Gingival Recession
Conditions
Keywords
Multiple Gingival Recessions, Volume-Stable Collagen Matrix, Subepithelial Connective Tissue Graft, Coronally Advanced Flap
Brief summary
Gingival recession is a clinical condition in which the gingival margin is displaced apically, exposing the root surface. This condition may be associated with esthetic concerns, dentin hypersensitivity, and difficulties in oral hygiene. Subepithelial connective tissue grafting is considered a standard surgical approach for root coverage, but it requires harvesting tissue from the palate, which may increase postoperative discomfort. Volume-stable xenogeneic collagen matrices have been proposed as an alternative biomaterial to reduce the need for a palatal donor site. This randomized controlled clinical trial will compare a volume-stable xenogeneic collagen matrix with an autogenous subepithelial connective tissue graft for the treatment of multiple gingival recessions. Participants will be allocated to one of two treatment groups. The test group will receive root coverage surgery using a volume-stable collagen matrix, while the control group will receive root coverage surgery using a subepithelial connective tissue graft. Clinical, patient-reported, esthetic, and digital outcomes will be assessed at baseline and during follow-up visits up to 12 months. The primary outcome will be the change in gingival recession depth from baseline to 12 months. Secondary outcomes will include keratinized tissue width, gingival thickness, percentage of root coverage, complete root coverage, dentin hypersensitivity, patient-reported satisfaction, early wound healing, and digital volumetric changes assessed by intraoral scanning.
Detailed description
This study is a randomized controlled clinical trial designed to evaluate the clinical performance of a volume-stable xenogeneic collagen matrix compared with an autogenous subepithelial connective tissue graft in the treatment of multiple gingival recessions. Eligible participants presenting multiple gingival recessions will be recruited and allocated to one of two parallel treatment groups. In the test group, participants will receive root coverage surgery using a volume-stable xenogeneic collagen matrix associated with a coronally advanced flap. In the control group, participants will receive root coverage surgery using an autogenous subepithelial connective tissue graft associated with a coronally advanced flap. Clinical assessments will include gingival recession depth, keratinized tissue width, probing depth, clinical attachment level, gingival thickness, percentage of root coverage, and complete root coverage. Patient-reported outcomes will include dentin hypersensitivity, postoperative comfort, esthetic satisfaction, and acceptance of the procedure. Standardized clinical photographs and intraoral scans will be obtained during follow-up. Digital analyses will be used to assess changes in soft tissue volume over time. The primary endpoint will be the change in gingival recession depth from baseline to 12 months. Secondary endpoints will include clinical, esthetic, patient-reported, wound healing, and digital volumetric outcomes assessed at predefined follow-up visits.
Interventions
DEVICEVolume-stable xenogeneic collagen matrix (VCMX)
A volume-stable xenogeneic collagen matrix will be used as a soft-tissue substitute for root coverage surgery. The matrix will be placed over the recession defects and covered by a coronally advanced flap.
An autogenous subepithelial connective tissue graft will be harvested from the palate and used for root coverage surgery. The graft will be placed over the recession defects and covered by a coronally advanced flap.
Sponsors
University of Sao Paulo
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The clinical examiner and the assessors responsible for photographic and digital outcome analyses will be masked to treatment allocation. The surgeon will not be masked because of the nature of the procedures. Participants will not be masked because the control group involves palatal tissue harvesting.
Intervention model description
Participants will be randomized into two parallel groups. The test group will receive root coverage surgery using a volume-stable xenogeneic collagen matrix associated with a coronally advanced flap. The control group will receive root coverage surgery using an autogenous subepithelial connective tissue graft associated with a coronally advanced flap.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 years or older. * Presence of at least two Cairo RT1 gingival recessions in anterior teeth and/or premolars. * Gingival recession depth greater than or equal to 2 mm. * Presence of at least 2 mm of keratinized gingiva apical to the gingival recession. * Indication for root coverage treatment due to esthetic concern and/or dentin hypersensitivity. * Sites with non-carious cervical lesions may be included if they are previously restored and, after restoration, present residual gingival recession greater than or equal to 2 mm. * Good plaque control, defined as full-mouth plaque score and full-mouth marginal gingival bleeding score below 20%.
Exclusion criteria
* Current smokers or individuals who stopped smoking less than 12 months before enrollment. * Decompensated systemic diseases. * Pregnancy or lactation. * Active periodontal disease. * Untreated root caries. * Previous mucogingival surgery in the study area.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Gingival Recession Depth | Baseline, 3 months, 6 months, and 12 months | Gingival recession depth will be measured clinically in millimeters as the distance from the cementoenamel junction to the gingival margin. The main comparison between groups will be performed at 12 months. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Gingival Recession Width | Baseline, 3 months, 6 months, and 12 months | Gingival recession width will be measured horizontally in millimeters at the level of the cementoenamel junction. |
| Keratinized Tissue Width | Baseline, 3 months, 6 months, and 12 months | Keratinized tissue width will be measured in millimeters from the gingival margin to the mucogingival junction. |
| Gingival Thickness | Baseline, 3 months, 6 months, and 12 months | Gingival thickness will be measured in millimeters at the treated sites using a standardized clinical method. |
| Probing Depth | Baseline, 3 months, 6 months, and 12 months | Probing depth will be measured in millimeters from the gingival margin to the bottom of the sulcus or pocket at the treated sites. |
| Clinical Attachment Level | Baseline, 3 months, 6 months, and 12 months | Clinical attachment level will be calculated in millimeters as probing depth plus gingival recession depth. |
| Percentage of Root Coverage | 3 months, 6 months, and 12 months | Percentage of root coverage will be calculated based on the reduction in gingival recession depth from baseline to 12 months. |
| Complete Root Coverage | 3 months, 6 months, and 12 months | Complete root coverage will be defined as the absence of residual gingival recession at the treated site. |
| Dentin Hypersensitivity | Baseline, 3 months, 6 months, and 12 months | Will be assessed after standardized air stimulation using a 0 to 100 visual analog scale. A score of 0 indicates no pain or sensitivity, and a score of 100 indicates the worst imaginable pain or sensitivity. Higher scores indicate worse dentin hypersensitivity. |
| Patient-Reported Esthetic Satisfaction | Baseline, 3 months, 6 months, and 12 months | Patient-reported esthetic satisfaction will be assessed using a 0 to 100 visual analog scale. A score of 0 indicates complete dissatisfaction, and a score of 100 indicates complete satisfaction. Higher scores indicate better esthetic satisfaction. |
| Digital Volumetric Changes | Baseline, 3 months, 6 months, and 12 months | Soft tissue volumetric changes will be assessed using intraoral scans and digital superimposition of three-dimensional Standard Tessellation Language (STL) models. |
| Early Wound Healing | 7 days, 14 days, and 30 days | Early wound healing will be assessed clinically during the postoperative period based on flap margin adaptation, suture stability, edema, inflammation, erythema, fibrin accumulation, tissue necrosis, epithelialization, biomaterial or graft exposure, and overall wound healing pattern. |
Countries
Brazil
Contacts
CONTACTEdgar Daniel Vargas Quiroga, DDS, MSc
CONTACTArthur Belem Novaes Jr, DDS, PhD
PRINCIPAL_INVESTIGATORArthur Belem Novaes Jr, DDS, PhD
University of Sao Paulo
STUDY_CHAIREdgar Daniel Vargas Quiroga, DDS, MSc
University of Sao Paulo
Outcome results
None listed