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 (MS) School of Dentistry
Aims. The aim of this prospective, randomized, blinded, controlled clinical trial was to compare clinical and patient-centered outcomes of Cairo recession type 1 (RT1) gingival recession defects treated with acellular dermal matrix (ADM) grafts and either Side Access Mucosal Releasing Incision (SAMRI) or Sulcular Tunnel Access (STA) techniques with coronal flap advancement (CAF). Methods. 11 patients, 22 surgical procedures and 81 gingival recession defect sites with Cairo RT1 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 post-surgically. Clinical measurements including 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 surgical visit. These clinical measurements were collected again at 3, 6, and 12 months, along with a practitioner-assessed esthetic outcome evaluation at 6 and 12 months. Surgical time and suturing time were recorded for both groups. Patient-centered outcomes were obtained at 1-week and 1-month utilizing the visual analog scale (VAS) to assess the iii patient’s 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. Both groups showed significant reduction in gingival recession. The mean midfacial gingival recession defect at the initial exam for the SAMRI group was 2.4 ± 1.02 mm, which was reduced to 1.0 ± 1.11 mm or 58% of root coverage at 3 months and 0.7 ± 0.64 mm or 71% of root coverage at 6 months. The mean midfacial gingival recession defect at the initial exam for the STA group was 2.2 ± 0.94 mm, which was reduced to 0.6 ± 0.86 mm or 73% of root coverage at 3 months and 0.9 ± 0.92 mm or 59% of root coverage at 6 months. The difference between the change of midfacial gingival recession in the SAMRI group (-1.7 mm) and the STA group (-1.3 mm) from baseline to 6 months was minimal. There were minimal differences between groups for changes in PD, AT, and KT. There was no average change in TT1 and TT2 in the SAMRI group while 0.4 mm and 0.7 mm of average change in TT1 and TT2 in the STA group at 6 months. The total procedure time per tooth in both groups was similar (SAMRI group: 21 minutes and 36 seconds, STA group: 21 minutes and 50 seconds). The average surgical time per tooth for the STA group was greater with the mean of 17 minutes and 10 seconds compared to SAMRI group with the mean of 16 minutes and 28 seconds. However, the average suturing time per tooth for the SAMRI group was greater with the mean of 5 minutes and 7 seconds compared to the STA group with the mean of 4 minutes and 39 seconds. Patient-centered outcomes (VAS score) at 1-week and 1-month iv revealed a slightly higher self-reported pain, swelling, bruising/bleeding, and activity tolerance in the SAMRI group compared to the STA group but the difference in between two groups was minimal. Practitioner-assessed esthetic outcomes were evaluated through the pink esthetic score (PES) and both groups resulted in high average scores (out of 14); 10.8 for the SAMRI group and 11.4 for the STA group at 12 months. All participants had highly satisfied and positive experience from both types of surgical procedures during the period of research study, which was assessed by patient satisfaction survey at 12 months. Conclusion. Within its limitation, both surgical techniques (SAMRI and STA) with coronally advanced flap and ADM can be used to treat Cairo RT1 gingival recession defects to achieve improvements in root coverage and improved esthetics with high level of patient satisfaction.
Lee, Wangsoo, "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" (2023). All ETDs from UAB. 407.