In the randomized comparative controlled trial, 50 patients with insufficient keratinized
      tissue at the anterior mandible were treated with either Modified coronally advanced tunnel
      or epithelialized free gingival graft. At baseline, 6th week, 6th month, 12th-month visits;
      keratinized tissue height, gingival thickness, recession depth, recession width, probing
      depth, and clinical attachment level, were evaluated. Keratinized tissue change, Gingival
      thickness change, root coverage, clinical attachment gain, and complete root coverage were
      calculated. Wound healing index, tissue appearance, patient expectations, aesthetics, and
      dentine hypersensitivity were assessed at baseline and 6th week.

Can Modified Coronally Advanced Tunnel be an Alternative in Gingival Phenotype Modification?

Gingival Phenotype

Epithelialized free gingival graft

Modified coronally advanced tunnel technique

Can Modified Coronally Advanced Tunnel be an Alternative to Epithelialized Free Gingival Graft Technique in Gingival Phenotype Modification? A Comparative Controlled Randomized Clinical Trial

GT, measured at the midpoint location between the gingival margin and mucogingival junction, using an endodontic spreader (#25 endodontic spreader, 25 mm; D-perfect, Shenzhen, China).

GT, measured at the mid-point location between the gingival margin and mucogingival junction, using an endodontic spreader (#25 endodontic spreader, 25 mm; D-perfect, Shenzhen, China).

KTH, measured from gingival margin to the mucogingival junction (MGJ).

Assoc. Prof. Dr.

RD, measured from the cemento-enamel junction (CEJ) to the most apical extension of the gingival margin.

Recession width (RW), the distance between the mesial gingival margin and the distal gingival margin of the tooth measured from the widest point of the recession.

Probing pocket depth (PD), measured from the gingival margin to the bottom of the gingival sulcus.

Clinical attachment level (CAL), measured from the cementoenamel junction to the bottom of the gingival sulcus.

Keratinized tissue change (KTC), GT change (GTC), root coverage, clinical attachment gain (CAG) were calculated in millimeters and percentages.

Wound healing index (WHI) was recorded two-weeks after surgery. The wound surface was visually inspected and the soft tissue healing was defined as 'uneventful' (score 1), 'slightly disturbed' (score 2) or 'poor' (score 3) based on the presence and severity of the items including patient discomfort, erythema, edema, suppuration and flap dehiscence.

Tissue appearance (TA) was evaluated by asking the patients to score the consistency, contour, color match, keloid formation degree and contiguity of their treated sites at T2. The scores were collected as points, shown in parentheses, by asking the consistency as firm (1p) or spongy (0p); contour as presence (2p) or absence (0p) of knife-edged and scalloped gingival margin; color match as excellent (3p), good (2p), adequate (1p) or unsatisfactory (0p); keloid formation degree as absent (1p) or present (0p); contiguity as the presence (-1p) or absence (0p) of each perceptible incision mark.

Dentine hypersensitivity (DH) was evaluated with air evaporative stimulus method at baseline and T2. After placement of finger(s) for preserving the nearby teeth, the recession sites were subjected to evaporative stimulus comprised of 1-second air blast from 1 to 3 mm distance by using the air spray at 40-65 psi pressure and 19±50C. After application, the patients were requested to give a score to their DH between 0 (=no pain) and 10 (=extreme pain).

Patient expectations (PE) were evaluated by requesting from the patients to rate their treatment results at T2, as satisfactory or not, in terms of appearance, experience and obtained root coverage.

Aesthetics (A) was evaluated by the patient at T1 by rating its level as excellent, good, fair or poor.

Initial sulcular incisions and flap separation were then carried out with tunnel knives. Dissection was extended at least 8 mm apically to the mucogingival junction and the muscle attachments were removed with curettes so that the flap could be moved in a coronal direction without tension. Interdental papillae were undermined to prepare the bed for connective tissue graft placement. Connective tissue graft was then inserted under the tunnel at the sites of recession and retracted laterally by sutures towards each end of the tunnel. After connective tissue graft positioning, the flap was gently stretched coronally to obtain passive flap closure. The exposed connective tissue was covered by connecting the adjacent flap margins with additional sutures.

A partial-thickness flap was elevated (blade #15c) with horizontal incisions at the cemento-enamel junction level of the adjacent teeth. Then, two vertical incisions extending to the apical were made from two ends of the horizontal incision. The epithelium in the framed region was removed with a scalpel and the underlying connective tissue was exposed. To achieve the best vascularization from the recipient site, bed preparation was completed with a split-thickness horizontal incision that joins the vertical incisions in the apical region.

Can Modified Coronally Advanced Tunnel be an Alternative in Gingival Phenotype Modification?

About this trial

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Type

Phase

Placebo

Accepting

Trial Timing

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