A Comparison of Side Access Mucosal Releasing Incision (SAMRI) and Sulcular Tunnel Access to Treat Gingival Recession.

Research data and daily clinical observations reveal that teeth with gingival recession and a lack of adequate keratinized tissue (KT) are more prone to persistent gingival inflammation, dentinal sensitivity, radicular (root) caries (tooth decay), faster periodontal attachment loss, and compromised plaque control. Soft tissue grating (by various techniques) aims at changing the quality, quantity and placement of the soft tissue around teeth by covering exposed root surfaces and creating or increasing the zone of keratinized mucosa (KM) surrounding the affected teeth. Both techniques tested have shown good clinical outcomes with regard to root coverage, but clinical reports suggest that decreased intrasurgical time and the simplified protocol of the SAMRI technique may result in improved clinical outcomes and/or a decrease in postoperative morbidity and complications as assessed by patients.

Specific aims for this project include the evaluation of:

• Percentage of root coverage at 6 and 12 months following grafting with SAMRI and sulcular tunnel access with ADM
• KT width at 6 and 12 month following grafting with SAMRI and sulcular tunnel access with ADM
• Change in tissue thickness of the grafted sites at 6 and 12 months
• Practitioner-assessed esthetic outcomes using a standardized pink esthetic scale (PES) at 6 and 12 months postoperatively
• Patient-assessed esthetic outcomes at 6 and 12 months post-operatively
• Patient centered outcomes including pain, bleeding, swelling, change in daily activities at 1 week and 1 month postoperatively

SAMRI incision to allow for coronally advanced flap and placement of acellular dermal matrix (ADM) graft

Procedure: SAMRI

Sulcular tunnel access incision to allow for coronally advanced flap and placement of acellular dermal matrix (ADM) graft

Procedure: STA

Side Access Mucosal Releasing Incision (SAMRI) will be performed on all individuals in this arm of the study to facilitate coronal advancement of the gingival flap and placement of acellular dermal matrix

Sulcular tunnel access incision will be performed on all individuals in this arm of the study to facilitate coronal advancement of the gingival flap and placement of acellular dermal matrix

Plazo: From baseline to 6 months and 12 months

Compare the change in the exposed root surface at sites with gingival recession.

Plazo: From baseline to 6 and 12 months

Compare the change in keratinized tissue (KT) between two incision designs for root coverage and tissue augmentation.

Plazo: From baseline to 6 and 12 months

Using a periodontal probe, soft tissue thickness will be measured (in mm) and compared between FGG and CTG following soft tissue grafting.

Plazo: From baseline to 6 and 12 months

Assess esthetic outcomes using an established periodontal esthetic score (PES). This score evaluates the color of the gum utilizing 5 subscales ranging from 0(worse) to 2 (better) allowing for a summed total score of 10.

Plazo: At 6 and 12 months postoperatively

A visual analogue scale (VAS) based questionnaire regarding esthetic appearance, pain, swelling, bruising, effects on daily activities will be administered. This measurement ranges from 0-10 (0 being better and 10 being worse).

Plazo: 1 week, 2 weeks, 1 month, 3 months, 6 months and 12 months postoperatively.

A visual analogue scale (VAS) based questionnaire regarding esthetic appearance, pain, swelling, bruising, effects on daily activities. This measurement ranges from 0-10 (0 being better and 10 being worse).

A Prospective, Randomized Clinical Trial to Compare Side Access Mucosal Releasing Incision (SAMRI) and Sulcular Tunnel Access Procedures With Coronally Advanced Flap and Acellular Dermal Matrix (ADM) to Treat Gingival Recession.