Multiple Recessions Coverage Using the Modified Tunnel Technique and Connective Tissue Graft with or Without...

There is continuing interest in using biologics in root coverage procedures. The aim of the present study was to explore the 2-year outcomes following multiple gingival recessions (GRs) coverage using the application of cross-linked hyaluronic acid (HA) in combination with modified coronally advanced tunnel (MCAT) together with subepithelial connective tissue graft (SCTG). Adopting a split-mouth design, 266 GRs were randomly allocated to either a test (MCAT + SCTG + HA) or control group (MCAT + SCTG). The main outcome variable was the stability of the obtained mean root coverage from 6 months to 24 months. Twenty-four patients were evaluated at the 2-year follow-up. Comparisons between test and control sides at the same time points were evaluated using the t-test for independent variables. The changes in time were compared by one-way analysis of variance with the Tukey post hoc test separately for the test and control groups. The study protocol was registered at ClinicalTrials.gov (NCT05045586). At 2 years, around ninety percent of recessions showed complete root coverage (87.02% of the test group and 91.90% of the control group). Mean root coverage did not differ between the two sides, with 81.37 ± 37.17% (test) and 84.63 ± 35.33% (control), respectively. Significant improvements in the reduction of gingival recession height, clinical attachment level gain, gingival thickness increase, and the root esthetic score were found in both groups after 2 years, but no statistically significant difference was observed between the groups. The adjunctive application of HA significantly improved soft tissue texture (STT, 0.94 ± 0.23 for the test group vs. 0.71 ± 0.46 for the control group). Treatment of multiple gingival recessions with MCAT + SCTG with or without HA yielded marked and comparable 2-year clinical outcomes, which could be maintained over a period of 24 months. The clinical relevance of the demonstrated significant difference in STT between groups may be minimal.