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Modified coronally advanced tunnel versus epithelialized free gingival graft technique in gingival phenotype modification: a comparative randomized controlled clinical trial

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Abstract

Objectives

The gingival thickness (GT) and keratinized tissue (KT) height are defined as the gingival phenotype. Both the modified coronally advanced tunnel technique (MCAT) and free gingival grafts (FGG) are used in modifying the gingival phenotype. This study aims to compare MCAT and FGG in gingival phenotype modification.

Materials and methods

One hundred and forty recessions in 50 patients with thin and insufficient keratinized tissue at the anterior mandible were treated with either MCAT or FGG. GT, KT height, recession depth, recession width, probing depth, and clinical attachment level were evaluated at baseline and 6 weeks, 6 months, and 12 months. GT change, KT change, root coverage (RC), clinical attachment gain, and complete root coverage (CRC) were calculated. The wound healing index, tissue appearance, patient expectations, aesthetic, and dentin hypersensitivity were assessed at baseline and 6 months.

Results

All periodontal variables showed significant change from baseline to 12 months in both groups (p < 0.05). While FGG resulted in more KT change (p < 0.001), all MCAT sites showed at least 2 mm KT change in 12 months. MCAT resulted in greater GT change (p < 0.05) and RC (p < 0.003). In contrast, there was no significant inter-group CRC difference (p = 0.523). All patient-based variables were favorable to MCAT (p < 0.05), except dentin hypersensitivity (p = 0.225).

Conclusions

Both techniques were successful in terms of gingival phenotype modification in the anterior mandible. Additional GT increase, RC, and patient-based outcomes favored MCAT, though KT change proved greater with FGG.

Clinical relevance

Clinicians may choose MCAT for higher GT increase whereas FGG for more KTC.

Trial registration number: NCT04690140 and date: 12/26/2020.

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Acknowledgements

The authors express their gratitude to Ege Nadir Aytac and Ayhan Parmaksiz for their significant contribution and support to the present study.

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Authors and Affiliations

  1. Faculty of Dentistry, Periodontology Department, Hacettepe University, 06230, Sihhiye, Ankara, Turkey

    Birtan Tolga Yilmaz, Elnur Comerdov, Ceren Kutuk & H. Gencay Keceli

  2. Faculty of Dentistry, Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain

    Jose Nart

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  1. Birtan Tolga Yilmaz
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  2. Elnur Comerdov
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Correspondence to H. Gencay Keceli.

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Ethics approval

The Hacettepe University Clinical Research Ethics Committee provided ethical approval for the project (02.05.2019, KA-19047). The trial (clinical trials no.: NCT04690140) was conducted in accordance with the principles of the Declaration of Helsinki (1975, revision Tokyo, 2004).

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Informed consent was obtained from all individual participants included in the study. The authors affirm that human research participants provided informed consent for publication of the images in Fig. 1.

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Yilmaz, B.T., Comerdov, E., Kutuk, C. et al. Modified coronally advanced tunnel versus epithelialized free gingival graft technique in gingival phenotype modification: a comparative randomized controlled clinical trial. Clin Oral Invest 26, 6283–6293 (2022). https://doi.org/10.1007/s00784-022-04580-0

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