Clinical Evaluation of (TCAF) Versus (CAF) Combined With Connective Tissue Graft in the Treatment of Multiple RT2 Gingival Recession Sites

Cairo University (CU)

Status: Begins enrollment in 1 month

Conditions: Gingival Recession, Plastic Surgery

Treatments: Procedure: TCAF

Study type: Interventional

Funder types: Other

Identifiers

NCT07064603

2025-17-1

Details and patient eligibility

About

the aim of the study is to evaluate the changes in gingival recession depth reduction following, treatment of multiple RT2 recession with tunnel coronal advanced flap in comparison to coronal advanced flap, both combined with connective tissue graft

Full description

Several techniques for gingival recession defects have been developed for treatment such as are pedicle soft-tissue graft (rotational flap procedures, advanced flap procedure and tunneling), free soft-tissue graft (epithelialized and subepithelial connective tissue graft) and regenerative procedures (barrier membrane or biologic mediators.

The coronally advanced flap and the tunneling technique are the most commonly performed surgical approaches for treating gingival recessions. Barootchi et al. 2024 conducted a clinical study using tunnel coronal advanced flap technique(TCAF) for treating multiple RT2 gingival recession defects ,in order to combine the advantage of both better access and graft stabilization in CAF and the preservation of the integrity of the papilla and better blood supply to the graft present in tunneling technique. From the previous study it was concluded that the combination of both techniques in the same surgical design can improve both the flap and graft vascularization and enhance clinical, esthetic, and patient-reported outcomes. To our knowledge, there is no conducted randomized clinical trials comparing the tunneled coronally advanced flap technique to the coronally advanced flap for gingival depth reduction in multiple RT2 recessions.

So, this clinical trial aims to address this gap of the literature.

Enrollment: 22 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients age 18 years or older.
• Multiple adjacent recession defect classified as RT2.
• Patients with healthy systemic condition (Mazzotti et al., 2023).
• An esthetic concern or hypersensitivity associated with GR
• The gingival recessions must have at least 1.5 mm of KTW.
• Presence of an identified CEJ (A step ≤ 1mm of the CEJ level)

Exclusion criteria

• Full-mouth plaque and bleeding scores >20 (O'Leary et al., 1972)
• Patients with active periodontal disease;
• Intake of any medications known to affect gingival homeostasis or to interfere with wound healing
• Pregnancy and nursing women
• Smokers: a contraindication for any plastic periodontal surgery (Khuller, 2009).
• Absence of cervical restorations, crowding or malalignment

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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22 participants in 2 patient groups

CORONAL ADVANCED FLAP WITH CONNECTIVE TISSUE GRAFT

Active Comparator group

Description:

The surgical papillae will be elevated using split thickness manner while maintaining the blade in a nearly parallel position to the root. * The flap apical to the exposed root will be elevated in a full-thickness The full thickness flap covers the avascular root exposure. * The releasing vertical incisions will be elevated protect the underlying bone in the lateral areas of the flap. * The part of the flap apical to bone exposure will be elevated by split-thickness, this step will be done so it is possible to move the flap passively in the coronal direction. * To permit the coronal advancement of the flap, all muscle insertions present in the thickness of the flap will be eliminated. This will be done by keeping the blade parallel to the external mucosal surface. The connective tissue graft, is harvested from the hard palate (donor site) then it will be sutured in the surgical recipient site then covered by the coronal advancement of the flap and suturing it.

Treatment:

Procedure: TCAF

Tunnel coronal advanced flap with connective tissue graft

Experimental group

Description:

only one surgical papilla will be elevated. The papilla chosen for incision must be with the least interproximal attachment loss. A slightly divergent vertical incision extending beyond the mucogingival junction then a horizontal incision at a distance equal to the recession depth plus 1 mm apical to the papilla tip. The other papillae integrity is preserved , and will be detached using tunneling miniblades and papilla elevator. The flap will be tunneled till the planned papilla .Connective tissue graft will be harvested the graft will be inserted underneath the flap and tunneled below the non-incised papillae. The TCAF is coronally advanced and stabilized 2 mm above the CEJ with sling and simple interrupted sutures at the level of the papillae and simple interrupted sutures for the vertical incision Further coronal advancement of the tunneled papilla with a suspended suture around the with a composite stop

Treatment:

Procedure: TCAF