RT2 Gingival Recession Clinical Trial
Official title:
The Effect of the Tunneling Technique With Subepithelial Connective Tissue Graft Versus Tunneling Technique With Deepithelialized Free Gingival Graft on the Papillary Height in the Treatment of RT2 Recession Defect: a Randomized Clinical Trial.
Complete coverage of the recession complemented with pleasing esthetics and minimal probing
measures are the main goals of root coverage procedures.
According to a consensus report from the AAP regeneration workshop on the periodontal soft
tissue root coverage procedures; most studies have been directed on RT-1 (Miller Class I and
II) defects and that further research on results in RT-2, RT-3 ( Miller Class III and IV)
defects is needed. Consequently, it was planned to conduct this research on RT-2 (Miller
Class III) recessions to overcome this gap of knowledge, de-epithelialized free gingival
graft is proposed aiming to enhance the papillary height, esthetic, with less pain and
postoperative trauma. Equally, it is considered a more conservative approach with fewer
complications.
Gingival recession has high prevalence among both individuals with periodontal disease and
those with high standers of oral hygiene. The management of RT-2 ( Miller Class III) gingival
recessions is very challenging and there is controversy in the literature concerning the most
predictable approach to treat these defects.
Treatment of gingival recession is performed to enhance esthetics, reduce dentinal
hypersensitivity, eliminate caries risk, stop the progression of gingival recession and
periodontal attachment loss and keratinized tissue augmentation to enable the patient to
maintain adequate plaque control.Gingival recession or "Marginal tissue recession" is
recognized as the apical migration of the marginal gingiva to its normal position on the root
surface. Connective tissue graft (CTG) is considered to be the best root coverage techniques
for the treatment of gingival recession defects.
However, it is challenging sometimes to harvest the largest volume of tissue especially in
thin palatal tissue as recently it was recommended to keep 2mm of soft tissue thickness
covering the palate to minimize the postoperative pain. Otherwise, necrosis/dehiscence of the
flap may happen which was reported to occur frequently for the trap-door approach. Moreover,
it is necessary to extend the dissection deeper into the palatal tissues to leave adequate
thickness of connective tissue to maintain the vitality of the primary flap which may cause
more painful post-operative course.
To overcome these limitations, CTG harvesting with de-epithelialized gingival grafts (DGG)
can be executed even in the presence of thin palatal tissues. CTG preparation can be
performed more superficially by this approach to obtain collagen-rich connective tissue from
Lamina pro- pria of the palatal mucosa. The findings of Zucchelli et al. study support the
observation that CTGs which are presumed to have denser connective tissue are comparatively
less prone to post-operative shrinkage . According to this assumption, DGG technique may
enable to harvest an adequate amount of dense and stable tissue
;