Comparison of techniques for root coverage of localized recessions: A 12-month follow-up randomized controlled trial

Comparison of techniques for root coverage of localized recessions: A 12-month follow-up randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of techniques for root coverage of localized recessions: A 12-month follow-up randomized controlled trial Samuel Batista Borges, Lidya Nara Marques Araújo, Gabriela Ellen Gomes, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4750407/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives To compare two techniques for the root coverage of unilateral, single type-1 gingival recessions. Materials and methods This randomized controlled trial evaluated thin-gingival phenotype individuals with unilateral and single RT1 undergoing root coverage procedures. The study compared the combinations of subepithelial connective tissue graft (SeCTG) with a coronally-advanced flap (CAF; control group) and with the tunnel technique (TT; test group). The main parameters assessed were probing depth (PD), gingival recession height (GH), keratinized tissue (KTW), gingival thickness (GT), and percentage of root coverage (RC). Patient-reported outcome measures (PROMs), such as postoperative pain, cervical dentin hypersensitivity (CDH), esthetics, satisfaction level, and quality of life were also assessed, over 12 months of follow-up. Data were statistically analyzed using paired Student’s t -test, Chi-square, McNemar, and Split-Plot Analysis of Variance with post hoc t -test (α = 5%). Results Forty-six subjects completed the study (CAF + SeCTG: 23; TT + SeCTG: 23). Significant reductions for GH and gains in CAL, KTW, and GT were observed in the intragroup analysis for both groups. No differences were found between techniques. RC increased significantly, but no intergroup differences were observed (CAF + SeCTG: 89.4%; TT + SeCTG: 87.1%; p = 0.071). Intragroup analysis indicated a modification in gingival phenotype (GP) from thin to thick ( p < 0.001). Both treatment protocols improved PROMs ( p < 0.001), with no differences between the techniques. Conclusions The two surgical approaches resulted in significant improvements with similar clinical efficacy regarding RC, including GH, CAL, KTW, gingival thickness, and PROMs. Clinical relevance CAF + SeCTG versus TT + SeCTG showed similar clinical, esthetic and patient-related outcomes; however, CAF + SeCTG had a shorter surgical time. Gingival recession. Tooth root. Connective tissue graft. Surgical flaps. Clinical trial Figures Figure 1 Figure 2 Introduction Treating exposed root surfaces has become a common concern due to patients' increasing esthetic demands [ 1 – 3 ]. Exposed roots often lead to issues like cervical dentin hypersensitivity (CDH), non-carious cervical lesions (NCCL), and difficulties in controlling dental biofilm, raising the risk of caries [ 4 – 8 ]. Root coverage techniques using subepithelial connective tissue grafts (SeCTG) yield the best clinical results, often achieving higher RC percentages and increased keratinized tissue width (KTW). They are regarded as the gold standard for treating gingival recessions [ 6 , 9 – 13 ]. The coronally advanced flap (CAF) is the most common procedure for treating GH, especially with SeCTG [ 14 ]. However, using relaxing vertical incisions can reduce blood supply to the flap, interfere with graft incorporation, and cause scars in esthetic areas [ 10 – 15 ]. The absence of vertical incisions may improve blood supply to the graft, accelerate healing and root coverage, and enhance esthetics after healing [ 16 , 17 ]. As alternatives to CAF with vertical incisions, techniques by Raetzke [ 18 ] and Bruno [ 16 ] offer good visual acuity and flap repositioning without tension, benefiting both dentists and patients as less invasive procedures. These methods allow gentle tissue manipulation and precise suturing, improving primary closure and wound stability [ 17 , 19 ]. However, there is currently insufficient evidence to support the superiority of one method over the other [ 16 , 18 ]. More refined research protocols are needed to establish the best clinical scenarios for each procedure. This study aimed to compare two techniques for achieving root coverage in unilateral, single type-1gingival recessions, in individuals with a thin gingival phenotype (GP). We hypothesize that both techniquesc [ 16 , 18 ], when associated with the SeCTG, demonstrate comparable efficacy for attaining root coverage and improving patient-reported outcome measures (PROMs), over a 12-month follow-up period. Materials and methods Study design, ethical aspects and sample This parallel, double-blind, randomized controlled trial (RCT) was registered under the code RBR-4PSXBY, in the Brazilian Registry of Clinical Trials (ReBEC, www.ensaiosclinicos.gov.br ) on April 2020, and was conducted between May 2020 and April 2022. The CONSORT statement for improving the quality of reports of parallel randomized controlled trial was followed in the preparation of the present RCT. The study was approved by the Research Ethics Committee on Human Subjects of the Federal University of Rio Grande do Norte (number 3.389.326/2019), and was in full accordance with the Helsinki Declaration of 1975, as revised in 2013 [ 20 ]. Informed consents were obtained from all the subjects. The determination of the sample size was performed using the OpenEpi public domain website ( http://www.openepi.com/OE2.3/Menu/OpenEpiMenu.htm ). The mean value of 2.60 mm for the width of KTW after twelve months was adopted [ 17 ] with a standard deviation of ± 0.81 mm, a confidence interval of 95% and a power of 80%. A difference of 0.92 mm between groups was considered statistically significant, resulting in a required sample size of 24 individuals per group. Accounting for a potential loss of at least 20% of the sample during the study, a total of 58 participants was required. Eligibility criteria and randomization To be included, patients were required to be aged between 18 and 55 years old and with unilateral, single type-1 gingival recession (RT1). Patients should have clinically healthy periodontium [ 21 ], with no interproximal attachment loss and no clinically detectable interproximal cementoenamel junctions (CEJ), on the mesial or distal sites [ 22 , 23 ], in premolars and/or upper canines (≥ 2 mm in depth, not exceeding 5 mm in depth). Furthermore, they should not have restorations over the recession, and present a thin GP, characterized by transparency of the periodontal probe when introduced into the gingival sulcus [ 24 ]. Individuals using orthodontic appliances were excluded from this study, as well as users of fixed or removable prostheses involving the canine and/or premolar teeth with gingival recession, smokers, pregnant or lactating women, and individuals with systemic diseases that may interfere with healing or periodontal health (diabetes, hypertension, blood dyscrasias in general, among others). Additionally, sites with recession defects associated with non-carious cervical lesions of deeper than 1 mm, caries lesions, teeth with evidence of pulpal pathology, molars, teeth with severe malposition (rotation or extrusion), and teeth with a history of previous mucogingival or periodontal surgery were excluded. The sample selection was convenience-based. The groups to which each individual participated was randomized through a simple random draw, using a randomization program. Just one tooth from each patient with gingival recession was selected. In cases of multiple gingival recessions, the deepest was chosen. In the case of two or more recessions of the same depth, a coin toss system was used for selection. Codes were assigned to each treatment, for TT + SeCTG (Raetzke´s technique) and CAF + SeCTG (Bruno´s technique), and the randomization was performed before the start of the study. This was a double-blind study, as neither the patient nor the examiner was aware of which surgical technique for root coverage had been employed. Clinical measurements Gingival recession height (GH), probing depth (PD), clinical attachment level (CAL), gingival phenotype (GP), keratinized tissue width (KTW), and gingival thickness (GT) were collected using a periodontal probe (PCP UNC 15, Hu-Friedy) by a calibrated examiner (L.N.M.A.) who was blinded to the treatments performed. In addition, the esthetic outcomes were evaluated using the Pink Esthetic Score (PES) [ 25 ] and the Root Coverage Esthetic Score (RES) [ 26 ]. Patient-reported outcome measures (PROMs) For the collection of data on CDH, esthetic self-perception, satisfaction degree, and postoperative pain, a standardized visual analogue scale (VAS) was presented to the patient [ 27 , 28 ]. Patients were required to rate, on a scale from 0 to 10, the impact of the area to be operated on esthetics and satisfaction level, as well as the level of postoperative pain at both the recipient and donor sites of the SeCTG, and the level of CDH. To measure this latter parameter, a burst of air was applied to the exposed cervical area for 1 second from approximately 1 cm away, protecting the adjacent teeth during the application. A higher score assigned on the VAS indicated a more negative evaluation. Data collection was performed before surgery, and at 6 and 12 months after surgery, while data on postoperative pain were collected at 8 hours, 24 hours, 7 days, 15 days, and 30 days after the surgical procedure. The pain assessment at 8 hours and 24 hours was conducted remotely. For the assessment of quality of life, the simplified OHIP-14 form [ 29 ] was applied at 6 and 12 months. Surgical Intervention All surgical procedures were performed at the Department of Dentistry of the Federal University of Rio Grande do Norte by the same operator (S.B.B.). Each participant received full mouth supragingival scaling, when necessary, as well as polishing and oral hygiene instructions, at 2 weeks before the scheduled surgery. In addition, patients were instructed to maintain an optimal toothbrushing technique to correct inadequate habits. For each of the two groups, a different technique was associated with SeCTG. Prior to surgery, infiltrative anesthesia was administered using an injection of mepivacaine containing vasoconstrictor (2% mepivacaine hydrochloride with epinephrine at a concentration of 1:100,000). After local anesthesia, the exposed root surfaces were polished with a rubber cup and pumice powder before flap elevation or scaling to plane the surface. The free gingival graft removal approach was used for harvesting the SeCTG graft, as described by Sullivan and Atkins [ 30 ] with subsequent de-epithelialization.31,32. For CAF + SeCTG, the technique proposed by Bruno [ 16 ] was performed. For TT + SeCTG, the technique proposed by Raetzke [ 18 ] was performed. The surgery time was measured using a stopwatch, from the first incision to the last suture. Post-operative instructions were provided to all subjects both verbally and in written form. All subjects also received 4 mg dexamethasone (tablet) one hour before the surgical procedure. After surgery, all volunteers took one 600mg ibuprofen tablet every 6 hours for 3 days when necessary. After suture removal at 2 weeks, patients were instructed to return to using the atraumatic brushing technique with a soft‐bristle toothbrush, while discontinuing the use of 0.12% chlorhexidine mouthwash rinses twice daily after surgery. Data and Statistical Analysis The Statistical Package for Social Science® 22.0 (IBM, San Francisco, CA, USA) software was used. Initially, a descriptive analysis of the data was performed to assess the distribution of normality of the quantitative data (PD, CAL, KTW, GT, GH, PES, RES, DCH, self-perceived esthetics, satisfaction, and postoperative pain) based on standard deviation, skewness, and kurtosis. This evaluation showed that the parameters followed the assumptions for normality, warranting the use of parametric tests. Data were statistically analyzed using paired Student t -test, t -test for independent samples, Chi-square, McNemar, and Split-Plot Analysis of Variance with post hoc t -test (α = 5%). Results Descriptive analysis Forty-six patients were assessed and treated in this parallel, randomized, double-blind controlled trial, from May 2020 to April 2022. All patients completed the study (Fig. 1 ). All surgeries were performed on canines or premolars located in the maxilla. The highest prevalence of gingival recessions was found in the first premolars (24; 52.2%), followed by the canines (14; 30.4%) and second premolars (8; 17.4%). A total of 46 teeth were evaluated, and these were equally distributed between the two groups (n = 23 each). With regard to gender and age, 26 (56.5%) female patients and 20 (43.5%) male patients, with a mean age of 28.41 years (range 19–49; ± 7.23), were treated. There was one postoperative complication associated with bleeding at the donor site for one patient in TT + SeCTG, and an infectious process in the recipient site of one patient in CAF + SeCTG (Fig. 2 ). Clinical outcomes The average surgery time was statistically higher for the TT + SeCTG, compared to the CAF + SeCTG (51 minutes ± 5.9; 40 minutes ± 5.6; p = 0.041, respectively). None of the clinical parameters were statistically significant different between the groups at the beginning of the study (Table 1 ). When comparing the means of quantitative clinical parameters for CAF + SeCTG and TT + SeCTG, no statistically differences were observed at any of the follow-up times for the variables PD and BOP, in both intra- and inter-group analyses (Table 2 ). The intragroup analysis demonstrated that GH was significantly decreased in both TT + SeCTG ( p < 0.001) and CA F + SeCTG ( p < 0.001), when comparing the means at baseline, to 6 months and to 12 months. The intergroup analysis did not demonstrate any statistically significant differences between the groups at 12-month (Table 2 ). The intragroup analysis showed that CAL was significantly reduced for both treatment groups and follow-up periods ( p < 0.001; p < 0.001, respectively). However, no statistically differences were observed in the intergroup analysis (Table 2 ). KTW significantly increased for both groups, when comparing the baseline with the 6-month follow-up ( p < 0.001), and baseline with 12-month follow-up ( p < 0.001). In the intergroup analysis, no statistically significant differences in KTW were found between groups over the follow-up periods (Table 2 ). There was also a significant increase in GT in the intragroup analysis between the follow-up periods ( p < 0.001, Table 2 ). The intergroup analysis did not show statistically differences for this parameter over the follow-up periods (Table 2 ). Intragroup analysis revealed that the % RC significantly increased at the 6- and 12-month time points, for both groups, when compared to baseline ( p < 0.001). However, no statistically significant differences were observed between the groups (Table 2 ). Table 1 Description of quantitative data, from the test (TT + SeCTG) and control (CAF + SeCTG) groups. Independent samples t-test Note: MD-GR, mesiodistal width of the gingival recession. TT, Tunnel Technique. SeCTG, Subepithelial Connective Tissue Graft. CAF, Coronally Advanced Flap. Test Group Group control x s Min-Max x s Min-Max P Surgical time (min) 51.0 5.9 30–57 40 5.6 38–65 0.041 MD-GR (mm) 3.1 0.6 1.6–3.7 3.5 0.8 1.8–4.2 0.283 SeCTG thickness (mm) 1.19 0.31 0.59–1.52 1.25 0.29 0.61–1.67 0.312 SeCTG length (mm) 6.2 1.4 5–10 6.7 1.4 6–11 0.324 SeCTG height (mm) 5.1 1.2 5–7 5.9 1.8 5–8 0.214 Table 2 Comparison of quantitative clinical parameters, for the test (TT + SeCTG) and control (CAF + SeCTG) groups, at baseline, and at 6- and 12-months follow-up. Split-Plot Analysis of Variance (SPANOVA). Baseline (x ± s ) 6 months (x ± s ) 12 months (x ± s ) Time Interaction Group versus Time p value Effect Size p value Effect Size PD (mm) CAF + SeCTG 1.96 ± 0.41 1.86 ± 0.43 1.83 ± 0.41 0.122 0.056 0.212 0.041 TT + SeCTG 1.93 ± 0.44 1.84 ± 0.4 1.82 ± 0.41 GH (mm) CAF + SeCTG 2.5 ± 1.2 0.29 ± 0.52 0.27 ± 0.38 < 0.001 0.524 0.314 0.113 TT + SeCTG 2.3 ± 0.97 0.33 ± 0.63 0.31 ± 0.59 CAL (mm) CAF + SeCTG 4.22 ± 1.32 2.1 ± 1.05 1.98 ± 1.1 < 0.001 0.215 0.245 0.032 TT + SeCTG 4.1 ± 1.29 2.0 ± 1.06 2.0 ± 1.11 KTW (mm) CAF + SeCTG 3.1 ± 1.32 5.1 ± 1.55 4.9 ± 1.51 < 0.001 0.452 0.327 0.021 TT + SeCTG 3.5 ± 1.45 4.9 ± 1.49 4.7 ± 1.45 GT (mm) CAF + SeCTG 0.76 ± 0.32 1.46 ± 0.3 1.52 ± 0.38 < 0.001 0.489 0.329 0.027 TT + SeCTG 0.81 ± 0.34 1.43 ± 0.29 1.49 ± 0.31 BoP CAF + SeCTG 0.68 ± 0.92 0.49 ± 0.89 0.47 ± 0.87 0.116 0.061 0.273 0.058 TT + SeCTG 0.65 ± 0.96 0.46 ± 0.87 0.45 ± 0.86 RC (%) CAF + SeCTG 0 ± 0 89.2 ± 14.5 89.4 ± 14.3 < 0.001 0.739 0.071 0.042 TT + SeCTG 0 ± 0 86.6 ± 13.9 87.1 ± 14.2 Note: TT, Tunnel Technique. SeCTG, Subepithelial Connective Tissue Graft. CAF, Coronally Advanced Flap. PD, Probing Depth. GH, Gingival Recession Height. CAL, Clinical Attachment Level. KTW, Keratinized Tissue Width. GT, Gingival Thickness. BoP, Bleeding on Probing. RC, Root Coverage When comparing the frequency of thick phenotypes in both groups, after intervention, the GP was found to have undergone a statistically significant change from thin to thick ( p < 0.001, McNemar test), between baseline and 6, and between baseline and 12 months (Supplementary T1). Table 3 illustrates the distribution of the main independent variables, in relation to RC (partial or complete) and GP (thin or thick), at 12 months. The association between RC and techniques was not statistically significant ( p = 0.078). The rates of total root coverage were found to be similar between groups. Of the 23 teeth treated in each group, there was a higher percentage of total RC than of partial RC for TT + SeCTG (18; 78.3%) and CAF + SeCTG (19; 82.6%). Additionally, Table 3 shows that the associations between KTW and RC, as well as between KTW and GP, were significant, with patients presenting a KTW of above 2mm having a higher percentage of complete RC (37; 86.1%; p < 0.001) and thick GP (43; 100%; p < 0.001). Furthermore, Table 3 demonstrates a statistically association between the use of orthodontic appliances and the distribution of total and partial RC. In cases where the individual had not used orthodontic appliances, there was a higher percentage of complete RC (25; 96.2%; p < 0.001). No significant associations were found between RC and GP and the independent variables sex, age, duration of orthodontic appliance use, and type of toothbrush (Table 3 ). Table 3 Distribution of the main independent variables, in relation to root coverage and gingival phenotype, at 12 months. Chi-square test Root Coverage t12 Gingival Phenotype t12 Partial (%) Total (%) p value Thin (%) Thick (%) p value Treatment group CAF + SeCTG 4 (17.4) 19 (82.6) 0.078 1 (4.35) 22 (95.65) 0.064 TT + SeCTG 5 (21.7) 18 (78.3) 2 (8.7) 21 (91.3) Sex Female 6 (23.1) 20 (76.9) 0.086 2 (7.7) 24 (92.3) 0.567 Male 3 (15) 17 (85) 1 (5) 19 (95) Age 18–30 years old 2 (9.1) 20 (90.9) 0.078 1 (3.9) 25 (96.1) 0.061 Over 30 years old 7 (29.2) 17 (70.8) 2 (18.2) 18 (81.8) KTW t12 Up to 2mm 3 (100) 0 < 0.001 3 (100) 0 0.003 Above 2mm 6 (13.9) 37 (86.1) 0 43 (100) Orthodontic appliance Yes 8 (40) 12 (60) < 0.001 2 (10) 18 (90) 0.332 No 1 (3.8) 25 (96.2) 1 (3.8) 25 (96.2) Time with the device Up to 42 months 4 (28.6) 10 (71.4) 0.465 1 (7.2) 13 (92.8) 0.258 Over 42 months 4 (66.7) 2 (33.3) 1 (16.6) 5 (83.4) Toothbrush type Extra soft or soft 6 (26.3) 36 (73.7) 0.257 1 (2.4) 41 (97.6) 0.756 Medium or hard 3 (44.4) 1 (55.6) 2 (50) 2 (50) Note: p value corresponds to the statistical significance for each independent categorical variable. The letter and number, t12, refers to the evaluated period. TT, Tunnel Technique. SeCTG, Subepithelial Connective Tissue Graft. CAF, Coronally Advanced Flap. KTW, Keratinized Tissue Width. PROMs The SPANOVA test showed statistically significant reductions in postoperative pain at both donor and recipient sites for both groups ( p < 0.001, Supplementary T2). There were no interactions between the sites for TT + SeCTG ( p = 0.781) or CAF + SeCTG ( p = 0.319) over time. However, comparing groups, an interaction was observed between recipient sites, with higher mean postoperative pain scores for TT + SeCTG at the 8-hour and 24-hour intervals ( p = 0.004). Post-hoc tests revealed a significant reduction in postoperative pain from 8 hours to 30 days after surgery at all operated sites (Supplementary T2). Supplementary T3 provides an overall assessment of the differences in the distribution of RES and PES scores at baseline and at 12 months. For RES, there was a null score at the initial baseline period, and scores of between 9 and 10 (excellent results) had a higher frequency (61%) for the CAF + SeCTG at 12 months follow-up. For PES, scores were approximately 6 for TT + SeCTG (17.5%) and CAF + SeCTG (21.7%) at baseline, increasing to higher scores (10), with frequencies of between 34.9% and 39.15% for the test and control groups, respectively, at 12 months (Supplementary T3). Supplementary T4 displays the distribution of individual components of RES for the TT + SeCTG (Raetzke) and CAF + SeCTG (Bruno) groups at 12 months. Findings indicate that the CAF + SeCTG had more teeth that achieved better scores for GM ( p < 0.001). No significant differences were observed for MTC, STT, MGJ, and GC (Supplementary T4). For PES scores, at baseline and at 12-months of follow-up, a statistical difference was observed for the intragroup comparison of mean GMC in CAF + SeCTG ( p < 0.001, Supplementary T5), and in TT + SeCTG ( p < 0.001). This difference was also observed for the mean GML in the CAF + SeCTG ( p < 0.001) and in TT + SeCTG ( p < 0.001) over follow-up. No statistically significant differences were found for the other variables of PES (Supplementary T5). Table 4 shows that no statistically differences were observed when comparing the mean total scores of RES and PES between both groups ( p = 0.689 and p = 0.243), and within the scores ( p = 0.215), at 12 months. Table 4 Difference between the mean RES and PES total scores, for the test (TT + SeCTG) and control (CAF + SeCTG) groups at 12 months. Student 's t-test CAF + SeCTG (x ± s) TT + SeCTG (x ± s) CI (95%) p value LL UL RES 8.59 ± 1.21 8.21 ± 0.49 0.08 1.28 0.689 PES 8.45 ± 1.29 8.48 ± 0.53 0.12 1.35 0.243 p value 0.215 Note: RES, Root Coverage Esthetic Score; PES, Pink Esthetic Score. TT, Tunnel Technique. SeCTG, Subepithelial Connective Tissue Graft. CAF, Coronally Advanced Flap. CI, Confidence Interval. Data analysis revealed significant decreases in the mean VAS scores for the parameters CDH, esthetics, and patient satisfaction, within each treatment group ( p < 0.05, Table 5 ). Statistical analysis also showed that there was no interaction between treatment groups and time, for all parameters. Post-tests found statistical differences only when comparing baseline values with those at each follow-up time (6 and 12 months; Table 5 ). Table 5 Cervical dentin hypersensitivity (CDH), self-perception of esthetics and patient satisfaction at baseline, and at 6- and 12-months follow-up. Split-Plot Analysis of Variance (SPANOVA). Baseline (x ± s ) 6 months (x ± s ) 12 months (x ± s ) Time Interaction Group versus Time p value Effect Size p value Effect Size CDH CAF + SeCTG 5.21 ± 1.84 0.72 ± 1.21 0.71 ± 1.31 < 0.001 0.545 0.325 0.048 TT + SeCTG 4.29 ± 1.79 0.81 ± 1.32 0.78 ± 1.47 Esthetic CAF + SeCTG 5.42 ± 2.22 1.32 ± 1.23 1.29 ± 1.21 < 0.001 0.441 0.432 0.247 TT + SeCTG 5.09 ± 2.12 1.27 ± 1.19 1.28 ± 1.25 Satisfaction CAF + SeCTG 6.09 ± 1.71 1.27 ± 1.12 1.31 ± 1.21 < 0.001 0.525 0.751 0.178 TT + SeCTG 5.96 ± 1.68 1.31 ± 1.62 1.32 ± 1.52 Note: TT, Tunnel Technique. SeCTG, Subepithelial Connective Tissue Graft. CAF, Coronally Advanced Flap. Lowercase letters show statistically significant differences between baseline and 6 months and between baseline and 12 months, for each group. Significant differences in the OHIP-14 were achieved in both groups, indicating an improvement in the quality of life of patients at 6 and 12 months after surgery ( p < 0.001, Supplementary T6). The other dimensions of the questionnaire also showed statistical differences, when comparing baseline and 6 months, and baseline and 12 months. The dimensions "physical pain" and "psychological discomfort" are among those that achieved better improvements, with progressive reductions in means. No statistical differences in the quality of life parameters were found between the groups (Supplementary T6). Discussion The efficacy of surgical techniques for root coverage (RC) using subepithelial connective tissue grafts (SeCTG) was previously tested to analyze the invasiveness, safety, and predictability [ 17 , 34 , 35 ]. This first controlled trial in thin phenotype patients compared two surgical techniques and showed that both treatment protocols (CAF + SeCTG and TT + SeCTG) significantly reduced gingival recession with no statistical differences between the groups. Similar studies confirmed the feasibility of these techniques for the treatment of single RT1 recessions, reducing patient morbidity in the postoperative period, ensuring predictability of root coverage and esthetics [ 17 , 36 – 38 ], and were less invasive, especially when relaxing vertical incisions were not used [ 12 , 17 ]. Using different flap designs (i.e., with relaxing incisions) compared to TT + SeCTG, the mean root coverage percentages were 87.2% and 77% [ 36 ], 88.6% and 78.1% [ 37 ], and 96.3% and 91.3% [ 38 ], in the control and test groups, respectively, after 6 months without statistically significant difference, except for the study by Salem et al. [ 38 ]. Santamaria et al. [ 36 ] attributed the inferior performance of the TT + SeCTG to the suture removal after 7 days. The authors also highlighted the need for extending follow-up by a further 6 months to make long-term conclusions. Accordingly, Neves et al. [ 37 ] observed that the RC percentage was not statistically significantly different between groups (Control: 89.5%; Test: 87.7%) after 2 years of comparable and stable clinical results. The authors also suggested that deficiencies related to each technique, identified in the short-term evaluation (6 months), tend to disappear over time. Such findings provide additional scientific support for the long-term stability of RC procedures using SeCTG [ 39 , 40 ]. Gobbato et al. [ 17 ], as in the present study, chose to perform the CAF + SeCTG technique, without relaxing incisions, as suggested by Bruno [ 16 ], and TT + SeCTG, obtaining RC means of 85% and 87% for control and test groups, respectively. In the present study, the mean RC percentages after 12 months were 89.4% and 87,1%. Indeed, according to systematic reviews, an average of RC of 84.7% and 80.9% can be expected when using the CAF + SeCTG approach [ 2 , 41 ], and 82.75% for TT + SeCTG [ 1 ], for the treatment of single RT1 recessions at 12 months of evaluation. Statistically significant differences in surgery time were observed in the present controlled trial. This can be explained by the fact that adequate execution of the Raetzke technique involves care and attention in patients with thin gingival tissue [ 18 ]. In this technique, the flap dissection is performed through the gingival sulcus with the use of tunneling instruments, which can make the procedure more time-consuming, compared to CAF [ 12 ]. Although root coverage is one of the primary goals for the treatment of gingival recessions, the gain in KTW and GT, with consequent change in GP, ensures treatment stability [ 1 , 42 ]. In this study’s intragroup comparison, both techniques were able to increase KTW significantly at 6 and 12 months, compared to baseline. Additionally, GT also significantly increased, when comparing follow-up with baseline, but no differences between the techniques, for KTW and GT, were observed over time. Consistent with the findings of this study, Neves et al. [ 37 ] also reported significant gains in KTW and GT for each group over time, but without statistically significant differences analysis. Using a similar methodology, Gobbato et al. [ 17 ] also noted increased KTW in TT + SeCTG compared to CAF + SeCTG after 12 months. However, the difference in KTW within groups might stem from non-standardized graft dimensions[ 1 ]. In this RCT, graft collection was standardized to each gingival recession's dimensions, showing no statistical differences between test and control groups in SeCTG graft thickness, length, or height. Recent reports suggest a link between gingival phenotype (GP) and oral mucosa thickness; individuals with a thin GP may have thinner palatal mucosa, impacting SeCTG harvesting [ 43 – 46 ]. To standardize graft thickness, this RCT used the free gingival graft technique [ 30 , 33 ] with subsequent de-epithelialization [ 31 , 32 ] GP evaluation, crucial for procedures like root coverage [ 44 ] and orthodontic treatment [ 47 ], 47 can be done using a periodontal probe [ 24 , 48 ], along with assessing keratinized tissue width (KTW) and gingival thickness (GT) [ 1 , 42 ]. Interestingly, individuals who had never undergone orthodontic treatment before exhibited a higher total root coverage rate of 96.2%. In contrast, those who had orthodontic treatment prior to root coverage surgery achieved a root coverage rate of only 60%. Therefore, bone morphological characteristics and tooth position should be carefully considered during planning. Orthodontic movements or vestibular projections of teeth for corrective purposes can lead to alveolar bone resorption, fenestrations, or dehiscence, thereby affecting root coverage outcomes [ 46 , 47 ]. Esthetic evaluation using RES and PES showed no significant differences between groups or scores after 12 months. (Table 4 ). The choice of scores does not appear to influence the esthetic evaluation at the end of treatment. Previous clinical studies have also evaluated esthetic factors and their influence on the choice of surgical technique [ 49 – 51 ], however, the available evidence is limited [ 6 , 37 ]. Findings regarding the overall mean RES align with clinical studies, systematic reviews, and meta-analyses comparing CAF + SeCTG and TT + SeCTG techniques [ 10 , 12 , 37 , 52 ]. RES-assessed gingival margin levels showed better scores in more cases. Longer-term studies observed decreasing score differences between groups, likely due to creeping attachment [ 10 , 12 , 37 , 53 ]. Additionally, Kerner et al. [ 54 ] recommended at least 12 months of follow-up for studies with professional esthetic evaluations. Esthetic evaluation and satisfaction often go hand in hand [ 2 , 12 , 13 , 55 , 56 ], highlighting RC techniques' positive impact on patient perception. VAS scores showed improved esthetics and satisfaction at 6 months, with no differences after 12 months between groups. TT + SeCTG has been associated with better esthetic outcomes [ 1 , 34 – 36 ]. However, a systematic review suggested that graft material influences esthetic outcomes more than flap design. SeCTG also provided higher RES scores and VAS averages than CAF or TT techniques without grafting, possibly due to the graft acting as a biological filler, reducing postoperative RG and improving RC results [ 12 ]. The impact of root coverage on individuals' oral health-related quality of life was also evaluated. A significant decrease in OHIP-14 means was observed at 6 and 12 months after the surgical procedure. Improvements in clinical parameters (mainly KTW, GT, and RC), as well as a decrease in CDH, seem to progressively enhance patients' quality of life. According to Wagner et al. [ 57 ] and Ng and Leung [ 58 ], GH above 2mm is associated with poor quality of life and could be significantly associated with higher OHIP-14. The effectiveness of both treatments for reducing CDH over time was clear, where the mean VAS scores reduced significantly for each treatment group compared to baseline, but without differences between groups. These results are supported by previous systematic reviews comparing the results of CAF + SeCTG and TT + SeCTG [ 1 , 58 , 59 , 60 , 61 ]. Some limitations include the different perceptions of patients regarding subjective parameters, such as postoperative pain, CDH, and esthetic, although a VAS was used. Furthermore, the results achieved should be evaluated for a longer time to verify the stability of treatments and the patient's perceptions regarding PROMs. Conclusions The results of the present study indicate that both techniques can provide stable outcomes, with significant improvements in clinical parameters and PROMs at 12 months post-procedures, without differences between the two flap design techniques. Declarations This study shows that using subepithelial connective tissue graft (SeCTG) with either the coronally-advanced flap (CAF) or tunnel technique (TT) gives similar results for root coverage and patient-reported outcomes, offering effective treatment options for single type-1 gingival recessions. This trial was registered on www.ensaiosclinicos.gov.br (No. RBR-4PSXBY). Conflicts of interest The authors declare that there are no conflicts of interest related to the study. Ethical approval The local ethical committee approved this clinical trial (ID 3.389.326/2019). Patient consent All patients gave written informed consent. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution Author contributions SBB: conceptualization, data curation, investigation, methodology, project administration, writing – original draft. LNMA: methodology, data curation, writing – review and editing. GEG: methodology, data curation. RSC: methodology, data curation. BCVG: conceptualization, data curation, investigation, methodology, project administration, writing – review and editing. All authors contributed to the interpretation of the data and drafting of the report, approved the final version, and agreed to be responsible for the work. Acknowledgement The authors thank all the patients who agreed to participate in this controlled trial, the Federal University of Rio Grande do Norte (Natal, Brazil), and the National Council of Scientific and Technological Development (CNPq). 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(a)(b), Baseline; (c) Incision design for harvesting the graft; (d) Step-by-step for graft desepithelization; (e) SeCTG; (f) Donor site suture; (g) After suturing the SeCTG with simple sutures, the flap was coronally advanced over the donor tissue, covering it as much as possible with sling sutures (CAF + SeCTG); (h) After insertion, the SeCTG was secured in place with simple sutures (TT + SeCTG). (i)(j) Healing at 6 months; (l)(m) Clinically stable results at 12 months post-intervention\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4750407/v1/1c16d376c3c52a80ccfa4060.jpg"},{"id":72084827,"identity":"49c51b35-954b-49a0-a150-4f2daa9d00a9","added_by":"auto","created_at":"2024-12-22 00:01:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1307428,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4750407/v1/8e880b87-51cd-4d3f-9117-f31c91f26aa3.pdf"},{"id":62656462,"identity":"d39df22d-b5b4-4b84-98d9-a75fb173f3b5","added_by":"auto","created_at":"2024-08-17 01:59:40","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":71764,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-4750407/v1/aa686c7fa8fa948460531712.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of techniques for root coverage of localized recessions: A 12-month follow-up randomized controlled trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTreating exposed root surfaces has become a common concern due to patients' increasing esthetic demands [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Exposed roots often lead to issues like cervical dentin hypersensitivity (CDH), non-carious cervical lesions (NCCL), and difficulties in controlling dental biofilm, raising the risk of caries [\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRoot coverage techniques using subepithelial connective tissue grafts (SeCTG) yield the best clinical results, often achieving higher RC percentages and increased keratinized tissue width (KTW). They are regarded as the gold standard for treating gingival recessions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe coronally advanced flap (CAF) is the most common procedure for treating GH, especially with SeCTG [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, using relaxing vertical incisions can reduce blood supply to the flap, interfere with graft incorporation, and cause scars in esthetic areas [\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The absence of vertical incisions may improve blood supply to the graft, accelerate healing and root coverage, and enhance esthetics after healing [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs alternatives to CAF with vertical incisions, techniques by Raetzke [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and Bruno [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] offer good visual acuity and flap repositioning without tension, benefiting both dentists and patients as less invasive procedures. These methods allow gentle tissue manipulation and precise suturing, improving primary closure and wound stability [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, there is currently insufficient evidence to support the superiority of one method over the other [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. More refined research protocols are needed to establish the best clinical scenarios for each procedure.\u003c/p\u003e \u003cp\u003eThis study aimed to compare two techniques for achieving root coverage in unilateral, single type-1gingival recessions, in individuals with a thin gingival phenotype (GP). We hypothesize that both techniquesc [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], when associated with the SeCTG, demonstrate comparable efficacy for attaining root coverage and improving patient-reported outcome measures (PROMs), over a 12-month follow-up period.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, ethical aspects and sample\u003c/h2\u003e \u003cp\u003eThis parallel, double-blind, randomized controlled trial (RCT) was registered under the code RBR-4PSXBY, in the Brazilian Registry of Clinical Trials (ReBEC, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.ensaiosclinicos.gov.br\u003c/span\u003e\u003cspan address=\"http://www.ensaiosclinicos.gov.br\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) on April 2020, and was conducted between May 2020 and April 2022. The CONSORT statement for improving the quality of reports of parallel randomized controlled trial was followed in the preparation of the present RCT. The study was approved by the Research Ethics Committee on Human Subjects of the Federal University of Rio Grande do Norte (number 3.389.326/2019), and was in full accordance with the Helsinki Declaration of 1975, as revised in 2013 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Informed consents were obtained from all the subjects.\u003c/p\u003e \u003cp\u003eThe determination of the sample size was performed using the OpenEpi public domain website (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.openepi.com/OE2.3/Menu/OpenEpiMenu.htm\u003c/span\u003e\u003cspan address=\"http://www.openepi.com/OE2.3/Menu/OpenEpiMenu.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The mean value of 2.60 mm for the width of KTW after twelve months was adopted [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] with a standard deviation of \u0026plusmn;\u0026thinsp;0.81 mm, a confidence interval of 95% and a power of 80%. A difference of 0.92 mm between groups was considered statistically significant, resulting in a required sample size of 24 individuals per group. Accounting for a potential loss of at least 20% of the sample during the study, a total of 58 participants was required.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEligibility criteria and randomization\u003c/h2\u003e \u003cp\u003eTo be included, patients were required to be aged between 18 and 55 years old and with unilateral, single type-1 gingival recession (RT1). Patients should have clinically healthy periodontium [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], with no interproximal attachment loss and no clinically detectable interproximal cementoenamel junctions (CEJ), on the mesial or distal sites [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], in premolars and/or upper canines (\u0026ge;\u0026thinsp;2 mm in depth, not exceeding 5 mm in depth). Furthermore, they should not have restorations over the recession, and present a thin GP, characterized by transparency of the periodontal probe when introduced into the gingival sulcus [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIndividuals using orthodontic appliances were excluded from this study, as well as users of fixed or removable prostheses involving the canine and/or premolar teeth with gingival recession, smokers, pregnant or lactating women, and individuals with systemic diseases that may interfere with healing or periodontal health (diabetes, hypertension, blood dyscrasias in general, among others). Additionally, sites with recession defects associated with non-carious cervical lesions of deeper than 1 mm, caries lesions, teeth with evidence of pulpal pathology, molars, teeth with severe malposition (rotation or extrusion), and teeth with a history of previous mucogingival or periodontal surgery were excluded.\u003c/p\u003e \u003cp\u003eThe sample selection was convenience-based. The groups to which each individual participated was randomized through a simple random draw, using a randomization program. Just one tooth from each patient with gingival recession was selected. In cases of multiple gingival recessions, the deepest was chosen. In the case of two or more recessions of the same depth, a coin toss system was used for selection. Codes were assigned to each treatment, for TT\u0026thinsp;+\u0026thinsp;SeCTG (Raetzke\u0026acute;s technique) and CAF\u0026thinsp;+\u0026thinsp;SeCTG (Bruno\u0026acute;s technique), and the randomization was performed before the start of the study. This was a double-blind study, as neither the patient nor the examiner was aware of which surgical technique for root coverage had been employed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eClinical measurements\u003c/h2\u003e \u003cp\u003eGingival recession height (GH), probing depth (PD), clinical attachment level (CAL), gingival phenotype (GP), keratinized tissue width (KTW), and gingival thickness (GT) were collected using a periodontal probe (PCP UNC 15, Hu-Friedy) by a calibrated examiner (L.N.M.A.) who was blinded to the treatments performed. In addition, the esthetic outcomes were evaluated using the Pink Esthetic Score (PES) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and the Root Coverage Esthetic Score (RES) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePatient-reported outcome measures (PROMs)\u003c/h2\u003e \u003cp\u003eFor the collection of data on CDH, esthetic self-perception, satisfaction degree, and postoperative pain, a standardized visual analogue scale (VAS) was presented to the patient [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Patients were required to rate, on a scale from 0 to 10, the impact of the area to be operated on esthetics and satisfaction level, as well as the level of postoperative pain at both the recipient and donor sites of the SeCTG, and the level of CDH. To measure this latter parameter, a burst of air was applied to the exposed cervical area for 1 second from approximately 1 cm away, protecting the adjacent teeth during the application. A higher score assigned on the VAS indicated a more negative evaluation.\u003c/p\u003e \u003cp\u003eData collection was performed before surgery, and at 6 and 12 months after surgery, while data on postoperative pain were collected at 8 hours, 24 hours, 7 days, 15 days, and 30 days after the surgical procedure. The pain assessment at 8 hours and 24 hours was conducted remotely. For the assessment of quality of life, the simplified OHIP-14 form [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] was applied at 6 and 12 months.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSurgical Intervention\u003c/h2\u003e \u003cp\u003eAll surgical procedures were performed at the Department of Dentistry of the Federal University of Rio Grande do Norte by the same operator (S.B.B.). Each participant received full mouth supragingival scaling, when necessary, as well as polishing and oral hygiene instructions, at 2 weeks before the scheduled surgery. In addition, patients were instructed to maintain an optimal toothbrushing technique to correct inadequate habits.\u003c/p\u003e \u003cp\u003eFor each of the two groups, a different technique was associated with SeCTG. Prior to surgery, infiltrative anesthesia was administered using an injection of mepivacaine containing vasoconstrictor (2% mepivacaine hydrochloride with epinephrine at a concentration of 1:100,000). After local anesthesia, the exposed root surfaces were polished with a rubber cup and pumice powder before flap elevation or scaling to plane the surface.\u003c/p\u003e \u003cp\u003eThe free gingival graft removal approach was used for harvesting the SeCTG graft, as described by Sullivan and Atkins [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] with subsequent de-epithelialization.31,32. For CAF\u0026thinsp;+\u0026thinsp;SeCTG, the technique proposed by Bruno [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] was performed. For TT\u0026thinsp;+\u0026thinsp;SeCTG, the technique proposed by Raetzke [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] was performed. The surgery time was measured using a stopwatch, from the first incision to the last suture.\u003c/p\u003e \u003cp\u003ePost-operative instructions were provided to all subjects both verbally and in written form. All subjects also received 4 mg dexamethasone (tablet) one hour before the surgical procedure. After surgery, all volunteers took one 600mg ibuprofen tablet every 6 hours for 3 days when necessary. After suture removal at 2 weeks, patients were instructed to return to using the atraumatic brushing technique with a soft‐bristle toothbrush, while discontinuing the use of 0.12% chlorhexidine mouthwash rinses twice daily after surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData and Statistical Analysis\u003c/h2\u003e \u003cp\u003eThe Statistical Package for Social Science\u0026reg; 22.0 (IBM, San Francisco, CA, USA) software was used. Initially, a descriptive analysis of the data was performed to assess the distribution of normality of the quantitative data (PD, CAL, KTW, GT, GH, PES, RES, DCH, self-perceived esthetics, satisfaction, and postoperative pain) based on standard deviation, skewness, and kurtosis. This evaluation showed that the parameters followed the assumptions for normality, warranting the use of parametric tests. Data were statistically analyzed using paired Student \u003cem\u003et\u003c/em\u003e-test, \u003cem\u003et\u003c/em\u003e-test for independent samples, Chi-square, McNemar, and Split-Plot Analysis of Variance with post hoc \u003cem\u003et\u003c/em\u003e-test (α\u0026thinsp;=\u0026thinsp;5%).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive analysis\u003c/h2\u003e \u003cp\u003eForty-six patients were assessed and treated in this parallel, randomized, double-blind controlled trial, from May 2020 to April 2022. All patients completed the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All surgeries were performed on canines or premolars located in the maxilla. The highest prevalence of gingival recessions was found in the first premolars (24; 52.2%), followed by the canines (14; 30.4%) and second premolars (8; 17.4%). A total of 46 teeth were evaluated, and these were equally distributed between the two groups (n\u0026thinsp;=\u0026thinsp;23 each).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWith regard to gender and age, 26 (56.5%) female patients and 20 (43.5%) male patients, with a mean age of 28.41 years (range 19\u0026ndash;49; \u0026plusmn; 7.23), were treated. There was one postoperative complication associated with bleeding at the donor site for one patient in TT\u0026thinsp;+\u0026thinsp;SeCTG, and an infectious process in the recipient site of one patient in CAF\u0026thinsp;+\u0026thinsp;SeCTG (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eClinical outcomes\u003c/h2\u003e \u003cp\u003eThe average surgery time was statistically higher for the TT\u0026thinsp;+\u0026thinsp;SeCTG, compared to the CAF\u0026thinsp;+\u0026thinsp;SeCTG (51 minutes\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9; 40 minutes\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6; \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.041, respectively). None of the clinical parameters were statistically significant different between the groups at the beginning of the study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). When comparing the means of quantitative clinical parameters for CAF\u0026thinsp;+\u0026thinsp;SeCTG and TT\u0026thinsp;+\u0026thinsp;SeCTG, no statistically differences were observed at any of the follow-up times for the variables PD and BOP, in both intra- and inter-group analyses (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe intragroup analysis demonstrated that GH was significantly decreased in both TT\u0026thinsp;+\u0026thinsp;SeCTG (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001) and CA F\u0026thinsp;+\u0026thinsp;SeCTG (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001), when comparing the means at baseline, to 6 months and to 12 months. The intergroup analysis did not demonstrate any statistically significant differences between the groups at 12-month (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe intragroup analysis showed that CAL was significantly reduced for both treatment groups and follow-up periods (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001; \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001, respectively). However, no statistically differences were observed in the intergroup analysis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). KTW significantly increased for both groups, when comparing the baseline with the 6-month follow-up (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001), and baseline with 12-month follow-up (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001). In the intergroup analysis, no statistically significant differences in KTW were found between groups over the follow-up periods (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere was also a significant increase in GT in the intragroup analysis between the follow-up periods (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The intergroup analysis did not show statistically differences for this parameter over the follow-up periods (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Intragroup analysis revealed that the % RC significantly increased at the 6- and 12-month time points, for both groups, when compared to baseline (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001). However, no statistically significant differences were observed between the groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of quantitative data, from the test (TT\u0026thinsp;+\u0026thinsp;SeCTG) and control (CAF\u0026thinsp;+\u0026thinsp;SeCTG) groups. Independent samples t-test Note: MD-GR, mesiodistal width of the gingival recession. TT, Tunnel Technique. SeCTG, Subepithelial Connective Tissue Graft. CAF, Coronally Advanced Flap.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTest Group\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eGroup control\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003es\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003es\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u0026ndash;57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38\u0026ndash;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMD-GR (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.6\u0026ndash;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.8\u0026ndash;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeCTG thickness (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.59\u0026ndash;1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.61\u0026ndash;1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeCTG length (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeCTG height (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of quantitative clinical parameters, for the test (TT\u0026thinsp;+\u0026thinsp;SeCTG) and control (CAF\u0026thinsp;+\u0026thinsp;SeCTG) groups, at baseline, and at 6- and 12-months follow-up. Split-Plot Analysis of Variance (SPANOVA).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(x\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003es\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003cp\u003e(x\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003es\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003cp\u003e(x\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003es\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eInteraction\u003c/p\u003e \u003cp\u003eGroup \u003cem\u003eversus Time\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEffect Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEffect Size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePD (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGH (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAL (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKTW (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGT (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRC (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.6\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eNote: TT, Tunnel Technique. SeCTG, Subepithelial Connective Tissue Graft. CAF, Coronally Advanced Flap. PD, Probing Depth. GH, Gingival Recession Height. CAL, Clinical Attachment Level. KTW, Keratinized Tissue Width. GT, Gingival Thickness. BoP, Bleeding on Probing. RC, Root Coverage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen comparing the frequency of thick phenotypes in both groups, after intervention, the GP was found to have undergone a statistically significant change from thin to thick (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001, McNemar test), between baseline and 6, and between baseline and 12 months (Supplementary T1). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrates the distribution of the main independent variables, in relation to RC (partial or complete) and GP (thin or thick), at 12 months.\u003c/p\u003e \u003cp\u003eThe association between RC and techniques was not statistically significant (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.078). The rates of total root coverage were found to be similar between groups. Of the 23 teeth treated in each group, there was a higher percentage of total RC than of partial RC for TT\u0026thinsp;+\u0026thinsp;SeCTG (18; 78.3%) and CAF\u0026thinsp;+\u0026thinsp;SeCTG (19; 82.6%). Additionally, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that the associations between KTW and RC, as well as between KTW and GP, were significant, with patients presenting a KTW of above 2mm having a higher percentage of complete RC (37; 86.1%; \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001) and thick GP (43; 100%; \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eFurthermore, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e demonstrates a statistically association between the use of orthodontic appliances and the distribution of total and partial RC. In cases where the individual had not used orthodontic appliances, there was a higher percentage of complete RC (25; 96.2%; \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001). No significant associations were found between RC and GP and the independent variables sex, age, duration of orthodontic appliance use, and type of toothbrush (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of the main independent variables, in relation to root coverage and gingival phenotype, at 12 months. Chi-square test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eRoot Coverage t12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eGingival Phenotype t12\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartial (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThin (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThick (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (82.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (4.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (95.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (78.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (91.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;30 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (96.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOver 30 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (81.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKTW t12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUp to 2mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove 2mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (86.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthodontic appliance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (96.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (96.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime with the device\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUp to 42 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (92.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOver 42 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (83.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToothbrush type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtra soft or soft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41 (97.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.756\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium or hard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNote: \u003cem\u003ep\u003c/em\u003e value corresponds to the statistical significance for each independent categorical variable. The letter and number, t12, refers to the evaluated period. TT, Tunnel Technique. SeCTG, Subepithelial Connective Tissue Graft. CAF, Coronally Advanced Flap. KTW, Keratinized Tissue Width.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePROMs\u003c/h2\u003e \u003cp\u003eThe SPANOVA test showed statistically significant reductions in postoperative pain at both donor and recipient sites for both groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Supplementary T2). There were no interactions between the sites for TT\u0026thinsp;+\u0026thinsp;SeCTG (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.781) or CAF\u0026thinsp;+\u0026thinsp;SeCTG (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.319) over time. However, comparing groups, an interaction was observed between recipient sites, with higher mean postoperative pain scores for TT\u0026thinsp;+\u0026thinsp;SeCTG at the 8-hour and 24-hour intervals (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004). Post-hoc tests revealed a significant reduction in postoperative pain from 8 hours to 30 days after surgery at all operated sites (Supplementary T2).\u003c/p\u003e \u003cp\u003eSupplementary T3 provides an overall assessment of the differences in the distribution of RES and PES scores at baseline and at 12 months. For RES, there was a null score at the initial baseline period, and scores of between 9 and 10 (excellent results) had a higher frequency (61%) for the CAF\u0026thinsp;+\u0026thinsp;SeCTG at 12 months follow-up. For PES, scores were approximately 6 for TT\u0026thinsp;+\u0026thinsp;SeCTG (17.5%) and CAF\u0026thinsp;+\u0026thinsp;SeCTG (21.7%) at baseline, increasing to higher scores (10), with frequencies of between 34.9% and 39.15% for the test and control groups, respectively, at 12 months (Supplementary T3). Supplementary T4 displays the distribution of individual components of RES for the TT\u0026thinsp;+\u0026thinsp;SeCTG (Raetzke) and CAF\u0026thinsp;+\u0026thinsp;SeCTG (Bruno) groups at 12 months. Findings indicate that the CAF\u0026thinsp;+\u0026thinsp;SeCTG had more teeth that achieved better scores for GM (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001). No significant differences were observed for MTC, STT, MGJ, and GC (Supplementary T4).\u003c/p\u003e \u003cp\u003eFor PES scores, at baseline and at 12-months of follow-up, a statistical difference was observed for the intragroup comparison of mean GMC in CAF\u0026thinsp;+\u0026thinsp;SeCTG (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001, Supplementary T5), and in TT\u0026thinsp;+\u0026thinsp;SeCTG (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001). This difference was also observed for the mean GML in the CAF\u0026thinsp;+\u0026thinsp;SeCTG (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001) and in TT\u0026thinsp;+\u0026thinsp;SeCTG (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001) over follow-up. No statistically significant differences were found for the other variables of PES (Supplementary T5). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that no statistically differences were observed when comparing the mean total scores of RES and PES between both groups (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.689 and \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.243), and within the scores (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.215), at 12 months.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifference between the mean RES and PES total scores, for the test (TT\u0026thinsp;+\u0026thinsp;SeCTG) and control (CAF\u0026thinsp;+\u0026thinsp;SeCTG) groups at 12 months. Student 's t-test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCI (95%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUL\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.243\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value 0.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eNote: RES, Root Coverage Esthetic Score; PES, Pink Esthetic Score. TT, Tunnel Technique. SeCTG, Subepithelial Connective Tissue Graft. CAF, Coronally Advanced Flap. CI, Confidence Interval.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData analysis revealed significant decreases in the mean VAS scores for the parameters CDH, esthetics, and patient satisfaction, within each treatment group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Statistical analysis also showed that there was no interaction between treatment groups and time, for all parameters. Post-tests found statistical differences only when comparing baseline values with those at each follow-up time (6 and 12 months; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCervical dentin hypersensitivity (CDH), self-perception of esthetics and patient satisfaction at baseline, and at 6- and 12-months follow-up. Split-Plot Analysis of Variance (SPANOVA).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(x\u0026thinsp;\u0026plusmn;\u0026thinsp;s )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003cp\u003e(x\u0026thinsp;\u0026plusmn;\u0026thinsp;s )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003cp\u003e(x\u0026thinsp;\u0026plusmn;\u0026thinsp;s )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eInteraction\u003c/p\u003e \u003cp\u003eGroup versus Time\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003cp\u003evalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEffect Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003cp\u003evalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEffect Size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCDH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEsthetic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.441\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u0026thinsp;+\u0026thinsp;SeCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eNote: TT, Tunnel Technique. SeCTG, Subepithelial Connective Tissue Graft. CAF, Coronally Advanced Flap. Lowercase letters show statistically significant differences between baseline and 6 months and between baseline and 12 months, for each group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSignificant differences in the OHIP-14 were achieved in both groups, indicating an improvement in the quality of life of patients at 6 and 12 months after surgery (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001, Supplementary T6). The other dimensions of the questionnaire also showed statistical differences, when comparing baseline and 6 months, and baseline and 12 months. The dimensions \"physical pain\" and \"psychological discomfort\" are among those that achieved better improvements, with progressive reductions in means. No statistical differences in the quality of life parameters were found between the groups (Supplementary T6).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe efficacy of surgical techniques for root coverage (RC) using subepithelial connective tissue grafts (SeCTG) was previously tested to analyze the invasiveness, safety, and predictability [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This first controlled trial in thin phenotype patients compared two surgical techniques and showed that both treatment protocols (CAF\u0026thinsp;+\u0026thinsp;SeCTG and TT\u0026thinsp;+\u0026thinsp;SeCTG) significantly reduced gingival recession with no statistical differences between the groups.\u003c/p\u003e \u003cp\u003eSimilar studies confirmed the feasibility of these techniques for the treatment of single RT1 recessions, reducing patient morbidity in the postoperative period, ensuring predictability of root coverage and esthetics [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], and were less invasive, especially when relaxing vertical incisions were not used [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUsing different flap designs (i.e., with relaxing incisions) compared to TT\u0026thinsp;+\u0026thinsp;SeCTG, the mean root coverage percentages were 87.2% and 77% [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], 88.6% and 78.1% [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], and 96.3% and 91.3% [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], in the control and test groups, respectively, after 6 months without statistically significant difference, except for the study by Salem et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Santamaria et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] attributed the inferior performance of the TT\u0026thinsp;+\u0026thinsp;SeCTG to the suture removal after 7 days. The authors also highlighted the need for extending follow-up by a further 6 months to make long-term conclusions. Accordingly, Neves et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] observed that the RC percentage was not statistically significantly different between groups (Control: 89.5%; Test: 87.7%) after 2 years of comparable and stable clinical results. The authors also suggested that deficiencies related to each technique, identified in the short-term evaluation (6 months), tend to disappear over time. Such findings provide additional scientific support for the long-term stability of RC procedures using SeCTG [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGobbato et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], as in the present study, chose to perform the CAF\u0026thinsp;+\u0026thinsp;SeCTG technique, without relaxing incisions, as suggested by Bruno [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and TT\u0026thinsp;+\u0026thinsp;SeCTG, obtaining RC means of 85% and 87% for control and test groups, respectively. In the present study, the mean RC percentages after 12 months were 89.4% and 87,1%. Indeed, according to systematic reviews, an average of RC of 84.7% and 80.9% can be expected when using the CAF\u0026thinsp;+\u0026thinsp;SeCTG approach [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], and 82.75% for TT\u0026thinsp;+\u0026thinsp;SeCTG [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], for the treatment of single RT1 recessions at 12 months of evaluation. Statistically significant differences in surgery time were observed in the present controlled trial. This can be explained by the fact that adequate execution of the Raetzke technique involves care and attention in patients with thin gingival tissue [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In this technique, the flap dissection is performed through the gingival sulcus with the use of tunneling instruments, which can make the procedure more time-consuming, compared to CAF [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough root coverage is one of the primary goals for the treatment of gingival recessions, the gain in KTW and GT, with consequent change in GP, ensures treatment stability [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. In this study\u0026rsquo;s intragroup comparison, both techniques were able to increase KTW significantly at 6 and 12 months, compared to baseline. Additionally, GT also significantly increased, when comparing follow-up with baseline, but no differences between the techniques, for KTW and GT, were observed over time. Consistent with the findings of this study, Neves et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] also reported significant gains in KTW and GT for each group over time, but without statistically significant differences analysis.\u003c/p\u003e \u003cp\u003eUsing a similar methodology, Gobbato et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] also noted increased KTW in TT\u0026thinsp;+\u0026thinsp;SeCTG compared to CAF\u0026thinsp;+\u0026thinsp;SeCTG after 12 months. However, the difference in KTW within groups might stem from non-standardized graft dimensions[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In this RCT, graft collection was standardized to each gingival recession's dimensions, showing no statistical differences between test and control groups in SeCTG graft thickness, length, or height.\u003c/p\u003e \u003cp\u003eRecent reports suggest a link between gingival phenotype (GP) and oral mucosa thickness; individuals with a thin GP may have thinner palatal mucosa, impacting SeCTG harvesting [\u003cspan additionalcitationids=\"CR44 CR45\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. To standardize graft thickness, this RCT used the free gingival graft technique [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] with subsequent de-epithelialization [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] GP evaluation, crucial for procedures like root coverage [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] and orthodontic treatment [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e],\u003csup\u003e47\u003c/sup\u003e can be done using a periodontal probe [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], along with assessing keratinized tissue width (KTW) and gingival thickness (GT) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInterestingly, individuals who had never undergone orthodontic treatment before exhibited a higher total root coverage rate of 96.2%. In contrast, those who had orthodontic treatment prior to root coverage surgery achieved a root coverage rate of only 60%. Therefore, bone morphological characteristics and tooth position should be carefully considered during planning. Orthodontic movements or vestibular projections of teeth for corrective purposes can lead to alveolar bone resorption, fenestrations, or dehiscence, thereby affecting root coverage outcomes [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEsthetic evaluation using RES and PES showed no significant differences between groups or scores after 12 months. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The choice of scores does not appear to influence the esthetic evaluation at the end of treatment. Previous clinical studies have also evaluated esthetic factors and their influence on the choice of surgical technique [\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], however, the available evidence is limited [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Findings regarding the overall mean RES align with clinical studies, systematic reviews, and meta-analyses comparing CAF\u0026thinsp;+\u0026thinsp;SeCTG and TT\u0026thinsp;+\u0026thinsp;SeCTG techniques [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. RES-assessed gingival margin levels showed better scores in more cases. Longer-term studies observed decreasing score differences between groups, likely due to creeping attachment [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Additionally, Kerner et al. [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e] recommended at least 12 months of follow-up for studies with professional esthetic evaluations.\u003c/p\u003e \u003cp\u003eEsthetic evaluation and satisfaction often go hand in hand [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], highlighting RC techniques' positive impact on patient perception. VAS scores showed improved esthetics and satisfaction at 6 months, with no differences after 12 months between groups. TT\u0026thinsp;+\u0026thinsp;SeCTG has been associated with better esthetic outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. However, a systematic review suggested that graft material influences esthetic outcomes more than flap design. SeCTG also provided higher RES scores and VAS averages than CAF or TT techniques without grafting, possibly due to the graft acting as a biological filler, reducing postoperative RG and improving RC results [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe impact of root coverage on individuals' oral health-related quality of life was also evaluated. A significant decrease in OHIP-14 means was observed at 6 and 12 months after the surgical procedure. Improvements in clinical parameters (mainly KTW, GT, and RC), as well as a decrease in CDH, seem to progressively enhance patients' quality of life. According to Wagner et al. [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e] and Ng and Leung [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], GH above 2mm is associated with poor quality of life and could be significantly associated with higher OHIP-14.\u003c/p\u003e \u003cp\u003eThe effectiveness of both treatments for reducing CDH over time was clear, where the mean VAS scores reduced significantly for each treatment group compared to baseline, but without differences between groups. These results are supported by previous systematic reviews comparing the results of CAF\u0026thinsp;+\u0026thinsp;SeCTG and TT\u0026thinsp;+\u0026thinsp;SeCTG [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSome limitations include the different perceptions of patients regarding subjective parameters, such as postoperative pain, CDH, and esthetic, although a VAS was used. Furthermore, the results achieved should be evaluated for a longer time to verify the stability of treatments and the patient's perceptions regarding PROMs.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe results of the present study indicate that both techniques can provide stable outcomes, with significant improvements in clinical parameters and PROMs at 12 months post-procedures, without differences between the two flap design techniques.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThis study shows that using subepithelial connective tissue graft (SeCTG) with either the coronally-advanced flap (CAF) or tunnel technique (TT) gives similar results for root coverage and patient-reported outcomes, offering effective treatment options for single type-1 gingival recessions.\u003c/p\u003e\n\u003cp\u003eThis trial was registered on www.ensaiosclinicos.gov.br (No. RBR-4PSXBY).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflicts of interest\u003c/strong\u003e \u003cp\u003eThe authors declare that there are no conflicts of interest related to the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e The local ethical committee approved this clinical trial (ID 3.389.326/2019).\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003ePatient consent\u003c/h2\u003e \u003cp\u003e All patients gave written informed consent.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor contributions SBB: conceptualization, data curation, investigation, methodology, project administration, writing \u0026ndash; original draft. LNMA: methodology, data curation, writing \u0026ndash; review and editing. GEG: methodology, data curation. RSC: methodology, data curation. BCVG: conceptualization, data curation, investigation, methodology, project administration, writing \u0026ndash; review and editing. All authors contributed to the interpretation of the data and drafting of the report, approved the final version, and agreed to be responsible for the work.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors thank all the patients who agreed to participate in this controlled trial, the Federal University of Rio Grande do Norte (Natal, Brazil), and the National Council of Scientific and Technological Development (CNPq). 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J Clin Periodontol 49(8):840\u0026ndash;851. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jcpe.13664\u003c/span\u003e\u003cspan address=\"10.1111/jcpe.13664\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gingival recession. Tooth root. Connective tissue graft. Surgical flaps. Clinical trial","lastPublishedDoi":"10.21203/rs.3.rs-4750407/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4750407/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo compare two techniques for the root coverage of unilateral, single type-1 gingival recessions.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e \u003cp\u003eThis randomized controlled trial evaluated thin-gingival phenotype individuals with unilateral and single RT1 undergoing root coverage procedures. The study compared the combinations of subepithelial connective tissue graft (SeCTG) with a coronally-advanced flap (CAF; control group) and with the tunnel technique (TT; test group). The main parameters assessed were probing depth (PD), gingival recession height (GH), keratinized tissue (KTW), gingival thickness (GT), and percentage of root coverage (RC). Patient-reported outcome measures (PROMs), such as postoperative pain, cervical dentin hypersensitivity (CDH), esthetics, satisfaction level, and quality of life were also assessed, over 12 months of follow-up. Data were statistically analyzed using paired Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test, Chi-square, McNemar, and Split-Plot Analysis of Variance with post hoc \u003cem\u003et\u003c/em\u003e-test (α\u0026thinsp;=\u0026thinsp;5%).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eForty-six subjects completed the study (CAF\u0026thinsp;+\u0026thinsp;SeCTG: 23; TT\u0026thinsp;+\u0026thinsp;SeCTG: 23). Significant reductions for GH and gains in CAL, KTW, and GT were observed in the intragroup analysis for both groups. No differences were found between techniques. RC increased significantly, but no intergroup differences were observed (CAF\u0026thinsp;+\u0026thinsp;SeCTG: 89.4%; TT\u0026thinsp;+\u0026thinsp;SeCTG: 87.1%; \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.071). Intragroup analysis indicated a modification in gingival phenotype (GP) from thin to thick (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001). Both treatment protocols improved PROMs (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001), with no differences between the techniques.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe two surgical approaches resulted in significant improvements with similar clinical efficacy regarding RC, including GH, CAL, KTW, gingival thickness, and PROMs.\u003c/p\u003e\u003ch2\u003eClinical relevance\u003c/h2\u003e \u003cp\u003eCAF\u0026thinsp;+\u0026thinsp;SeCTG versus TT\u0026thinsp;+\u0026thinsp;SeCTG showed similar clinical, esthetic and patient-related outcomes; however, CAF\u0026thinsp;+\u0026thinsp;SeCTG had a shorter surgical time.\u003c/p\u003e","manuscriptTitle":"Comparison of techniques for root coverage of localized recessions: A 12-month follow-up randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-17 01:59:35","doi":"10.21203/rs.3.rs-4750407/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a255f528-f1ab-45b6-8825-536344c77328","owner":[],"postedDate":"August 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-21T23:53:08+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-17 01:59:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4750407","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4750407","identity":"rs-4750407","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}