Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions: a randomized clinical trial

Background: Although ample evidence supports connective tissue graft (CTG) use for root coverage, there is need for research on recipient site preparation approaches. The purpose of this study was to compare the outcomes of trapezoidal coronally advanced flap (CAF) and coronally advanced tunnel flap (TUN) when used in conjunction with CTG. Methods: Forty-two patients presenting 42 single maxillary, Miller Class I and II, gingival recession defects were randomly assigned to receive either CAF + CTG (N = 21) or TUN + CTG (N = 21). Clinical, patient-centred, and aesthetic outcomes were assessed. Results: Six months postoperatively, both groups resulted in significant reduction in recession depth and increases in keratinized tissue thickness and width. CAF + CTG and TUN + CTG mean root coverage was 87.2 ± 27.1% and 77.4 ± 20.4% respectively (p = 0.02). Complete root coverage was achieved in 71.4% and 28.6% of defects treated with CAF + CTG and TUN + CTG respectively (p = 0.01). At 7 days postoperatively, TUN + CTG patients reported significantly less pain experience (p = 0.04). Both approaches reduced dentine hypersensitivity by approximately 85% (p < 0.05). Patient-based aesthetic evaluation indicated significant improvement for both groups. Although patient- and professional-based aesthetic assessments revealed no differences between groups, tissue texture was significantly better for TUN + CTG (p = 0.02). Conclusions: For root coverage of single maxillary recession defects, CAF + CTG was more effective than TUN + CTG (ClinicalTrial.org-NCT02814279).