Modified Coronally Advanced Tunnel for Mandibular Lingual Root Coverage

NCT07590960 | Not Yet Recruiting

• 1 other identifier: STUDY26020003
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

This study will follow adults who have gum recession on the tongue side of the lower teeth. Participants will receive a gum surgery called the Modified Coronally Advanced Tunnel technique with a connective tissue graft taken from the roof of the mouth. The study will include 20 participants and will follow them for up to 24 months after surgery. The main outcome is how much of the exposed root is covered 6 months after surgery. The study will also measure gum thickness, gum width, tooth sensitivity, healing, patient comfort, satisfaction, and three-dimensional soft tissue changes using intraoral scans.

Conditions

Gingival Recession; Mucogingival Deformity - Insufficient Keratinized Tissue

Keywords

Gingival Recession; Tissue Grafts; Tooth Sensitivity

Outcome Measures

Primary Outcomes (1)

• Mean Change in Root Coverage from Baseline at 6 Months

  Mean root coverage will be calculated as baseline recession depth minus recession depth at 6 months post-surgery. Recession depth will be measured in millimeters from the cementoenamel junction to the gingival margin at the mid-lingual aspect using a UNC-15 periodontal probe by a calibrated examiner blinded to baseline measurements

  Baseline and 6 months post-surgery.

Secondary Outcomes (19)

• Percentage Root Coverage at 6 Months

  6 months post-surgery

• Frequency of Complete Root Coverage at 6 Months

  6 months post-surgery

• Change from Baseline in Recession Depth at 6 Months

  Baseline and 6 months post-surgery

• Change from Baseline in Recession Width at 6 Months

  Baseline and 6 months post-surgery

• Change from Baseline in Clinical Attachment Level at 6 Months

  Baseline and 6 months post-surgery

Study Arms (1)

Modified Coronally Advanced Tunnel with Connective Tissue Graft

EXPERIMENTAL

Adults with single or multiple Cairo RT1 mandibular lingual gingival recessions of at least 3 mm on mandibular incisors, canines, or premolars who will receive standardized Modified Coronally Advanced Tunnel surgery with a deepithelialized connective tissue graft and will be followed for up to 24 months.

Procedure: Modified Coronally Advanced Tunnel with Connective Tissue Graft

Interventions

Modified Coronally Advanced Tunnel with Connective Tissue Graft PROCEDURE

The procedure consists of lingual tunnel preparation without vertical releasing incisions, followed by placement of a deepithelialized connective tissue graft harvested from the palate. Root surface conditioning may be performed with EDTA gel before graft placement. The graft is positioned to cover the exposed root surface, and the lingual flap is advanced coronally and secured with sutures to achieve stable, tension-free coverage.

Modified Coronally Advanced Tunnel with Connective Tissue Graft

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18-65 years
• Single or multiple Cairo RT1 lingual gingival recessions ≥3 mm on mandibular incisors, canines, or premolars
• Identifiable CEJ on the lingual aspect
• Vital uniradicular teeth
• Full-mouth plaque score \<20%
• Smokes less than 10 cigarettes per day
• Adequate mouth opening for lingual access
• Sufficient palatal donor tissue thickness (≥2 mm at 2-3 mm from gingival margin)

You may not qualify if:

• Positive urine pregnancy test or self-reported lactation
• Smoker more than 10 cigarettes per day
• Uncontrolled systemic diseases, at the discretion of the PI (diabetes HbA1c \>7%, cardiovascular disease, immunocompromised)
• Use of medications affecting periodontal tissues (phenytoin, calcium channel blockers, immunosuppressants)
• Use of blood thinners
• Previous root coverage surgery at treated sites
• Teeth with cervical restorations or caries on lingual surfaces
• Inadequate attached gingiva (\<1 mm)
• Prominent lingual frenum attachment requiring frenectomy

Sponsors & Collaborators

• University of Pittsburgh: lead

Study Sites (1)

University of Pittsburgh School of Dental Medicine

Pittsburgh, Pennsylvania, 15261, United States

Location

Related Publications (17)

• Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol. 2011 Jul;38(7):661-6. doi: 10.1111/j.1600-051X.2011.01732.x. Epub 2011 Apr 20.

  PMID: 21507033 BACKGROUND

• Cairo F, Rotundo R, Miller PD, Pini Prato GP. Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol. 2009 Apr;80(4):705-10. doi: 10.1902/jop.2009.080565.

  PMID: 19335093 BACKGROUND

• Aroca S, Keglevich T, Barbieri B, Gera I, Etienne D. Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: a 6-month study. J Periodontol. 2009 Feb;80(2):244-52. doi: 10.1902/jop.2009.080253.

  PMID: 19186964 BACKGROUND

• Tavelli L, Barootchi S, Nguyen TVN, Tattan M, Ravida A, Wang HL. Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta-analysis. J Periodontol. 2018 Sep;89(9):1075-1090. doi: 10.1002/JPER.18-0066. Epub 2018 Aug 13.

  PMID: 29761502 BACKGROUND

• Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol. 2015 Feb;86(2 Suppl):S8-51. doi: 10.1902/jop.2015.130674.

  PMID: 25644302 BACKGROUND

• Zuhr O, Baumer D, Hurzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014 Apr;41 Suppl 15:S123-42. doi: 10.1111/jcpe.12185.

  PMID: 24640997 BACKGROUND

• Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Preshaw PM, Reynolds MA, Sculean A, Susin C, West NX, Yamazaki K. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1:S237-S248. doi: 10.1002/JPER.17-0733.

  PMID: 29926943 BACKGROUND

• Scheyer ET, Sanz M, Dibart S, Greenwell H, John V, Kim DM, Langer L, Neiva R, Rasperini G. Periodontal soft tissue non-root coverage procedures: a consensus report from the AAP Regeneration Workshop. J Periodontol. 2015 Feb;86(2 Suppl):S73-6. doi: 10.1902/jop.2015.140377.

  PMID: 25644301 BACKGROUND

• Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Periodontol. 2018 Jun;89 Suppl 1:S204-S213. doi: 10.1002/JPER.16-0671.

  PMID: 29926948 BACKGROUND

• Barootchi S, Tavelli L, Zucchelli G, Giannobile WV, Wang HL. Gingival phenotype modification therapies on natural teeth: A network meta-analysis. J Periodontol. 2020 Nov;91(11):1386-1399. doi: 10.1002/JPER.19-0715. Epub 2020 Jun 12.

  PMID: 32392401 BACKGROUND

• Assis G, Nevins M, Kim DM. The Use of Autogenous Gingival Graft for Treatment of Lingual Recession on Mandibular Anterior Teeth. Int J Periodontics Restorative Dent. 2017 Sep/Oct;37(5):667-671. doi: 10.11607/prd.3263.

  PMID: 28817130 BACKGROUND

• Soileau KM. Treatment of a mucogingival defect associated with intraoral piercing. J Am Dent Assoc. 2005 Apr;136(4):490-4. doi: 10.14219/jada.archive.2005.0205.

  PMID: 15884319 BACKGROUND

• Wilcko MT, Wilcko WM, Murphy KG, Carroll WJ, Ferguson DJ, Miley DD, Bouquot JE. Full-thickness flap/subepithelial connective tissue grafting with intramarrow penetrations: three case reports of lingual root coverage. Int J Periodontics Restorative Dent. 2005 Dec;25(6):561-9.

  PMID: 16353531 BACKGROUND

• Zucchelli G, Bentivogli V, Ganz S, Bellone P, Mazzotti C. The connective tissue graft wall technique to improve root coverage and clinical attachment levels in lingual gingival defects. Int J Esthet Dent. 2016;11(4):538-548.

  PMID: 27730223 BACKGROUND

• Mehrotra VK, Triveni MG, Tarun Kumar AB, Chandra RV. Minimally invasive treatment of mandibular anterior lingual defects by vestibular incision subperiosteal tunnel access technique and connective tissue graft: a case report. Clin Adv Periodontics. 2017;7(4):195-200.

  BACKGROUND

• Alves JP, Marques TM, Malta Santos NB, Correia Sousa M, Coutinho Alves C, Correia AR. Lingual Incision Subperiosteal Tunnel Access: Proof of Concept 18-Month Follow-Up. Clin Adv Periodontics. 2019 Dec;9(4):196-202. doi: 10.1002/cap.10072. Epub 2019 Sep 26.

  PMID: 31507099 BACKGROUND

• Yadav VS, Kamra P, Singh N, Chandra RV. Treatment of multiple lingual gingival recession defects in mandibular incisors with modified coronally advanced tunnel technique. Contemp Clin Dent. 2018;9(Suppl 2):S345-9.

  BACKGROUND

MeSH Terms

Conditions

Gingival Recession; Dentin Sensitivity

Condition Hierarchy (Ancestors)

Gingival Diseases; Periodontal Diseases; Mouth Diseases; Stomatognathic Diseases; Periodontal Atrophy; Tooth Diseases

Study Officials

• Andrea Ravida, DDS, MS, PhD

  University of Pittsburgh, Department of Periodontics and Preventive Dentistry

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Andrea Ravida, DDS, MS, PhD

CONTACT

4126488595; andrearavida@pitt.edu

Carla Sanchez, MS

CONTACT

4126241179; cab28@pitt.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Masking Details: A calibrated examiner, blinded to baseline measurements, will perform all post-operative clinical assessments to minimize measurement bias.
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: Prospective single-arm case series. All enrolled participants undergo the same surgical intervention (Modified Coronally Advanced Tunnel technique with deepithelialized connective tissue graft) for treatment of mandibular lingual gingival recessions.

Study Record Dates

• First Submitted: May 1, 2026
• First Posted: May 15, 2026
• Study Start: May 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): December 1, 2028
• Last Updated: May 19, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)