Treatment of multiple adjacent RT 1 gingival recessions with the modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: 9-year results of a split-mouth randomized clinical trial

Abstract

Objectives To evaluate t he long-term outcomes following treatment of RT 1 multiple adjacent gingival recessions (MAGR) using the modified coronally advanced tunnel (MCAT) with either a collagen matrix CM or a connective tissue graft (CTG). Material and methods Sixteen of the original 22 subjects included in a randomized, controlled split-mouth clinical trial were available for the 9-year follow-up (114 sites). Recessions were randomly treated by means of MCAT + CM (test) or MCAT + CTG (control). Complete root coverage (CRC), mean root coverage (MRC), gingival recession depth (GRD), probing pocket depth (PD), keratinized tissue width (KTW), and thickness (KGT) were compared with baseline values and with the 12-month results. Results After 9 years, CRC was observed in 2 patients, one in each group. At 9 years, MRC was 23.0 ± 44.5% in the test and 39.7 ± 35.1% in the control group (p = 0.179). The MRC reduction compared to 12 months was − 50.1 ± 47.0% and − 48.3 ± 37.7%, respectively. The upper jaw obtained 31.92 ± 43.0% of MRC for the test and 51.1 ± 27.8% for the control group (p = 0.111) compared to the lower jaw with 8.3 ± 46.9% and 20.7 ± 40.3%. KTW and KGT increased for both CM and CTG together from 2.0 ± 0.7 to 3.1 ± 1.0 mm (< 0.0001). There were no statistically significant changes in PD. Conclusion The present results indicate that (a) treatment of MAGR using MCAT in conjunction with either CM or CTG is likely to show a relapse over a period of 9 years, and (b) the outcomes obtained in maxillary areas seem to be more stable compared to the mandibular ones. Clinical relevance The mean root coverage at 12 months could not be fully maintained over 9 years. On a long-term basis, the results seem to be less stable in the mandible as compared to maxillary areas.

Soft Tissue Substitutes in Periodontal and Peri-Implant Soft Tissue Augmentation: A Systematic Review

“…In a recent study [ 28 ] presenting the 9-year outcomes of a prior RCT by Aroca et al [ 24 ], among the 16 participants from the 9-year follow-up, mRC decreased from 73.2% to 23.0% in the CMX group and from 88.0% to 39.7% in the CTG group. Interestingly, there were no significant differences between the groups after 9 years ( p = 0.179).…”

Long‐term stability of gingival margin and periodontal soft‐tissue phenotype achieved after mucogingival therapy: A systematic review

“…It should be considered that, although some treatment arms involving the use of autograft and allografts also resulted in a decrease in GT over time (Barootchi et al, 2019; Dominiak et al, 2006; Tavelli et al, 2019; Zuhr et al, 2021), these groups also achieved greater GT thickness after RC, compared to CAF and EMD + CAF. Also, some trials found evidence of GT increase in the long term for sites treated with either autogenous grafts or soft‐tissue substitutes (Barootchi et al, 2019, 2021; Molnár et al, 2022; Skurska et al, 2022). Thus, the variability in the percentages of GT changes between short‐ and long‐term follow‐ups (i.e., some studies/treatment arms demonstrated GT increase while others reduction) and the final long‐term GT outcomes (≥1 mm for all sites treated with soft‐tissue augmentation procedures) suggests that the observed long‐term changes might be related to a biological remodelling/contraction of the gingival tissue.…”

“…Also, some trials found evidence of GT increase in the long term for sites treated with either autogenous grafts or soft-tissue substitutes (Barootchi et al, 2019(Barootchi et al, , 2021Molnár et al, 2022;Skurska et al, 2022).…”

Comparative evaluation of pinhole surgical technique with and without A‐PRF in the treatment of multiple adjacent recession defects: A clinico radiographic study

“…The present study purposely included MAGRD in the maxillary arch as there have been reports in the literature pertaining to different results in terms of root coverage in the maxillary and mandibular defects with the former yielding better results 11,31 . Both of these studies reported three‐fold differences in the maxillary and mandibular defects.…”

“…complexity of MAGRD and at the same time causing minimal discomfort for the patient. There is presently paucity of literature pertaining to the effectiveness of PST in MAGRD and so the study was undertaken to address the problem.The present study purposely included MAGRD in the maxillary arch as there have been reports in the literature pertaining to different results in terms of root coverage in the maxillary and mandibular defects with the former yielding better results 11,31. Both of these studies reported three-fold differences in the maxillary and mandibular defects.…”