflacht, Germany) were used to mobilize the gingivo-papillary unit and prepare the supraperiosteal tunnel bed. After passing the coronal edge of the alveolar bone with the tunnel instrument placed in the soft tissue, it was advanced towards the apical mucogingival junction with small, circular movements. This procedure was repeated by entering from the sulcus of each tooth. Care was taken to ensure that the prepared flaps were in the same layer and opened towards each other. In the interdental areas, the papillary complex was carefully separated from the periosteum and mobilized in the buccal direction. Thus, mobilization of the entire buccal soft tissue complex was achieved in the coronal direction. After these procedures, it was checked whether the flap covered the recession areas without tension.
Sponsors
Yuzuncu Yil University
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
19 Years to 52 Years
Healthy volunteers
Yes
Inclusion criteria
Presence of Miller Class I or II recession defects in at least two adjacent teeth in the maxillary or mandibular arch * Recession depth ≥ 2 mm * Recession areas present on intact, caries-free teeth with no restorations
Exclusion criteria
* ▪ History of periodontal surgery in the target area within the past 6 months * Use of antibiotics within the past 6 months * Pregnancy or lactation * Presence of Miller Class III or IV gingival recession * Recession defects on molar teeth * Undergoing orthodontic treatment, * Presence of parafunctional habits * Individuals with contraindications for periodontal surgery were excluded from the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Probing Depth | baseline and 6th month | Each tooth was measured from the gingival margin to the sulcus base using a periodontal Williams probe, and probing depths were recorded. |
| The percentage of Root Coverage (RCP) | Baseline and 6 months | In this study, the difference between the root surface coverage rate in areas with gingival recession was evaluated by subtracting the 6th month recession depth from the pre-treatment recession depth. |
| Clinical Attachment Level | baseline and 6th months | The distance from the mid-buccal point of the teeth to the groove/pocket base based on the cemento-enamel junction was measured in mm with a periodontal probe. |
| Recession Depth | baseline and 6th month | The mid-buccal point of the teeth with gingival recession was measured with a periodontal probe, taking the cemento-enamel junction as the basis, until the coronal part of the gingival margin. |
| Width of Keratinized Tissue | baseline and 6th month | Clinically, it is determined by subtracting the distance between the free gingival margin and the mucogingival line from the distance to the groove/pocket base. |
| Transgingival Gingival Thickness | baseline and 6th month | In this study, gingival thickness was determined by the transgingival probing method. |
| Gingival İndex | Baseline and 6th month | Loe ve Silness, 1963 (0-3, skor) |
| Plaque Index | baseline and 6th month | Silness ve Löe, 1966 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Oral Health Impact Profile-14 and Provoked Sensitivity (PS), | baseline and 6th month | Postoperative morbidity was assessed using quality of life measurements (Oral Health Impact Profile-14, OHIP-14), provoked sensitivity (PS), and the operation durations of the groups. PS was evaluated preoperatively at the recession sites to detect dentin hypersensitivity by applying a 3-second air spray provocation administered by the clinician. |
Countries
Turkey (Türkiye)
Outcome results
None listed