Semester

Spring

Date of Graduation

2024

Document Type

Thesis

Degree Type

MS

College

School of Dentistry

Department

Periodontics

Committee Chair

Arif Salman

Committee Member

Shorouk Elnagdy

Committee Member

Jennifer Franko

Abstract

Aim: The primary objective is to retrospectively compare the mean root coverage (MRC) achieved using a coronally advanced flap and sub-epithelial connective tissue graft (CAF + CTG) with that achieved using the tunnelling technique and sub-epithelial connective tissue graft (TUN + CTG) for the treatment of multiple recession defects. The secondary objectives are to compare the proportion of complete root coverage (CRC) achieved with CAF + CTG compared to TUN + CTG, compare the proportion of CRC achieved in these two techniques with respect to level of training (American board-certified periodontist or Graduate periodontics residents) and to evaluate the incidence of complications between these two techniques and between the two levels of training.

Materials & Methods: The current retrospective study is a subset of a larger population of consecutive patients that received soft tissue grafting at West Virginia College of Dentistry from November 1st, 2016 to October 31st, 2021. Patient charts, including clinical notes, periodontal charting and dental radiographs, of 132 patients contributing 249 recession defects were reviewed. Of these, data was assessed to include patients whom received CAF + CTG or TUN + CTG for the management of multiple recession defects. Minimum follow-up period was set at 6wks. A total of 55 recession defects (n CAF + CTG = 23, n TUN +CTG = 32) in 18 patients were included. Data was extracted for demographic variables, patient-, tooth- and site-related factors. Primary outcome was mean root coverage (MRC) between the two techniques. Secondary outcomes are complete root coverage (CRC), complications and influence of level of training. Descriptive and inferential statistical analyses were performed. Significance level was set at p = 0.05.

Results: Overall, MRC was found to be 96 0.12% for CAF + CTG groups compared to 86 0.24% for TUN + CTG group. Linear regression analysis found no statistically significant difference (p = 0.0845) between the two techniques in the mean root coverage that was achieved. There was a statistically significant difference in the MRC achieved between the two recession types (RT1 vs RT2) within the TUN + CTG group only (p-value = 0.0196, 95% CI: -26.402, -2.5073), indicating that the mean root coverage for RT2 defects is approximately 14.5% less than RT1 defects when TUN + CTG was performed. CRC was achieved in 19 out of 23 defects (82.6%) in the CAF + CTG group and 21 out of 32 defects (65.6%) in the TUN + CTG group. Minimal complications occurred.

Conclusions: Considering the limitations of the current study, the results indicate that TUN + CTG for the management of multiple recession defects shows no statistically significant difference in terms of mean root coverage compared to CAF + CTG, which has been posed as the “gold standard” treatment for single and multiple gingival recession defects. It may be postulated that the use of either technique for management of multiple gingival recession defects may be appropriate treatment modalities with high clinical outcomes. Superiority has not been definitively established. Prognostic factors leading to more favorable outcomes require further investigation.

Embargo Reason

Publication Pending

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Available for download on Saturday, April 26, 2025

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