Gingival Recession, Mucogingival Surgery
Conditions
Keywords
plaque index, Bleeding On Probing, Gingival Recession, Multiple Adjacent Gingival Recession, V-reverse suture, anchored sling suture, mean root coverage, root coverage esthetic score, complete root coverage, keratinized tissue width, gingival thickness, probing depth, recession depth, root coverage, coronally advanced tunnel, patient-reported experience measures, pilot study, split-mouth, gingiva, periodontium
Brief summary
The goal of this split-mouth pilot study is to study the effect of two different suturing techniques in root coverage using coronally advanced flap tunnel in multiple adjacent recession cases to see which technique will give superior outcomes in term of mean root coverage percentage, and root coverage esthetic score after 3-months. The main questions it aims to answer are: * Does a suturing technique gives superior mean root coverage percentage over another? * Does a suturing technique gives superior root coverage esthetic score? Researcher will compare between V-reverse suturing technique and anchored sling suture to see which will result in superior mean root coverage percentage, and root coverage esthetic score after 3-months. Participants will: * Come in for a first visit to check your gum health, check eligibility and to be provided with scaling and polishing if needed. * Come in for surgery and clinical measurements. * Participant will be asked to complete post-operative questionnaire for 14 days. * Re-evaluated after 1 week and suture removal at 2 weeks. * Follow-up after 1 and 3 months.
Detailed description
This split-moth pilot study is designed to assess the comparative effectiveness of V-reverse suturing technique(test) and anchored sling suturing technique (Control) in patients with bilateral multiple adjacent gingival recession. The primary aim of the study is to compare the test and control groups in terms of the obtained mean root coverage (mRC) and Root coverage esthetic score (RES) in 3 months. The secondary aims are to compare the two groups in terms of Complete root coverage (CRC), Keratinized tissue width (KTW), Gingival thickness (GT), Recession depth (REC), Probing depth (PD), and Patient-reported outcomes and satisfaction. At surgery day (T0) baseline measurements and photographs will be taken for all participants and they will be treated with coronally advanced tunnel with autogenous connective tissue graft harvested from the palate for both sides. Each side will be randomly allocated for either V-reverse suturing technique (test) or anchored sling suturing technique (control) to advance the tunnel coronally. At the end of the surgery postoperative instructions will be delivered to all patients in a written and oral manner, in conjunction with a medical prescription, and post-operative questionnaire to fill for the next 14 days to capture patient-reported experience measures (PREMs). Participants will be re-evaluated at 1 week and at 2 weeks sutures will be removed. At (T1) 1 month after surgery the following parameters will be recorded : bleeding on probing (BOP), plaque index (PI), and recession depth. At (T2) 3 month after surgery the following parameters will be recorded : bleeding on probing (BOP), plaque index (PI), recession depth, probing depth (PD), clinical attachment loss (CAL), gingival thickness (GT), keratinized tissue width (KTW), Root coverage esthetic score (RES), mean root coverage% (mRC%), and complete root coverage(cRC "YES/NO").. Visual analog scale from 0 - 10 (10- very dissatisfied, 0- very satisfied) at each visit after surgery was taken to assess patients overall satisfaction, and another visual analog scale from 0 - 10 (10- worst pain, 0- no pain) to assess patients perceptions of pain. Photographs will be taken at each visit, all indices will be recorded by a calibrated examiner, and oral hygiene instructions will be reinforced at each visit. The trial will be conducted in accordance with the Declaration of Helsinki (2013) and Good Clinical Practice (GCP) guidelines. Approval has been granted by the Institutional Review Board (IRB) of Jordan University of Science and Technology. Written informed consent will be obtained from all participants prior to enrollment. Adverse events will be documented, monitored, and reported according to IRB requirements.
Interventions
PROCEDUREcoronally advanced tunnel with v-reverse suture
The V-reverse suturing technique can be a valid technique for improving graft and flap stability in the midfacial region which is likely the most crucial area that should be firm for achieving complete root coverage following the tunnel approach. The V-reverse suture starts in the palatal aspect, passing below the splinted contact point. Then the needle engages the graft and the flap (from inside to outside) ≈3 mm apical to the soft tissue margin in the mid-facial area. Then the needle passes to the palatal side under the contact point. Then the needle turns one round around the splinted composite (without pinching the soft tissue), and then the knot is performed and tightened over the composite. At the end, the sutures form a V-reverse shape
PROCEDUREcoronally advanced tunnel with anchored sling suture
In addition to interrupted sutures, sling sutures have also regularly been applied as a conventional method of suturing to advance periodontal flaps over exposed root surfaces and connect the papillae to the interdental connective tissues, and composite stops where added to provide better stability.
Sponsors
King Abdullah University Hospital
Jordan University of Science and Technology
Deanship of Scientific Research/Jordan University of Science and Technology
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Intervention model description
This study is conduct in a split mouth fashion, meaning each patient arch is divided into quadrants, each quadrant is then randomized to either the test or the control group. Therefore, the study is considered a parallel-group (within-subject) design in terms of participant recruitment, because each subject receives two experimental interventions. However, from an intervention and randomization perspective, it is a comparative trial where the mouth is divided into quadrants (e.g., left and right) that are randomly assigned to different suturing techniques.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Age ≥ 18 years * Periodontally and systemically healthy; * Good plaque control (FMPS \< 20%) * Presence of two quadrants exhibiting multiple (2 or more sites) adjacent RT1 or RT2 gingival recession ≥ 2 mm in at least one site. * Non-smoker.
Exclusion criteria
* Smoking * Pregnant or lactating women; * Untreated periodontitis; * Systemic disorders with compromised healing potential; * Use of medications (immuno-suppressants, phenytoin, or anything else that might affect soft tissue healing); * Undergoing radiotherapy; * History of mucogingival surgery. * Presence of severe tooth malposition, rotation, or super-eruption. * Presence of root caries or inadequate prosthetic restorations; * Persistence of uncorrected gingival trauma from toothbrushing.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| mean root coverage percentage | 3 months | It represents the average percentage of the initial recession depth that has been successfully covered by new gum tissue over a defined period. |
| root coverage esthetic score | 3 months | (RES) is a, 10-point, five-variable system developed by Cairo et al. (2009) to objectively evaluate the success of gingival recession treatment. It evaluates root coverage (60% weight, 0-6 points) and four soft tissue parameters: margin contour, tissue texture, junction alignment, and color (40% weight, 1 point each). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of complete root coverage | 3 months | a periodontal surgical outcome where the gingival margin is repositioned to the level of, or coronal to, the cementoenamel junction (CEJ), completely covering previously exposed root surfaces |
| change in keratinized tissue width | at baseline and 3 months | Measured as the distance from gingival margin to mucogingival junction (MGJ) using a periodontal probe (UNC15). |
| change in gingival thickness | at baseline and at 3 months | Probe visibility technique was used, by inserting a periodontal probe (UNC15) in mid-facial aspect of the tooth, and thin gingival biotype is defined as ≤ 1mm (visible probe), while thick is \> 1mm (invisible probe). |
| change in recession depth | at baseline, 1 month, and 3 months | Measured as the distance between the cementoenamel junction (CEJ) and gingival margin using a periodontal probe (UNC15). |
| Patient reported experience measures (PREMs) | For 14 days after surgery | were assessed using validated translations of the OHIP-14 questionnaire into the native language of all participants. Patients were instructed to use a postoperative diary for the first 14 days after the surgery to capture patient-reported experience measures (PREMs). The diary was designed to assess patient recovery in four main areas: post-surgery sequelae, pain and discomfort, oral function, interference with daily activities. |
| change in probing depth | at baseline and 3 months | Measured as the distance from the gingival margin to the base of the pocket using a periodontal probe (UNC15). |
| Patient satisfaction score | day one, 1week, 2weeks, 1 month, 3months after surgery | Visual analog scale from 0 - 10 (10- very dissatisfied, 0- very satisfied) at each visit after surgery was taken to assess patients overall satisfaction. |
| Patient perception of pain score | day one, 1 week, 2 weeks following surgery | Visual analog scale from 0 - 10 (10- worst pain, 0- no pain) to assess patients perceptions of pain. |
Countries
Jordan
Contacts
STUDY_CHAIRReem Abdel-Hafez
Jordan University of Science and Technology
Outcome results
None listed