Evaluation of the Clinical Efficacy of De-Epithelialized Free Gingival Graft in the Treatment of Gingival Recessions

Yuzuncu Yıl University

Status: Completed

Conditions: Gingival Recessions

Treatments: Procedure: Using the tunnel technique in the treatment of gingival recession

Study type: Interventional

Funder types: Other

Identifiers

NCT07100808

17.06.2020/14

Details and patient eligibility

About

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).

Full 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.

Enrollment: 60 patients

Sex: All

Ages: 19 to 52 years old

Volunteers: Accepts Healthy Volunteers

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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60 participants in 3 patient groups

Subepithelial Connective Tissue Grafts Group

Active Comparator group

Description:

The single incision technique was used as a guide for harvesting the SCTG from the palatal region. After achieving hemostasis in the palatal area, the incision site was primarily closed using 4-0 silk sutures with a cross-suture technique. The graft, held with guide sutures, was slid beneath the interdental papillae and placed into the tunnel bed. The elevated papillary complex was sutured together with the graft using 5-0 monofilament sutures (Neoplene, polypropylene, Turkey) and secured coronally and over the root surface, covering the graft, using vertical double-cross sutures. The surgical procedure, suturing technique, and sutures used on the recipient site were standardized across all groups.

Treatment:

Procedure: Using the tunnel technique in the treatment of gingival recession

•Scalpel-based De-epFGG Group

Active Comparator group

Description:

In this group, the De-epFGG technique recommended by Zucchelli et al. was applied. The epithelial layer on the outer surface of the harvested graft was removed by holding a 15C scalpel (Swann-Morton LTD, Sheffield, England) parallel to the surface. The prepared CTG was then placed in the tunnel bed at the desired position using guide sutures.

Treatment:

Procedure: Using the tunnel technique in the treatment of gingival recession

Er,Cr:YSGG Laser-based De-epFGG Group

Active Comparator group

Description:

Before the laser application, patients were asked to wear the necessary protective eyewear. The graft dimensions required for the recipient site were marked on the palatal donor area using a 15C scalpel. The donor site was irradiated with a 2780 nm Er,Cr:YSGG laser (WaterLase iPlus; USA Biolase Technology Inc., Irvine, CA), and the de-epithelialization procedure was completed intraorally. The surface layer formed as a result of the laser application was removed using a moist sponge.

Treatment:

Procedure: Using the tunnel technique in the treatment of gingival recession