Clinical and aesthetic outcomes of enamel matrix derivative and subepithelial connective tissue graft using the modified coronally advanced tunnel technique: a randomized controlled trial.

OBJECTIVES: This randomized controlled clinical trial evaluated the short-term clinical outcomes of the modified coronally advanced tunnel technique combined with three different regenerative approaches-subepithelial connective tissue graft (as the gold standard), enamel matrix derivative (as a donor-site-sparing alternative), and their combination (to explore potential synergistic effects)-in treating recession type 1 gingival defects.

METHODOLOGY: A total of 52 systemically healthy patients (aged 18-60) with 90 recession type 1 gingival defects were enrolled and randomly assigned to one of the three treatment groups: Group 1 (n=18; subepithelial connective tissue graft), Group 2 (n=19; enamel matrix derivative), and Group 3 (n=15; both materials). Primary outcome consisted of the percentage of root coverage at 6 months. Secondary outcomes included plaque index, gingival index, gingival recession depth, gingival recession width, clinical attachment level, keratinized tissue width, gingival thickness, wound healing index, probing depth, and root coverage aesthetic score. Clinical parameters were measured at baseline, 3, and 6 months, and aesthetic outcomes were assessed at 6 months.

RESULTS: All groups showed significant improvements in clinical parameters. Mean root coverage was 80.4% for Group 1, 76.2% for Group 2, and 73.6% for Group 3, with no significant differences among them. Keratinized tissue width significantly increased in Group 1 and Group 3, but not in Group 2. Mean root coverage aesthetic score values were 7.74 ± 2.35, 7.54 ± 2.39, and 7.62 ± 1.97, respectively (p > 0.05).

CONCLUSION: Within the limitations of this study, including its short-term follow-up period and baseline differences in recession width, all three groups exhibited comparable clinical and aesthetic outcomes at 6 months. Clinical Trial Registration Number: NCT06504329.