title: Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial.
abstract: OBJECTIVE
  Subepithelial connective tissue grafts (SeCTG) in conjunction with a coronally advanced flap (CAF) or with tunneling technique (TT) are common periodontal procedures with similar indications for the treatment of a denuded root surface; however, it is unclear whether patient discomfort and postoperative morbidity are comparable in both approaches. The aim of this randomized controlled clinical trial was to compare the patient morbidity and root coverage outcomes of a SeCTG used in combination with a CAF or TT.
  
  
  METHODS
  For this single-center, randomized, clinical trial, patients were randomly assigned to receive SeCTG + CAF (control group) or SeCTG + TT (test group). Postoperative questionnaires at 3 days post intervention were administered to evaluate postoperative discomfort, bleeding, and inability to masticate. Evaluation of patients' perception of pain was performed using a visual analog scale (VAS). Clinical outcomes including percentage of root coverage (RC) and complete root coverage (CRC) were recorded 12 months postoperatively.
  
  
  RESULTS
  Fifty patients (25 SeCTG + CAF and 25 SeCTG + TT) completed the study. Healing was uneventful for all test and control patients. The SeCTG + TT group showed a longer chair time (33.6 (3.6) and 23.6 (4.2) min for the SeCTG + TT and the SeCTG + CAF, respectively), as well as more painkiller consumption: 2736 vs. 1536 mg (p < 0.001). At the same time, the SeCTG + CAF group reported less pain or discomfort in all four sections of the questionnaire: pain experienced within the mouth as a whole, pain experienced throughout the day, pain experienced at night, and edema experienced after the surgery (p = 0.002, p = 0.001, p = 0.001, and p = 0001, respectively). Both treatments showed clinical efficacy in terms of root coverage as no differences per group were observed in the percentage of root coverage (87 vs. 85 %, p = 704) or patients with complete root coverage (60 vs. 52 %, p = 0.569).
  
  
  CONCLUSIONS
  SeCTG + TT is associated with a greater incidence of pain and discomfort compared to SeCTG + CAF in early postoperative periods, as well as a longer chair time. Both treatments showed similar clinical efficacy in terms of root coverage.
  
  
  CONCLUSIONS
  The results of this study may influence the surgeon's choice on which root coverage procedure should be performed considering the need of more chair time and more painkiller assumption with the tunneling technique.
authors.affiliation: Department of Periodontology, School of Dentistry, University of Padova, Padua, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Gobbato
authors.affiliation: Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Carrer de Josep Trueta Sant Cugat del Vallès, 08195, Barcelona, Spain. jose@nartperiodoncia.com.
authors.forename: Jose
authors.initials: J
authors.lastname: Nart
authors.affiliation: Department of Periodontology, School of Dentistry, University of Padova, Padua, Italy.
authors.forename: Eriberto
authors.initials: E
authors.lastname: Bressan
authors.affiliation: Department of Periodontology, School of Dentistry, University of Padova, Padua, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mazzocco
authors.affiliation: Department of Prosthodontics, School of Dentistry, University of Padova, Padua, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Paniz
authors.affiliation: Department of Prosthodontics, School of Dentistry, University of Milan, Milan, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Lops
mesh_terms: D000328:Adult; D003238:Connective Tissue / Q000637:transplantation*; D004955:Esthetics, Dental; D005260:Female; D005889:Gingival Recession / Q000601:surgery*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis; D017060:Patient Satisfaction; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D014092:Tooth Root / Q000601:surgery*; D016896:Treatment Outcome
keywords: Connective tissue; Gingival recession; Patient morbidity; Randomized controlled clinical trial; Root coverage
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