Pinhole vs Tunnel Techniques for Gum Recession

Recruiting in Palo Alto (17 mi)

Overseen by Mohanad Al-Sabbagh

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Nehal Almehmadi

Disqualifiers: Non-salvageable teeth, Infection, Pregnancy

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial compares two minor surgeries for treating receding gums. It focuses on patients with this condition and aims to see which method better covers exposed roots and thickens gums by moving existing tissue.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

Is the Pinhole Surgical Technique safe for treating gum recession?

The Pinhole Surgical Technique (PST) is considered safe for treating gum recession, with minimal postoperative complications reported in studies. It is a minimally invasive procedure that does not require additional surgical sites, and patients have reported high satisfaction with the aesthetic outcomes. ^{1 2 3 4 5}

How does the Pinhole and Tunnel treatment for gum recession differ from other treatments?

The Pinhole Surgical Technique (PST) and Tunnel Technique are unique because they are minimally invasive procedures that do not require cutting or suturing, unlike traditional methods that often involve grafting from another site in the mouth. These techniques focus on repositioning the gum tissue to cover exposed roots, offering quicker recovery and less discomfort for patients. ^{1 3 4 6 7}

Research Team

Mohanad Al-Sabbagh

Principal Investigator

University of Kentucky

Eligibility Criteria

This trial is for adults aged 18-75 with mild to moderate gum recession on at least one stable tooth, who are generally healthy (ASA class I and II) and have good oral hygiene (low plaque and bleeding scores). Pregnant or breastfeeding individuals, those with infected gums around the affected area, or teeth that can't be saved are excluded.

Inclusion Criteria

American Society of Anesthesiology class I and II

I am between 18 and 75 years old.

full mouth plaque score (FMPS) and full mouth bleeding score (FMBS) below 20%

Exclusion Criteria

I have severe gum recession around teeth that cannot be saved.

pregnant or breastfeeding females

The area for my graft does not have any infection, swelling, or discharge.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo Pinhole surgical technique and Tunnel technique for treatment of soft tissue recession

1 day

1 visit (in-person)

Post-operative Monitoring

Participants are monitored for post-operative pain and healing progress

1 week

1 visit (in-person)

Follow-up

Participants are monitored for changes in gingival thickness, root coverage, and other outcomes

6 months

1 visit (in-person) at 6 months

Treatment Details

Interventions

• Pinhole surgical technique (Procedure)
• Tunnel technique (Procedure)

Trial Overview The study compares two surgical methods for treating gum recession without using patient's own tissue: the pinhole surgical technique (PST) and tunnel technique. Each participant will receive both treatments in different areas of their mouth randomly.

Participant Groups

Group I: Pinhole/Tunnel Experimental Treatment 1 Intervention

Participants will receive Pinhole surgical technique for treatment of soft tissue recession at one side of the mouth and Tunnel technique for treatment of soft tissue recession at the other side of the mouth

Pinhole surgical technique is already approved in Canada for the following indications:

Approved in Canada as Chao Pinhole Surgical Technique for:

• Gum recession
• Soft tissue recession

Who Is Running the Clinical Trial?

Nehal Almehmadi

Lead Sponsor

Trials

1

Recruited

30+

Mohanad Al-Sabbagh

Lead Sponsor

Trials

2

Recruited

50+

Findings from Research

The pinhole surgical technique (PST) for root coverage showed a high predictability of 81.2% for Class I and II recession sites, with a mean defect reduction of 94.0%, making it a promising alternative to traditional graft techniques.

PST is minimally invasive, requiring only a small incision and no secondary surgical site, with a mean procedure time of 22.3 minutes and high patient satisfaction at 95.1%, indicating its potential for effective and efficient treatment of gum recession.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A novel approach to root coverage: the pinhole surgical technique. Chao, JC.[2013]

In a study involving 12 healthy patients with multiple gum recession defects, the minimally invasive coronally advanced tunnel technique (MI-CAT) with orthodontic buttons and suturing resulted in a higher complete root coverage rate of 73% compared to 56% in the control group after 6 months.

Both the test and control groups achieved similar aesthetic scores for root coverage, indicating that MI-CAT is an effective and predictable method for treating gum recession without compromising aesthetic outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of Multiple Gingival Recessions Using a Minimally Invasive Coronally Advanced Tunnel: A Randomized Controlled Clinical Trial. Khanna, D., George, JP., Babrawala, IS., et al.[2022]

The Tunnel technique (TUN) shows promising effectiveness for treating gingival recession, achieving an average root coverage of about 82.75% for localized defects and 87.87% for multiple defects, particularly in maxillary areas and lower Miller Class defects.

While TUN and the Coronally Advanced Flap (CAF) procedures yield similar results in terms of root coverage and esthetic outcomes, CAF tends to provide better complete root coverage when the same graft materials are used, suggesting that CAF may be the superior option in certain cases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta-analysis. Tavelli, L., Barootchi, S., Nguyen, TVN., et al.[2022]

The tunnel technique for treating localized and multiple gingival recessions has been shown to be effective, as demonstrated by a systematic review and meta-analysis, which consolidates data from various studies.

This technique not only improves the aesthetic appearance of the gums but also promotes better healing outcomes, making it a valuable option for periodontal treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tunneling Technique in Conjunction With Autogenous Graft or Graft Substitutes Is a Predictable Surgical Approach to Achieve Root Coverage in Isolated or Multiple Gingival Recession Defects. Elangovan, S.[2020]

The study involved 165 patients with multiple adjacent gingival recession defects, comparing the effectiveness of pinhole surgical technique (PST) alone versus PST combined with advanced platelet rich fibrin (A-PRF).

Results showed that the combination of PST with A-PRF significantly improved clinical outcomes, including greater reductions in gingival recession depth and width, as well as increased keratinized tissue width and gingival thickness, compared to PST alone.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative evaluation of pinhole surgical technique with and without A-PRF in the treatment of multiple adjacent recession defects: A clinico radiographic study. Trivedi, DS., Kolte, AP., Kolte, RA., et al.[2023]

Connective tissue grafting combined with the tunnel procedure is an effective method for managing gingival recession defects, allowing for root coverage in a single operation and showing positive histological evidence of periodontal regeneration in human subjects.

Clinical trials indicate that this technique results in early tissue healing, improved blood supply, and excellent aesthetic outcomes, making it a favorable option for patients and enhancing the success rate of root coverage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A promising periodontal procedure for the treatment of adjacent gingival recession defects. Tözüm, TF.[2005]

References

1. United States pubmed.ncbi.nlm.nih.gov

A novel approach to root coverage: the pinhole surgical technique. [2013]

2. England pubmed.ncbi.nlm.nih.gov

Treatment of Multiple Gingival Recessions Using a Minimally Invasive Coronally Advanced Tunnel: A Randomized Controlled Clinical Trial. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta-analysis. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Tunneling Technique in Conjunction With Autogenous Graft or Graft Substitutes Is a Predictable Surgical Approach to Achieve Root Coverage in Isolated or Multiple Gingival Recession Defects. [2020]

5. England pubmed.ncbi.nlm.nih.gov

Comparative evaluation of pinhole surgical technique with and without A-PRF in the treatment of multiple adjacent recession defects: A clinico radiographic study. [2023]

6. Canada pubmed.ncbi.nlm.nih.gov

A promising periodontal procedure for the treatment of adjacent gingival recession defects. [2005]

7. Germany pubmed.ncbi.nlm.nih.gov

Influence of graft thickness on tunnel technique procedures for root coverage: a pilot split-mouth randomized controlled trial. [2023]