Eighteen participants will be recruited.
Included participants will be:
Gender: Male and Female
Age: >20 years
Have RT1 and RT2 gingival recession
Exclusion criteria:
Medically compromised
History of certain medications
Pregnant females
Periapical involvement in selected teeth
History of periodontal surgery involving experimental teeth
If the problem was due to orthodontic treatment
Interventions: Participants will be divided into two groups, group A (test group) and
group B ( control group).
Pre-surgical phase (including supragingival scaling and root planning) will be carried out to
both groups, followed by oral hygiene instructions.
Then, Participants will be explained about each procedure. 7
For group A (test group):
Inverted periosteal pedicle flap will be carried out as follows according to Shetty 2014:
Patients will be explained about the procedure. Non-surgical phase will include supragingival
scaling and root planning, followed by oral hygiene instructions.
The surgical procedure will be carried out three weeks after non-surgical phase as follows:
Horizontal incisions will be made perpendicular to the adjacent papillae at the level of
the cement-enamel junction (CEJ) preserving the gingival margin of the affected teeth.
Sulcular incisions on the buccal/facial aspect of the involved teeth.
Vertical incisions extending beyond the mucogingival junction will be made at the line
angles of the distal most and the mesial most teeth.
A partial thickness flap will then be elevated till an adequate amount of periosteum is
exposed.
A horizontal incision will then be given at the apical extent of the periosteum where it
is still attached to the bone.
The periosteum will then be separated from the underlying bone and reflected coronally
to an extent where it is still attached to the bone.
The reflected periosteum will then be inverted such that the cambium layer covers the
denuded root.
Once the periosteum is in place, it is sutured and secured.
The reflected partial thickness flap will be coronally advanced such that it covers the
periosteum and will be sutured using a sling suture.
The vertical incision will be sutured using an interrupted suture. 8
For group B (control group):
Coronally advanced flap with subepithelial connective tissue graft will be carried out; an
envelope flap design will be used according to Zucchelli & De Sanctis 2000 as follows:
An intrasulcular incision will be performed involving at least one tooth mesial and at
least one tooth distal to the teeth with gingival recessions.
Oblique incisions will be traced at the interdental soft tissue level to achieve a
coronal rotation of the surgical papilla.
The flap will be then raised up to the mucogingival junction (MGJ) with a periosteal
elevator and mobilized with a sharp horizontal periosteal incision beyond the MGJ.
Exposed root surfaces will be carefully treated with gentle root planing.
The anatomic interdental papillae will be carefully de-epithelialized.
The split-full-split thickness flap will be then passively positioned above the CEJ of
the involved teeth and interrupted or sling sutures were positioned to achieve optimal
buccal flap adaptation.
The connective tissue graft will be harvested from the palate using the trap door
technique (Langer & Langer 1985), adapted to cover each exposed root about 1 mm beyond
the CEJ, and stabilized with resorbable sutures.
The flap will be then coronally sutured using sling or interrupted sutures.
Post-surgical protocol (Pini-Prato et al.,2010 and Cairo et al., 2016) :
Participants for both groups will be instructed to:
Intermittently apply an ice bag for the first 4 hours.
Take ibuprofen 600 mg at the end of the surgical procedure and will be instructed to
take another tablet 6 h later and additional doses if needed.
Avoid any mechanical trauma and tooth-brushing for 3 weeks in the surgical area.
Smokers will be reminded to quit smoking during the trial time (6 months).
Chlorexidine rinses will be prescribed twice daily for 1 min. seven days after the
surgery.
Sutures will be removed and prophylaxis will be performed. 9
About 3 weeks after surgery, patients will be instructed to resume mechanical
tooth-cleaning.
Follow up strategy:
Patients will be recalled after 3and 6 months after surgery.
