Tunnel vs. coronally advanced flap in combination with a connective tissue graft for the treatment of multiple gingival recessions: a multi-center randomized clinical trial

Jerián González-Febles, Mario Romandini, Florencia Laciar-Oudshoorn, Fernando Noguerol, Crystal Marruganti, Antonio Bujaldón-Daza, Ion Zabalegui, Mariano Sanz, Jerián González-Febles, Mario Romandini, Florencia Laciar-Oudshoorn, Fernando Noguerol, Crystal Marruganti, Antonio Bujaldón-Daza, Ion Zabalegui, Mariano Sanz

Abstract

Objective: To evaluate the efficacy of the partial-thickness non-advanced tunnel technique (TUN) versus the coronally advanced flap (CAF), both combined with a connective tissue graft, in the treatment of multiple gingival recessions.

Materials and methods: Twenty-nine patients (83 teeth) affected by multiple gingival recessions were treated in two clinical centers with either the test (TUN) or the control (CAF) intervention combined with a connective tissue graft. Outcomes at 3 and 6 months after surgery included complete root coverage (CRC-primary outcome), mean root coverage (mRC), changes in recession depth (RD), probing pocket depth (PPD), and keratinized tissue height (KT). Root sensitivity and root coverage esthetic score (RES) were also evaluated at 6-month examination. Surgery duration, wound healing index (WHI), and patient-reported outcome measures (PROMs) were additionally considered.

Results: At 6 months, CRC was observed in 80.9% and 79.5% of the teeth treated with TUN and CAF, respectively (odds ratio = 1.2; p = 0.802). No differences between groups were also observed in terms of mRC (TUN = 94.0%; CAF = 91.1%), RD and PPD reductions, root sensitivity, RES, and WHI. KT increase was significantly higher in teeth treated with TUN (Difference in Means - MD = - 1.0 mm; p = 0.001). Surgery duration was shorter (MD = - 19.3 min; p = 0.001), and patients reported less intra-surgical pain (MD = - 16.4; p = 0.028) as well as postoperative morbidity in TUN compared with CAF.

Conclusions: Both surgical interventions showed a similar efficacy in terms of root coverage, albeit TUN was associated with a higher increase in KT and with a milder patient's surgical experience.

Clinical relevance: Both techniques have shown similar efficacy for the coverage of exposed root surfaces, although clinicians may consider TUN as less invasive.

Trial registration: Clinicaltrials.gov (NCT05122468).

Keywords: Clinical trial; Dentistry; Gingival recession; Minimally invasive surgical procedures; Mucogingival surgery; Patient-reported outcome measures; Root coverage procedures.

Conflict of interest statement

The authors declare no competing interests.

The authors declare no competing interests.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
Images illustrating interventions by group allocation. A–F Study case treated with a CAF: A pre-operative view; B flap elevation; C CTG sutured; D flap sutured; E 10 days; F 6 months. G–L Study case treated with TUN: G, H, I pre-operative view; J CTG sutured; K 10 days; L 6 months. CAF, coronally advanced flap; CTG, connective tissue graft; TUN, split-thickness non-advanced tunnel
Fig. 2
Fig. 2
Self-reported pain, medications, PREMs, and OHIP-14 during the 14-day postoperative period. Blue continuous line: subjects treated with CAF. Orange dashed line: subjects treated with TUN. A Worst pain; B average pain; C current pain; D at least one medication (pain-killers and/or anti-inflammatory drugs); E PREMs; F OHIP-14. CAF, coronally advanced flap; OHIP-14, oral health-related quality of life-14; PREMs, patient-reported experience measures; TUN, split-thickness non-advanced tunnel; VAS, visual analogue scale

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