Treatment Of Gingival Recession Research Articles

Clinical substantiation of the platelet-rich plasma effectiveness in complex surgical treatment of gingival recession

Gingival recession is a non-inflammatory pathological process characterized by apical migration of the marginal gingiva below the CEJ. The use of platelet-rich plasma is one of the current technologies in the complex treatment of gingival recession. The aim of the study was to increase the effectiveness of surgical treatment of gingival recession using platelet plasma. As a result of the treatment of gingival recession I, II and III Millers classes, the coverage area of the recipient surface was 84%, 77% and 60%, accordingly; the thickness of the keratinized gingiva increased by an average of 2 times. The use of platelet plasma in the complex treatment of gingival recession optimizes the healing period in the regeneration phase, improves the microcirculation of periodontal tissues and reduces the duration of treatment by an average of three days; shows more efficiency due to less physiological shrinkage of the graft over time.

Electrospun methacrylated natural/synthetic composite membranes for gingival tissue engineering

New functional materials for engineering gingival tissue are still in the early stages of development. Materials for such applications must maintain volume and have advantageous mechanical and biological characteristics for tissue regeneration, to be an alternative to autografts, which are the current benchmark of care. In this work, methacrylated gelatin (GelMa) was photocrosslinked with synthetic immunomodulatory methacrylated divinyl urethanes and defined monomers to generate composite scaffolds. Using a factorial design, with the synthetic monomers of a degradable polar/hydrophobic/ionic polyurethane (D-PHI) and GelMa, composite materials were electrospun with polycarbonate urethane (PCNU) and light-cured in-flight. The materials had significantly different relative hydrophilicities, with unique biodegradation profiles associated with specific formulations, thereby providing good guidance to achieving desired mechanical characteristics and scaffold resorption for gingival tissue regeneration. In accelerated esterase/collagenase degradation models, the new materials exhibited an initial rapid weight loss followed by a more gradual rate of degradation. The degradation profile allowed for the early infiltration of human adipose-derived stromal/stem cells, while still enabling the graft's structural integrity to be maintained. In conclusion, the materials provide a promising candidate platform for the regeneration of oral soft tissues, addressing the requirement of viable tissue infiltration while maintaining volume and mechanical integrity. Statement of significanceThere is a need for the development of more functional and efficacious materials for the treatment of gingival recession. To address significant limitations in current material formulations, we sought to investigate the development of methacrylated gelatin (GelMa) and oligo-urethane/methacrylate monomer composite materials. A factorial design was used to electrospin four new formulations containing four to five monomers. Synthetic immunomodulatory monomers were crosslinked with GelMa and electrospun with a polycarbonate urethane resulting in unique mechanical properties, and resorption rates which align with the original design criteria for gingival tissue engineering. The materials may have applications in tissue engineering and can be readily manufactured. The findings of this work may help better direct the efforts of tissue engineering and material manufacturing.

Leukocytic platelet rich fibrin (L-PRF) versus subepithelial connective tissue graft (SCTG) using tunneling technique in treatment of gingival recession: Randomize controlled clinical study

Introduction: Gingival recession is a problem encountered daily in clinical practice, its etiology is often a multifactorial one. Surgical treatment is the only method to reverse this condition. Objective: to evaluate the effectiveness of leukocytic platelet rich fibrins (L-PRF) versus subepithelial connective tissue graft (SCTG) in the management of recession defects Miller’s class I or II (RT1) using the tunnel technique (TUN). Methods: 20 systemically healthy patients were allocated randomly to TUN with L-PRF (group A), and TUN with SCTG (group B). Probing depth, clinical attachment level, recession depth, width of keratinized tissue, gingival thickness, and recession esthetic score and wound healing index are clinical variables measured at baseline,14 days, 3 months, and 6 months postoperatively. Results: Significant improvement in mean CAL, and RD for both groups, and significant difference in GT and WKT for group B as well as higher RES. A significant difference was also recorded in group A for WHI Conclusions: Both grafting modalities in combination with tunnel technique improved gingival phenotype switching. Although SCTG gives higher esthetic and functional results including better color matching, tissue contour and increased width of keratinized tissue, L-PRF has superior healing properties and can be used as an alternative to treat multiple gingival recession defects where the need of second surgical site is eliminated.

Comparative Evaluation of Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique With and Without Advanced Platelet Rich Fibrin for Treatment of Maxillary Anterior Gingival Recessions.

Gingival recession is an apical shift of the gingival margin with exposure of the root surface to the oral cavity which creates an aesthetic problem. The present study was attempted to compare Vestibular incision subperiosteal tunnel access (VISTA) with and without Advanced platelet rich fibrin(A-PRF) in the treatment of Miller's class I gingival recessions. 24 patients were assigned randomly either to test (VISTA with A-PRF) or control (VISTA alone) group. Clinical parameters like recession depth (RD), recession width (RW), clinical attachment loss (CAL), width of keratinized gingiva (WKG), gingival thickness (GT) and probing depth (PD) were recorded at baseline,3 and 6 months post operatively. Inter group comparison of mean RC in mm, %RC, ΔWKG and CAG revealed no statistically significant difference (p>0.05). Change in GT showed statistically significant improvement in test group. Within the limitations of this study, both treatment options (VISTA with A-PRF and VISTA alone) have resulted in predictable and comparable root coverage with increased gingival thickness in the test group.

Treatment of Maxillary Gingival Recessions Using the Modified Coronally Advanced Tunnel Technique in Combination with a Volume-Stable Collagen Matrix: A Prospective Case Series with a 12-Month Follow-up

The aim of this case series was to evaluate the clinical performance of a new volume-stable collagen matrix (VCMX) in combination with the modified coronally advanced tunnel technique (MCAT) for the treatment of gingival recessions. Thirteen patients with a total of 33 maxillary RT1 single and multiple gingival recessions were included in the study. Probing pocket depth (PPD), recession width (RECW), recession depth (REC), height of keratinized tissue (HKT), and gingival thickness (GT) were assessed at baseline and at the 12-month follow-up. Postoperative healing was uneventful in all cases without any complications. At 12 months, mean root coverage (MRC) was 92.88%, with complete root coverage (CRC) in 87.88% of treated sites. The present findings suggest that VCMX in combination with MCAT results in predictable coverage of maxillary RT1 gingival recessions. Further studies with larger sample sizes and control groups are needed to support these preliminary outcomes.

Amniotic membrane versus platelet-rich fibrin in treatment of gingival recession- a randomized control trial

ObjectiveTo determine the efficacy of latelet-rich fibrin (PRF) and Amniotic membrane (AM) along with the coronally advanced flap (CAF) technique in treating Miller’s class I gingival recession (GR) defects. Material and methodsA total of 32 sites with Miller’s class I GR defects were distributed into Group A (CAF + PRF, n = 16) and Group B (CAF + AM, n = 16). Clinical parameters like gingival index (GI), plaque index (PI), gingival bleeding index (GBI), gingival sulcus depth (GSD), relative attachment level (RAL), and gingival marginal level (GML) were measured at baseline and at 3, 6 and 9 months after surgical intervention. ResultsPRF and AM with CAF were effective treatment modalities for treating Miller’s class I GR defects, with an average root coverage value of 2.00 ± 0.75 mm in Group A and 1.5 ± 0.3 mm in Group B. Complete coverage (100 %) was obtained in 57 % sites of group A and 49 % sites of group B. At the 9-month follow-up, there was a significant increase in relative attachment levels in both groups when compared to baseline. ConclusionIn the present study it was observed that there was a clinically and statistically significant improvement in root coverage with both groups. PRF-treated sites showed > 50 % complete coverage and hence were superior. AM showed comparable results to PRF and could be used as an alternative.

Xenogeneic collagen matrix vs. connective tissue graft for the treatment of multiple gingival recession: a systematic review and meta-analysis.

The aim of this systematic review (SR) compared the effect of xenogeneic collagen matrix (XCM) vs. connective tissue graft (CTG) for the treatment of multiple gingival recession (MGR) Miller Class I and II or Cairo type I. Five databases were searched up to August 2022 for randomized clinical trials (RCTs) comparing the clinical effects of XCM vs. CTG in the treatment of MGR. The random effects model of mean differences was used to determine reduction of gingival recession (GR), gain in keratinized tissue width (KTW), gain in gingival thickness (GT) and gain in clinical attachment level (CAL). The risk ratio was used to complete root coverage (CRC) at 6 and 12months. 10 RCTs, representing 1095 and 649 GR at 6 and 12months, respectively, were included in this SR. The meta-analysis showed no statistically significant difference in GR reduction, KTW gain GT gain or CAL gain between groups at 6months. However, at 12months of follow-up, differences favoring the control group were observed (p < 0.05). CRC was significantly higher in the CTG group at 6 and 12months. Regarding dentine hypersensitivity (DH), no statistically significant differences were found between groups at 6 and 12months of follow-up (p < 0.05). At 12months, CTG showed significantly superior clinical results in the treatment of MGR: however, this difference was not observed in the decrease of DH.

Root coverage using modified tunneling technique with acellular dermal matrix for treatment of gingival recession associated with orthodontic treatment: A case report

Background: Gingival recession has a number of causes, including orthodontic therapy. The degree and extent of gingival recession and orthodontic therapy are strongly correlated. Care must be taken in choosing the best soft tissue grafting technique. Development of a number of new and improved surgical techniques, including the modified tunneling technique. Case Management: A-24-year-old female patient came to Periodontic Clinic Dental Hospital of Airlangga University with a chief complain of gingival recession in mandibular central incisors since 6 months ago. The patient complained about dental sensitivity. The dental history revealed that she had undergone fixed orthodontic therapy for 7 years. She revealed the fixed orthodontic appliance was put off since 8 months ago. The patient concern about her appearance and aesthetic problem. Gingival recession on buccal surface tooth 31 and 41 extending 1,5-2 mm apical of the incisors was found in clinical assessment. This case classified as Miller class III. The doctor planned root coverage procedure using modified tunnel technique. Acellular dermal matrix (Surederm®) was chosen as a gingival graft. Discussion: Creating a "tunnel" through the buccal mucosa to treat gingival recession enables coronal repositioning of the soft tissue with predictable root coverage and a pleasing appearance. Tissue graft implantation is made possible by a horizontal incision. Conclusion: In brief, root coverage using modified tunnel technique is effective and predictable treatment modality. Comparing with other root coverage method it give quite satisfying result. The use of Acellular Dermal Matrix (ADM) considered as an alternative to Connective Tissue Graft (CTG).

Anatomy-driven complexity classification for soft-tissue tunneling procedures.

The tunnel technique (TUN) preserves the integrity of the papilla by creating envelope flaps that allow for the insertion of a connective tissue graft, and/or biomaterials. (1) A comprehensive overview of tunneling flap procedures in the treatment of gingival recessions (GRs) for soft tissue coverage is presented and (2) A classification system for soft and hard tissue anatomy of GR sites which may aid the clinician in determining the surgical complexity is being introduced. A novel clinical classification system is proposed to illustrate complexity levels determined by soft and hard tissue anatomy of GR sites such as the mucogingival junction proximity to the gingival margin, bone morphotype, and mucosal margin thickness. TUN is highly effective in treating single/multiple GRs. Its limitations are related to variability in surgical site anatomy and operator expertise. A classification system based on anatomical soft and hard tissue variations has been proposed to help identify complexity levels encountered during tunneling procedures. Site-related factors directly impact the surgical variables related to tissue trauma, flap tension, soft tissue management, muscle pull, and wound stability during the healing of gingival recessions (GRs). The achievement of expedited and favorable wound healing is crucial to obtaining quantitative and qualitative success in the treatment of GR and the long-term stability of root coverage. A classification system based on anatomical soft and hard tissue variations has been proposed to facilitate tunneling procedures while respecting surgical principles.

Collagen-based scaffolds with high wet-state cyclic compressibility for potential oral application

Soft tissue substitutes have been developed to treat gingival recessions to avoid a second surgical site. However, products of pure collagen for clinical application lack their original mechanical strengths and tend to degrade fast in vivo. In this study, a collagen-based scaffold crosslinked with oxidized sodium alginate (OSA-Col) was developed to promote mechanical properties. Compared with commercial products collagen matrix (CM) and collagen sponge (CS), OSA-Col scaffolds presented higher wet-state cyclic compressibility, early anti-degradation ability, similar hemocompatibility and cytocompatibility. Furthermore, in the subcutaneous implantation experiment, OSA2-Col3 scaffolds showed better anti-degradation performance than CS scaffolds and superior neovascularization than CM scaffolds. These results demonstrated that OSA2-Col3 scaffolds had potential as a new soft tissue substitute for the treatment of gingival recessions.

Modified Coronally Advanced Tunnel (MCAT) Technique with or without Vestibular Incision for the Treatment of Multiple Gingival Recessions: A Case Series and Literature Review

&lt;p&gt;Treatment of multiple gingival recessions with periodontal plastic surgery is challenging due to several factors that needed to be considered in one surgical session. The success and stability of root-coverage outcomes depend on gingival thickness (GT), defect characteristics and anatomical limitations addressing hard and soft tissue relationships and periodontal structures. Root coverage is less predictable in the presence of interproximal attachment loss. Evidence on the treatment of multiple recession-type defects, particularly Miller Classes III and IV, is scarce. The modified coronally advanced tunnel technique (MCAT) has been report-ed to exert root-coverage effects in Miller Class III cases via partial papilla elevation. To gain surgical access in challenging anatomies, the use of additional vestibular incisions (vestibular incision subperiosteal tunnel access, [VISTA]) has been proposed. In this case report, two patients who underwent surgeries for Miller Class II-III recessions with thin phenotypes are described. After non-surgical periodontal treatment, creeping attachment of 0.5-1 mm was observed in some teeth in case 1. Both patients underwent the treatment of MCAT technique combined with connective tissue grafting, whereas only the patient in case 2 underwent VIS-TA. Complete root coverage, increased GT and aesthetic outcomes with a follow-up period of at least 5 months were achieved in multiple teeth in both cases. The report and the literature review suggested that MCAT w/wo VISTA can predict root coverage and modify phenotypes for the treatment of multiple recessions.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Gingival Recession Treatment by Free Graft Fixed with Silk Sutures vs Vicryl Plus

Gingival Recession Treatment by Free Graft Fixed with Silk Sutures vs Vicryl Plus

A Comparison of the Efficacy of Coronally Positioned Flap And Tunnel Technique in the Treatment of Gingival Recessions

Dişeti çekilmesi (DÇ), dişeti kenarının mine sement sınırına (MSS) göre apikale kayması ve kök yüzeyinin ağız ortamına açılması olarak tanımlanır. DÇ tedavisinin temel amacı; açığa çıkmış kök yüzeylerinin, inflamasyon bulguları gözlenmeyen, minimum sondlama derinliğine ve ideal estetiğe sahip yumuşak dokuyla kapatılmasıdır. DÇ’yle ilişkili dişin yüzey durumu da değerlendirilmelidir. Çürüksüz servikal lezyonlar (ÇSL), DÇ’ye sıkça eşlik etmektedir. DÇ tedavisinde; koronale pozisyone flep (KPF) ve tünel (TUN) teknikleri, tek başına veya bağ dokusu grefti (BDG) ile kombinasyon halinde sıkça kullanılmıştır. Estetik sonuçlar açısından değerlendirildiğinde, iki teknik arasında anlamlı bir fark olmadığı, ancak gerekli durumlarda yapılan BDG ilavesinin estetiği iyileştirdiği bildirilmiştir. Keratinize doku yüksekliği (KDY) ve dişeti kalınlığı (DK) BDG ilave kararını vermede önemli parametrelerdir. KDY ≤ 1 mm ve DK &lt; 1 mm olduğunda BDG ilavesi yapılması önerilmektedir. Yapılan çalışmalarda kök kapama miktarı açısından KPF ve TUN teknikleri arasında anlamlı bir fark bulunmazken TUN tekniğinde vertikal insizyon olmaması post-operatif morbiditeyi büyük oranda azaltmaktadır.

Comparison of morbidity at the donor site and clinical efficacy at the recipient site between two different connective tissue graft harvesting techniques from the palate: A randomized clinical trial.

This study was conducted to compare the pain levels in patients and the clinical efficacy of grafts obtained using two techniques, namely de-epithelialized gingival graft (DGG) and subepithelial connective tissue graft (SCTG), in combination with coronally advanced flap (CAF) for the treatment of multiple adjacent gingival recessions. Twelve patients were treated using DGG+CAF on one side and SCTG+CAF on the other. The patients' pain levels at the surgical site, the number of analgesics taken on days 3 and 7, the mean root coverage (MRC), the percentage of complete root coverage (CRC), color match, and gingival thickness (GT) at the graft recipient site were evaluated 6 months after surgery. The total number of analgesics taken during the 7-day period after surgery and pain levels at the surgical site from day 3 to day 7 were significantly higher in the DGG+CAF group compared to the SCTG+CAF group (P=0.001). In the 6-month follow-up, color match and CRC were significantly higher in the SCTG+CAF group, while GT was significantly higher in the DGG+CAF group. There was no significant difference in MRC between the two groups. The pain and analgesic consumption levels were higher in the DGG+CAF group compared to the SCTG+CAF group, and the recipient site had a weaker color match. However, this technique can lead to a greater increase in the thickness of the grafted area.

Twenty-five years of recombinant human growth factors rhPDGF-BB and rhBMP-2 in oral hard and soft tissue regeneration.

Contemporary oral tissue engineering strategies involve recombinant human growth factor approaches to stimulate diverse cellular processes including cell differentiation, migration, recruitment, and proliferation at grafted areas. Recombinant human growth factor applications in oral hard and soft tissue regeneration have been progressively researched over the last 25 years. Growth factor-mediated surgical approaches aim to accelerate healing, tissue reconstruction, and patient recovery. Thus, regenerative approaches involving growth factors such as recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and recombinant human bone morphogenetic proteins (rhBMPs) have shown certain advantages over invasive traditional surgical approaches in severe hard and soft tissue defects. Several clinical studies assessed the outcomes of rhBMP-2 in diverse clinical applications for implant site development and bone augmentation. Current evidence regarding the clinical benefits of rhBMP-2 compared to conventional therapies is inconclusive. Nevertheless, it seems that rhBMP-2 can promote faster wound healing processes and enhance de novo bone formation, which may be particularly favorable in patients with compromised bone healing capacity or limited donor sites. rhPDGF-BB has been extensively applied for periodontal regenerative procedures and for the treatment of gingival recessions, showing consistent and positive outcomes. Nevertheless, current evidence regarding its benefits at implant and edentulous sites is limited. The present review explores and depicts the current applications, outcomes, and evidence-based clinical recommendations of rhPDGF-BB and rhBMPs for oral tissue regeneration.

Minimally Invasive Gingival Recession Treatment by Using Vista Combined With PRF and Collagen Membrane: A Case Report

Abstract Root exposure generates major concerns regarding aesthetics and other problems like hypersensitivity and root caries. Gingival recession has traditionally been treated by periodontal plastic surgery, often using soft tissue grafts to fill the defect with excellent clinical results. Advancements in root coverage procedures in the aesthetic zone have led to increasing the ability of clinicians to harness a treatment modality that delivers better outcomes with less surgical morbidity. Collagen membrane is most commonly used for guided tissue regeneration (GTR). On the other hand, platelet-rich fibrin (PRF) has gained popularity due to its simple method of acquisition, low cost and the presence of growth factors. Therefore, this case report describes the treatment of a 38-year-old patient with bilateral multiple Miller’s class I recession defects extending from central incisors to canines by using the vestibular incision subperiosteal tunnel access (VISTA) with PRF and collagen membrane. Clinical parameters such as recession height (RH) and width of keratinised gingiva (WKG) were measured at 6-month and 1-year follow up intervals. The 6-month follow-up revealed optimum root coverage with excellent outcomes for both sites, with an increase in the width of keratinised gingiva and a decrease in the recession height, and less discomfort in the site treated with a PRF membrane. These clinical parameters were maintained at the 1-year follow up. The increase in the width of keratinised gingiva and the decrease in the recession height in both groups and the patient compliance due to this minimally invasive procedure suggests its potential use when aesthetics and patient comfort are of paramount concern.

Root coverage surgeries using modified tunneling technique of xenogenic collagen matrix versus autologous connective tissue graft as a treatment of Miller class II gingival recession (RCT study)

BackgroundRecently, there is increased demand for periodontal plastic surgery and development of new surgical approaches for aesthetic purposes. Gingival recession (GR) is the exposure of the root surfaces leading to esthetic problems, hypersensitivity, caries of the roots and teeth loss. Coronally advanced flap is considered a predictable treatment of GR but it needs a filler like subperiosteal connective tissue graft (CTG) which is considered as the gold standard treatment approach. The aim of the present study is to compare the clinical benefits and effectiveness of a xenogenic collagen matrix (mucoderm, botiss, dental, Berlin, Germany) to CTG for treatment of GR.ResultsRegarding clinical parameters, mean preoperative values for attached gingiva, probing depth, clinical attachment loss and gingival recession for group I were (1.8 ± 0.7 mm, 1.2 ± 0.3 mm, 6.6 ± 0.4 mm and 5.4 ± 0.2 mm) respectively. While mean postoperative values were (2.3 ± 0.9 mm, 1.1 ± 0.4 mm, 3.4 ± 0.5 mm and 2.7 ± 0.7 mm For group two preoperative mean values were (1.9 ± 0.3 mm, 1.1 ± 0.5 mm, 6.8 ± 0.5 mm and 5.4 ± 0.2 mm) respectively. While mean for postoperative values of attached gingiva, probing depth, clinical attachment loss and gingival recession for group tow were (2.5 ± 0.6 mm, 0.8 ± 0.3 mm, 3.7 ± 0.2 mm and 3.1 ± 0.3 mm) respectively All of the clinical parameters measured showed a significant difference between pre ad postoperative measurements while there was no significant differences between the two groups (test and control group). Regarding the patients satisfaction the percentage was greater in test group but the difference was not statistically significant.ConclusionsIn general, all of the parameters measured showed a significant difference between pre and postoperative measurements for each group but there is no significant difference between the two groups using (two treatment approaches. Both treatment procedures are considered efficient in increasing zone of attached gingiva and decreasing its clinical attachment loss. Mucoderm is considered as an efficient alternative to CTG for treatment of gingival recession.

Treatment of deep single RT2 and RT3 antero-mandibular gingival recessions with a combination of surgical techniques: A case series study.

To evaluate root coverage (RC) in deep single antero-mandibular RT2 and RT3 gingival recessions (GR) and to investigate the influence of several factors in RC. Fifteen single antero-mandibular GR with a minimum depth of 3 mm were consecutively treated with a new one-stage technique (laterally positioned flap with a tunnel access and a connective tissue graft). At baseline and at 12-month follow-up, the percentage of mean root coverage (%MRC), the recession reduction (RecRed), complete root coverage (CRC) and the gain of keratinized tissue width (KTW) were assessed. Descriptive, intergroup comparative and correlation analyses were performed. At 12 months, a %MRC of 77.29 ± 21.48% with a mean RecRed of 4.10 ± 1.51 mm was achieved. The %MRC was 84.71 ± 21.08% in RT2, and 62.43 ± 14.17% in RT3. The mean gain of KTW was 2.10 ± 0.89 mm, with a mean gain of 2.0 ± 1.03 mm for RT2 and 2.3 ± 0.57 mm for RT3. CRC was observed in six cases, all of them being RT2. A positive association was found between the %MRC and the initial position of the tooth and of both papillae. This technique might be a valuable approach for the treatment of deep single antero-mandibular RT2 and RT3 recessions, even in malpositioned teeth. A combination of different surgical techniques could provide greater vascularization to the CTG especially in malpositioned teeth in sextant V with a large avascular area to be covered.

Levels of smoking and outcome measures of root coverage procedures: a systematic review and meta-analysis.

This systematic review and meta-analysis was performed to investigate if there was a significant association between the number of cigarettes smoked per day and the results of root coverage procedures. Electronic search was performed through PubMed, Web of Science, Embase, and Scopus until January 2023. Studies were included if evaluated the outcomes of periodontal plastic surgery procedures for the treatment of gingival recession in smokers. Statistical evaluation was conducted using random-effects method to analyze the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CI). From a total of 4494 references, 15 studies were considered relevant to be included in this study. The results showed that 44.39% sites had complete root coverage (CRC) at 6months (non-smokers: 54.06%, < 10 cigarettes/day: 48%, 10-20 cigarettes/day: 19.56%, ≥ 20 cigarettes/day: 50%). Mean root coverage at 6months were as follows: non-smokers: 74.94% ± 16.71%, < 10 cigarettes/day: 84.20% ± 2.24%, 10-20 cigarettes/day: 75.30% ± 14.69%, ≥ 20 cigarettes/day: 68.75% ± 26.51%. A significant difference was revealed between non-smokers and individuals who smoked 10-20 cigarettes/day in terms of CRC at 6months: OR = 0.15 (95% CI = 0.03 to 0.71; P = .017). However, no significant difference was detected comparing 10-20 and ≥ 20 cigarettes/day. As there was not enough data available, any definitive conclusions about the connection between an increase in the amount of cigarettes consumed per day and the results of root coverage procedures could not be reached. Further research is required with comparative studies involving individuals who smoke varying numbers of cigarettes.

Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a Meta-analysis.

This study aimed to evaluate the efficacy and long-term stability of tunnel technique (TUN) and coronally advanced flap (CAF) combined with connective tissue graft (CTG) in treating gingival recession. Databases including PubMed, Web of Science, Embase, and CNKI were electronically searched to collect randomized controlled trial (RCT) of CAF+CTG compared to TUN+CTG in the treatment of Miller class Ⅰ or Ⅱ gingival recession on September 1, 2022. There were 8 RCTs with 305 patients (454 recession sites) participating. The results of the Meta-analysis revealed that, in terms of mean root coverage (MRC) of main indicators, no significant difference was found between the CAF group and the TUN group in both short- and long-term results, which were [MD: 1.45%, 95%CI (-2.93%, 5.82%), P=0.52] and [MD: -0.70%, 95%CI (-6.41%, 5.00%), P=0.81]. However, the CAF group outperformed the TUN group in the long term [MD: 5.69%, 95%CI (0.87%, 10.50%), P=0.02], and the results of complete root coverage (CRC) analysis were similar to those of MRC. In the short term, the TUN group grew keratinized gingiva significantly faster than the CAF group [MD: -0.38 mm, 95%CI (-0.67 mm, -0.10 mm), P=0.008]. Long-term findings revealed no significant difference between the two groups [MD: -0.26 mm, 95%CI (-0.94 mm, 0.43 mm), P=0.46]. The TUN group's secondary index root coverage esthetic score (RES) was statistically significantly higher than the CAF group's [MD: 0.62, 95%CI (0.28, 0.96), P=0.000 3]. Given that there were few results included in the literature and the heterogeneity was too great, no significant difference was observed in the postoperative VAS pain index score [MD: 0.53, 95%CI (-1.96, 3.03), P=0.68]. This study discovered that both CAF+CTG and TUN+CTG can achieve good root coverage in treating gingival recession, with CAF outperforming TUN and both groups achie-ving good long-term stability. After the operation, the TUN group had a higher RES than the CAF group. Given the limitations of this study, more high-quality studies are needed in the future to demonstrate the efficacy of TUN in gingival retraction surgery.