A Prospective Randomized Clinical Trial to Compare Side Access Mucosal Releasing Incision (SAMRI) and Sulcular Tunnel Access and Root Coverage Procedures with Coronally Advanced Flap and Acellular Dermal Matrix (ADM) to Treat Teeth with Gingival Recession and Lack of Adequate Keratinized Tissue. A Pilot Study
Advisory Committee Chair
Advisory Committee Members
Date of Award
Degree Name by School
Master of Science in Dentistry (MScD) School of Dentistry
Aims. The primary aim of this randomized, blinded, controlled clinical trial was to compare clinical and patient-centered outcomes obtained following soft tissue grafting utilizing the Side Access Mucosal Releasing Incision (SAMRI) or Sulcular Tunnel Access (STA) procedures with acellular dermal matrix (ADM) and coronal flap advancement to treat Miller Class I and II recession defects on single rooted teeth. Methods. Five patients and eight recession defect sites with Miller Class I or II gingival recession and £ 2mm of keratinized tissue at each site were randomly divided into two groups (A: SAMRI, B: STA) and were treated and evaluated for 12 months postsurgically. Clinical measurements consisting of probing depths (PD), recession, plaque index (PI), gingival index (GI), width of attached tissue (AT), width of keratinized tissue (KT), tissue thickness 2mm apical to the gingival margin (TT1) and tissue thickness 5mm apical to the gingival margin (TT2) were collected at the time of surgery. These clinical measurements were collected again at 3, 6, and 12 months, along with a practitionerassessed esthetic outcome evaluation at 6 and 12 months. Surgery time and suturing time were recorded for both groups. Patient-centered outcomes were obtained at 1 week and 1 iii month utilizing the visual analog scale (VAS) to assess their perception of pain, bruising/bleeding, swelling and any changes to their regular activities imposed by the healing from the procedure [activity tolerance scale (ATS)]. Mean and standard deviations of the clinical and patient-centered outcomes were calculated. Results. The mean facial recession defect at the initial exam for the SAMRI group was 2.90 ± 0.94mm which was reduced to 0.86 ± 0.65mm or 70% defect coverage at the end of 6 months and 0.78 ± 0.94mm or 73% defect coverage at the end of 12 months. The mean facial recession defect at the initial exam for the STA group was 2.26 ± 1.10mm which was reduced to 1.05 ± 1.03mm or 54% defect coverage at the end of 6 months and 1.75 ± 1.22mm or 23% defect coverage at the end of 12 months. The difference between the change from baseline to 6 and 12 months in the SAMRI and STA group were all statistically significant (p < 0.05). There were no statistically significant differences between groups for changes in PD, AT, and KT. There were no statistically significant differences between the two groups for changes in TT1, but there were statistically significant differences in TT2 (p < 0.05). The suturing time was greater for the SAMRI group with a mean of 4 minutes and 47 seconds compared to the STA group with a mean of 3 minutes and 3 seconds. Patient-centered outcomes at 1 week revealed greater selfreported pain, swelling, bruising/bleeding, and activity tolerance in the SAMRI group compared to the STA group; however, none of these differences was statistically significant. Practitioner-assessed esthetic outcomes were evaluated through the Pink Esthetic Score (PES) and both groups resulted in high average scores (out of 14); 10.67 for SAMRI group and 10.92 for STA group at the end of 12 months. The participants also iv completed a patient satisfaction survey related to their experience in the study at the 12- month visit. Conclusion. Both the SAMRI and the STA technique resulted in a reduction in facial recession (root coverage), but the SAMRI group resulted in a statistically significant greater amount compared to the STA group. There were minimal changes for AT, KT, TT1 and TT2 for both groups. The SAMRI group required a longer suturing time and resulting in greater discomfort to the patient compared to the STA group.
Jo, Karen Younghee, "A Prospective Randomized Clinical Trial to Compare Side Access Mucosal Releasing Incision (SAMRI) and Sulcular Tunnel Access and Root Coverage Procedures with Coronally Advanced Flap and Acellular Dermal Matrix (ADM) to Treat Teeth with Gingival Recession and Lack of Adequate Keratinized Tissue. A Pilot Study" (2022). All ETDs from UAB. 119.