Treatment of Multiple Adjacent Class I and Class II Gingival Recessions by Modified Microsurgical Tunnel Technique and Modified Coronally Advanced Flap Using Connective Tissue Graft

Abstract

A BSTRACT Background: Complete and uneventful recession coverage should be the aim of gingival recession treatment. Systematic reviews have said that coronally advanced flap with connective tissue graft (CTG) is the gold standard for gingival recession treatment. Minimally invasive procedures with optical magnification allow minimal tissue manipulation and precise adaptation of wound edges helping in faster and uneventful healing, thus bringing about a satisfactory clinical and patient outcome. Thus, the following study compares the clinical- and patient-related outcomes of modified microsurgical tunnel technique (MMTT) and modified coronally advanced flap (MCAF) using CTG in the coverage of multiple adjacent Miller’s class I and II gingival recessions. Materials and Methods: Gingival recession patients were selected and were assigned randomly to either MMTT+CTG or MCAF+CTG. Clinical parameters were evaluated at 1, 3, and 6 months. Patient’s satisfaction level was assessed by measuring root coverage esthetic score, hypersensitivity, and morbidity. The statistical analysis was performed using commercially available software SPSS version 14. Descriptive statistics were expressed as mean±standard deviation for each parameter. Intragroup comparison was done by using the paired T -test. Intergroup comparison was done using the independent Student’s T -test. The significance level was set at P = 0.05. Results: MMTT+CTG showed a statistically significant greater clinical- and patient-related outcome. Conclusion: MMTT+CTG, being a closed procedure, preserves the blood supply, helps in faster healing, and does not compromise the esthetics. All these lead to decreased morbidity and increased patient satisfaction which makes MMTT a superior technique than the conventional procedure in gingival recession treatment.

A Systematic Review of Randomized Clinical Trials Evaluating the Efficacy of Minimally Invasive Surgery for Soft Tissue Management: Aesthetics, Postoperative Morbidity, and Clinical Results

“…Eighteen more studies were eliminated after reading the complete text because they failed to meet several requirements for selection. Ultimately, this systematic review comprised 11 randomized clinical trials [ 3 , 7 , 10 , 19 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] ( Figure 1 ).…”

“…The experiments evaluated 273 patients with a minimum sample of 7 patients [ 19 ] and a maximum sample of 40 [ 7 , 27 ], followed by a period of between 4 months [ 7 ] and 2 years [ 28 , 32 ]. These trials assessed MIST for papilla preservation [ 27 , 28 ], excessive gingival display [ 3 ], minimally invasive flapless implant placement [ 7 ], and treatment of gingival recessions [ 10 , 19 , 29 , 30 , 31 , 32 , 33 ]. Most of the clinical trials had a parallel [ 7 , 27 , 29 , 31 ] or split-mouth design [ 3 , 10 , 19 , 32 , 33 ].…”

“…These trials assessed MIST for papilla preservation [ 27 , 28 ], excessive gingival display [ 3 ], minimally invasive flapless implant placement [ 7 ], and treatment of gingival recessions [ 10 , 19 , 29 , 30 , 31 , 32 , 33 ]. Most of the clinical trials had a parallel [ 7 , 27 , 29 , 31 ] or split-mouth design [ 3 , 10 , 19 , 32 , 33 ]. Moreover, three studies used biomaterials [ 27 , 28 , 30 ].…”

“…Considering the treatment of gingival recessions, contradictory results were observed. While four randomized clinical trials presented greater root coverage with MIST (98–99%; p < 0.05) [ 10 , 26 , 27 , 33 ], three randomized clinical trials did not show differences between groups [ 19 , 29 , 31 ]. Furthermore, one experiment described that MIST presented a significant difference in the ultrasonographic thickness of gingiva ( p < 0.003) [ 30 ].…”

“…Four randomized clinical trials indicated high patient satisfaction with MIST for root coverage and papillary augmentation ( p < 0.05) [ 10 , 19 , 28 , 30 ], and one trial described an ideal result from an aesthetic point of view using MIST [ 33 ]. Instead, three randomized clinical trials reported great and similar satisfaction for root coverage in the patients of both groups [ 29 , 31 , 32 ]. Similarly, one randomized clinical trial reported equal manifestations of satisfaction in the test and control groups during the treatment of excessive gingival display ( p > 0.05).…”