Tuberosity Versus Palatal Connective Tissue Graft on the Treatment of Single Maxillary Recession-type Defects

NCT ID: NCT06404762

Last Updated: 2024-09-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-07-01

Study Completion Date

2025-02-01

Brief Summary

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The goal of this randomized clinical study is to assess the root coverage outcomes and patient morbidity following the treatment of single maxillary recession-type defects using a coronally advanced flap (CAF) combined with a subepithelial connective tissue graft (SCTG) harvested from the maxillary tuberosity (MT) versus lateral palate (LP). The secondary objective is to evaluate the histological characteristics of graft compositions harvested from the different regions (MT versus LP).

Therefore, the following questions related to the study are raised:

* Do SCTGs harvested from MT (tSCTG) and LP (pSCTG) exhibit similar root coverage outcomes in the treatment of single maxillary recession-type defects using CAF?
* What are the histological characteristics of tSCTG and pSCTG?

A total of 30 patients who have been referred to the Gazi University Department of Periodontology will be randomly assigned to receive tSCTG or pSCTG in combination with CAF. Clinical measurements will be recorded at baseline, 1, 3, 6, and 12 months after surgeries. Immediately after interventions; a questionnaire evaluating post-operative pain, discomfort, sensitivity, and bleeding will be given to the patients. The amount of non-steroid anti-inflammatory drugs used will be recorded at 1, 2, 3, 7, 14 and 28 days after surgery. Descriptive morphologic analysis of the grafts will be assessed in terms of the presence of inflammatory cells, connective tissue cellularity, vascularization, adipose tissue, and collagen structure.

Detailed Description

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The treatment of gingival recessions using the coronally advanced flap (CAF) in combination with palatal subepithelial connective tissue graft (pSCTG) is highly predictable and frequently accepted in periodontal plastic-aesthetic surgeries. However, due to its limitations and disadvantages, clinicians often use grafts harvested from different autogenous areas or multiple non-autogenous materials as an alternative.

CAF combined with pSCTG is considered the gold standard for root coverage procedures. However, factors such as the density of vascular structures, a close approximation to nerves, and postoperative morbidity remain concerning for clinicians using palatal connective tissue grafts. Because of this, researchers have sought different techniques for palatal connective tissue harvesting and/or different autogenous donor areas. The maxillary tuberosity region has been found to have a denser lamina propria and is farther from nerve/vascular bundles.

Despite differences in harvesting techniques, literature has presented similar root coverage outcomes, lesser post-operative bleeding, and pain for SCTGs harvested from the maxillary tuberosity (tSCTG) compared to pSCTG groups. Decreased post-operative pain after tSCTG harvesting could be explained by higher amounts of connective tissue present in the donor area after harvesting and avoiding trauma created by food consumption and tongue movements in the region. Clinical data also showed an increased amount of keratinized tissue and its stability after augmentation, favoring tSCTG. Considering structural differences, literature has shown that tSCTG provides more thickness, a more abundant lamina propria, and denser collagen compared to pSCTG. However, due to the size of the harvested tSCTG not being as abundant as pSCTG, it can be assumed that the augmented areas were limited to multiple recessions or defects.

Conditions

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Gingival Recession, Localized

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized controlled clinical study
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators

Study Groups

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tSCTG+ CAF

Single, isolated gingival recessions; excluding molars; at maxilla will be treated with subepithelial connective tissue graft harvested from the maxillary tuberosity in conjunction with a coronally advanced flap

Group Type ACTIVE_COMPARATOR

tSCTG+ CAF

Intervention Type PROCEDURE

In the tSCTG group, at the distal end of a second maxillary molar, an incision will be made using a double-bladed scalpel (SKU 10-130-05D; Hu-Friedy, Chicago, IL, USA) bucco-palatally, forming a 1,5 mm thick parallel line. Secondary incisions will be made to separate the graft using a 15c blade on the buccal and palatal sides. Later, the graft will be de-epithelialized extra-orally using a blade

pSCTG+ CAF

Single, isolated gingival recessions; excluding molars; at maxilla will be treated with subepithelial connective tissue graft harvested from the lateral palate in conjunction with a coronally advanced flap

Group Type ACTIVE_COMPARATOR

pSCTG+ CAF

Intervention Type PROCEDURE

In pSCTG group; the graft will be harvested through a single-incision approach at the lateral palatal mucosa

Interventions

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tSCTG+ CAF

In the tSCTG group, at the distal end of a second maxillary molar, an incision will be made using a double-bladed scalpel (SKU 10-130-05D; Hu-Friedy, Chicago, IL, USA) bucco-palatally, forming a 1,5 mm thick parallel line. Secondary incisions will be made to separate the graft using a 15c blade on the buccal and palatal sides. Later, the graft will be de-epithelialized extra-orally using a blade

Intervention Type PROCEDURE

pSCTG+ CAF

In pSCTG group; the graft will be harvested through a single-incision approach at the lateral palatal mucosa

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Non-smoker, systemically healthy
* No active periodontal disease
* Maxillary anterior and premolar teeth with single, isolated recessions RT 1 (Miller 1 \&2)
* Absences of non-carious cervical lesions (NCCL) and non-detectable cemento-enamel junction (CEJ)
* Buccal gingival recession defects between 2-5 mm in depth

Exclusion Criteria

* Presence of caries lesions or restorations in the cervical area
* Intake of medications that impede periodontal tissue health and healing
* Medical contraindications for periodontal surgical procedures
* Pregnancy and lactation
* Bleeding and plaque scores ≥ 20%
* Probing depths \> 4 mm
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Gazi University

OTHER

Sponsor Role lead

Responsible Party

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Sıla Çağrı İşler

Assoc Prof

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Gazi University Faculty of Dentistry

Ankara, Çankaya, Turkey (Türkiye)

Site Status RECRUITING

Countries

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Turkey (Türkiye)

Central Contacts

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Assoc Prof Dr, PhD

Role: CONTACT

+905069966074

Prof Dr, PhD

Role: CONTACT

+905325513603

Facility Contacts

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Sila Cagri Isler, Assoc Prof

Role: primary

References

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Zucchelli G, Amore C, Sforza NM, Montebugnoli L, De Sanctis M. Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study. J Clin Periodontol. 2003 Oct;30(10):862-70. doi: 10.1034/j.1600-051x.2003.00397.x.

Reference Type BACKGROUND
PMID: 14710766 (View on PubMed)

Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol. 2015 Feb;86(2 Suppl):S8-51. doi: 10.1902/jop.2015.130674.

Reference Type BACKGROUND
PMID: 25644302 (View on PubMed)

Jung UW, Um YJ, Choi SH. Histologic observation of soft tissue acquired from maxillary tuberosity area for root coverage. J Periodontol. 2008 May;79(5):934-40. doi: 10.1902/jop.2008.070445.

Reference Type BACKGROUND
PMID: 18454674 (View on PubMed)

Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M. Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol. 2010 Aug 1;37(8):728-38. doi: 10.1111/j.1600-051X.2010.01550.x. Epub 2010 Jun 24.

Reference Type BACKGROUND
PMID: 20590963 (View on PubMed)

Other Identifiers

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E-21071282-050.99-519910

Identifier Type: -

Identifier Source: org_study_id

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