Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 5-year results of an RCT using 3D digital measurement technology for volumetric comparison of soft tissue changes.

Abstract

Comparison of the clinical efficacy (digitally volumetric, aesthetic, patient-centred outcomes) of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 5years after gingival recession therapy. In 18 patients contributing 36 RT1 recessions, study models were collected at baseline and follow-ups. Optical scans assessed recessions computer-assisted [recession depth, recession reduction (RECred), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness]. Root coverage aesthetic Score (RES) was used for aesthetic evaluation and visual analogue scales for patient-centred data collection applied. Sixty months after surgery, 50.0% (TUN+CTG) and 0.0% (CAF+EMD) of sites showed CRC (p=0.0118), 82.2% (TUN+CTG) and 32.0% (CAF+EMD) achieved RC, respectively (p=0.0023). CTG achieved significantly better RECred (TUN+CTG: 1.75±0.74mm; CAF+EMD: 0.50±0.39mm; p=0.0009) and aTHK (TUN+CTG: 0.95±0.41mm; CAF+EMD: 0.26±0.28mm; p=0.0013). RES showed superior outcomes (p=0.0533) for TUN+CTG (6.86±2.31) compared to CAF+EMD (4.63±1.99). The study failed to find significant differences related to patient-centred outcomes (TUN+CTG: 8.30±2.21; CAF+EMD: 7.50±1.51; p=0.1136). Five years after treatment, CTG resulted in better clinical and aesthetic outcomes than CAF+EMD. Increased THK was associated with improved outcomes for RECred and RC.