Journal of Periodontology; Copyright 2016

DOI: 10.1902/jop.2016.150676

Collagen Matrix With Tunnel Technique Compared to Connective

Tissue Graft for the Treatment of Periodontal Recession
Randomized Clinical Trial
Marta Cielik-Wegemund*, Beata Wierucka-Mynarczyk*, Marta Tanasiewicz, ukasz
Gilowski
*Department of Periodontal and Oral Mucosa Diseases, Department of Conservative
Dentistry with Endodontics, School of Medicine with the Division of Dentistry in Zabrze,
Medical University of Silesia in Katowice, Poland.

Department of Conservative Dentistry with Endodontics, School of Medicine with the

Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland.

Chair and Department of Pharmacology, School of Medicine with the Division of Dentistry
in Zabrze, Medical University of Silesia in Katowice, Poland.

Background: The aim of this study was to compare the efficacy of root coverage using the tunnel
technique with collagen matrix and the same technique with a connective tissue graft (CTG) for the treatment of
multiple recessions of Miller Classes I and II over a short period of time.
Material and Methods: Twenty-eight patients were enrolled in the study. Patients in the control group
were treated with CTGs using the tunnel technique whereas patients in the test group were treated with
xenogenic collagen matrix. Clinical recordings were obtained at baseline and after 3 and 6 months. The
percentage of average recession coverage (ARC) and the percentage of patients with complete recession
coverage (CRC) were evaluated after 3 and 6 months after the surgery.
Results: Significant decreases in both groups according to recession parameters compared to baseline
measurements were recorded. The mean recession depth (0.21mm vs. 0.39mm) and the area of recession
(0.31mm2 vs. 0.53mm2) after 6 months were significantly higher in the test group (p<0.05). The mean width of
the keratinized tissue increased at a similar rate in both groups (1.0mm for controls vs. 0.8mm for test group).
The mean ARC after 6 months was 95% in the control group and 91% in the test group (p<0.05) and the
percentage of patients with complete coverage of all recessions was 71.4% (10/14) in the control group and
14.3% (2/14) in the test group (p<0.05).
Conclusion: Xenogenic collagen matrix combined with the tunnel technique led to a satisfactory ARC
and an increase in the width of the keratinized tissue similar to a CTG, but it yielded a lower, unsatisfactory
CRC.

KEYWORDS:
gingival recession; connective tissue graft; mucogingival surgery.

Gingival recession can be defined as the displacement of the gingival margin apical to the
cement-enamel junction (CEJ) with root surface exposure because of the destruction of the
marginal gingival tissues of one or more teeth.1 However, a more accurate term is
periodontal recession because the periodontal ligament and alveolar bone are also lost.
The challenge for periodontal plastic surgical procedures is to achieve stable and complete
root coverage with the attachment of the tissue margin at the cemento-enamel junction and no
bleeding on probing as well as a minimal probing depth of the healthy gingival sulcus.1-3
A variety of surgical techniques (laterally positioned flap, or coronally advanced flap,
tunnel technique) have been evaluated in the last few years to obtain root coverage with
regard to predictability and the amount of root coverage achieved.1,3,4
The tunnel recession coverage method presented by Blanes and Allen, Zabalequi et al, and
Santarelli et al is a modification of the envelope method described by Raetzke.5-8 Exposed
1

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roots are covered using only sulcular incisions, so scars from vertical releasing incisions are
avoided in the tunnel technique. In addition to improved wound healing, the results of the root
coverage have been very satisfying.9-12
Procedures using connective tissue grafts (CTGs) and the tunnel technique result in good
predictability of root coverage, but they requires a second surgical site.13 For patients with
multiple recessions, it can be difficult to harvest sufficient connective tissue from the palate,
and multiple surgeries can be necessary to achieve an optimal result.14 Therefore, the
availability of soft tissue substitutes appears useful for the treatment of these conditions.
Because the efficacy of the tunnel technique depends on the combined application of a
connective tissue graft14, the question is whether the collagen matrix could be an alternative to
a CTG for this technique. In particular, to the best of our knowledge, only one randomized
clinical trial (RCT) could be found in the literature that compared the efficacy of this
procedure with using collagen matrix or a CTG.15 It should be stated that different collagen
matrix products were used: Mucograft was used in the study by Aroca et al, and Mucoderm
was used in the present study. Mucoderm is an acellular sterilized collagen matrix derived
from porcine dermis consisting of collagen types I and III and elastin. The natural collagen
matrix has a positive impact on wound healing and tissue integration.16 Mucoderm was
designed, developed and registered as a substitute for soft tissue graft for socket preservation,
soft tissue augmentation and recession coverage procedures. Until now, the presented study is
the first RCT using Mucoderm in the tunnel technique.

AIM
The purpose of this clinical study was to compare the short-term (3-6 months) outcomes of
root coverage using the tunnel technique with a CTG and the same technique with collagen
matrix for the treatment of multiple recessions of Miller Classes I and II.

MATERIALS AND METHODS

Study Design
This study was a randomized, controlled clinical trial of 6 months in duration. The study was
conducted with the approval of the Local Ethical Committee (Institutional Review Board
associated with the Medical University of Silesia, Katowice, Poland; protocol resolution no.
KNW/0022/KB1/108/12). The ClinicalTrials.gov identifier is NCT02632240. Patients eligible
for the study were informed of the potential risks and benefits of the study and they signed
informed consent statements. The treatment procedures were conducted from October 2014 to
April 2015.
Null Hypothesis and Primary and Secondary Outcomes
The null hypothesis assumed that no significant differences were observed between the two
treatment groups with regard to the following clinical parameters: the clinical attachment level
(CAL), recession depth (RD), recession width (RW) and keratinized tissue width (KTW).
The primary outcome variable was the assessment of the CAL. The secondary outcome
variables included the assessment of the recession depth and width, keratinized tissue width,
complete recession coverage and average percentage of root coverage.

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Intra-Examiner Reproducibility
Ten patients not included in this study with diagnoses of multiple recessions were used to
calibrate the examiner (LG). The examiner evaluated the patients on two occasions 24 hours
apart. Clinical measurements (RD, RW, KTW, CAL, depth of gingival sulcus, distance from
the cement-enamel junction to the mucogingival junction) were obtained with the same
method as in the main study. The calibration was accepted if 95% of the recordings could be
reproduced within a difference of 1 mm.
Patient Population
Twenty-eight systemically healthy, non-smoking patients (F-19, M-9; aged 20 to 50 years
old) with 106 recessions of Miller Classes I and II were selected from the patients in the
Department of Periodontal and Oral Mucosa Diseases. All of the patients requested treatment
for aesthetic reasons and/or dentin hypersensitivity of exposed roots.
Fourteen patients (12 women and 2 men) with 47 defects in the control group were treated
with connective tissue graft combined with the tunnel technique (18 recessions in
themandible, 29 in the maxilla). The test group consisted of 14 patients (F-7, M-7) with 59
defects. They were treated with collagen matrix using the tunnel technique (20 recessions in
the mandible, 39 in the maxilla).
The following inclusion criteria were applied:
An age of 18 to 60 years old;
Systemically healthy with no contraindications for periodontal surgery;
Absence of clinical signs of active periodontal disease;
Presence of a minimum of two adjacent periodontal recessions of Miller Class I or II
on both sides of the maxillary or mandibular arch with at least 2 mm in recession depth;
Presence of an identifiable CEJ (a step 1mm at the CEJ level and/or presence of root
abrasion, but with identifiable CEJ was accepted) 17; and
Approximal Hygiene Index (API) 15% and Sulcus Bleeding Index (SBI) 10%.
Patients were excluded on the basis of the following criteria:
Pregnant or lactating;
Systemic disease with compromised healing potential or infectious disease;
Usage of medication known to affect gingival conditions (hyperplasia) or to interfere
with healing (steroids);
Non-vital teeth, caries, prosthetic crowns or restorations involving the cementoenamel junction area;
Tobacco smoking; and
Drug or alcohol abuse.
Each patient received oral hygiene instructions and was motivated to maintain his or her
oral health. The patients were instructed using a non-traumatizing buccal brushing technique
(roll technique) with a soft toothbrush. All of participants were enrolled by one investigator
(MCW). The Sulcus Bleeding Index and API were evaluated (by LG) one month and one

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week before surgery in the patients enrolled in the study. The final examination confirmed the
patients compliance with the study enrollment criteria.
Clinical Measurements
In all cases, preoperative clinical measurements were recorded with a CP15 periodontal
probe, which had markings every millimeter. The measurements were rounded to the nearest
0.5 mm. At baseline and at 3 and 6 months post-surgically, the following measurements were
recorded for each treated site: RD (recession depth) was measured from the mid-facial point
of the CEJ to the free gingival margin; RW (recession width) was measured horizontally at
the CEJ level; KTW (width of keratinized tissue) was measured from the mucogingival
junction to the gingival margin; CAL (clinical attachment level) was recorded from the CEJ to
the deepest point of the gingival sulcus; CEJ-MGJ was recorded from CEJ to the
mucogingival junction; PD (depth of gingival sulcus) was recorded from the gingival margin
to the deepest point of gingival sulcus; and RA was the exposed root surface area (the area of
a triangle with the recession width as the base and the recession depth as the height of the
triangle). The periodontal recession coverage rating was calculated 3 and 6 months after
surgery as the average percentage of root coverage (ARC) and the percentage rate of patients
with complete coverage of all recessions (CRC). All pre- and postoperative measurements
were obtained by the same previously calibrated examiner (LG), who was blinded to the
treatment assignment.
Surgical Protocol
Following clinical examination, the patients were randomly (block randomization method)
assigned to one of the study groups by another investigator (BWM). Randomization was
performed using a computer-generated program. The random allocation sequence was handed
to the investigator who performed all of the surgical procedures (MCW) on the day of
surgery.
After local anesthesia the exposed root surfaces were planed using curettes to eliminate
calculus and plaque present and rotary burrs to eliminate surface roughness.
Control Group
The sulcular incisions enabled access for the supraperiosteal preparation of the buccal tissue
using a 15 C blade. The incision was extended to the adjacent tooth on both sides of the
recessions. The undermining procedure was extended into the mucosal tissue using the
tunneling instruments and then the pouch preparations were connected to each other via the
intrasulcular incisions. The dissection of the entire buccal aspect was performed as a partialthickness flap according to the method described by Blanes and Allen.5 Only the papillary
region was left attached. At the end, the papillae were fully detached with the periosteum,
which was the authors modification of the original method. The high risk of rupture and
tearing when performing a split-thickness flap was the reason for using a mucoperiosteal flap
in this delicate region, and it was performed with a small elevator to minimize trauma. The
second surgical site was created on the palate with the Hurzeller-Weng technique.18 The
surgeon placed a particular emphasis on harvesting connective tissue grafts with a similar
thickness to the thickness of the collagen matrix (approximately 1.5mm). The thickness was
measured with calipers. After the connective tissue was harvested, pressure was applied to the
donor area with gauze soaked in saline. A hemostatic sponge was placed on the palatal
wound. The donor area was closed with cross mattress non-resorbable 5-0 sutures. Then, the
connective tissue graft was placed into the tunnel and was stabilized using 6-0 absorbable

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suspensory sutures. The mobilized mucous flap was advanced coronally, and 6-0 nonabsorbable suspensory sutures were stitched.
Test Group
In the test group the surgical site was prepared in the same manner as in the control group.
Previously rehydrated collagen matrix was placed into the tunnel. Then, the matrix was
stabilized separately to each tooth using 6-0 absorbable suspensory sutures. The mobilized
mucous flap was advanced coronally, and 6-0 non-absorbable suspensory sutures were
stitched.
Post-Surgical Instructions and Evaluation of Aesthetics and Morbidity
Healing was inspected on the 1st, 7th and 14th days after the surgical procedure by the surgeon
(MCW). Sutures were removed after 2 weeks. All of the patients received instructions for
proper home care. They did not brush the surgical site for 2 weeks but rinsed twice daily with
a 0.12% solution of chlorhexidine gluconate. The patients in the test group were prescribed
antibiotics because of the implanted xenogenic material. At all of the postoperative
appointments, the areas were deplaqued and polished. On the day of the procedure, a
questionnaire was administered to each patient. It included the evaluation of pain and swelling
in the region of the recession coverage using a visual analog scale (VAS) of 100mm
performed separately. The participants assessed the morbidity on the 1st, 2nd, 4th, 7th and 14th
days after surgery. Two weeks after surgery all of the patients were controlled and instructed
in tooth cleaning in the surgical area using a soft tooth brush and the roll technique. At 3 and 6
months after surgery, all of the clinical measurements were recorded again (LG). Color
matching, contour and the presence of keloids was scored 6 months after surgery using a VAS
by an investigator blinded to the group assignment, who evaluated all of the preoperative
measurements (LG).
Statistical Analysis
Using differences in the clinical attachment level as the primary outcome, with an expected
mean difference between groups after therapy of 1 mm and an expected standard deviation of
0.8 mm, it was estimated that, with 90% power and a level of significance of 0.05, the number
of treated patients in each group should be 14. For all of the statistical evaluations the patient
was maintained as the unit of measurement. Full mouth data analysis was performed for API
and SBI, whereas defect site measurements were obtained for PD, CAL, RD, RW, KTW,
CEJ-MGJ, and RA. Therefore, mean values and standard deviations (SD) for clinical variables
were calculated for each patient per treatment. The complete coverage of the recession was
determined as the percentage of patients having complete coverage achieved for all defects.
The statistical evaluation was based on previous comparative studies of the treatment of
multiple recessions.15,19 The Shapiro-Wilk test was used to determine the normal distribution
of the studied parameters. Intragroup differences between measurements of clinical
parameters at three time points (the initial examination and after 3 and 6 months) were
analyzed by Friedmans ANOVA. Differences in the results of clinical parameters between
groups at different stages were tested with the Mann-Whitney U test. Fishers exact test was
applied to the categorical data as the frequency of the complete coverage of recessions (CRC).
A p-value less than 0.05 was considered statistically significant. All of the findings were
analyzed using Statistica software, version 10.

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RESULTS
All of the patients completed the study and attended all of the recall visits. A total of 106
recessions were treated in 28 patients using the tunnel technique and a CTG (control group;
n=14) or bioresorbable collagen matrix (test group; n=14). The study included 30 incisors, 15
premolars and 1 molar in the control group and 33 incisors and canines, 18 premolars, and 5
molars in the test group.
The mean values of the depth of the sulcus (PD) did not change post-surgically in either
group, and no statistically significant differences between treatment groups (p>0.05) at any
time point were observed. Significant (p<0.001) decreases in CAL, RD, RW, RA and CEJMGJ were observed in both groups at 3 and 6 months compared to the baseline measurements
and no statistically significant differences between treatment groups (p>0.05) were observed
at baseline. There were no significant differences between the groups after 3 and 6 months in
CAL, PD, RW and CEJ-MGJ. However, statistically significant differences were recorded in
the mean recession depth after 3 and 6 months of 0.21 in the control group and 0.39 in the test
group. Significant differences were also recorded in RA (0.31 for control group vs. 0.53 for
the test group) and ARC (95% vs. 91%) after 3 and 6 months. Significant (p<0.001) increases
in the width of keratinized tissue (KTW) were observed in both groups at 3 and 6 months
compared to the baseline measurements and no statistically significant differences between
treatment groups (p>0.05) were observed at baseline or at 3 and 6 months after surgery
(Figures. 1 and 2). The exact results of the clinical parameters are presented in Table 1.
The complete coverage rate of all of the recessions of individual patients (CRC) was
71.4% (10/14) in the control group and 14.3% (2/14) in the test group at 3 and 6 months postsurgery. The difference in the CRC between groups was statistically significant (Table. 2).
The percentages of completely covered recessions in the control and test groups were 83%
and 70%, respectively, but the difference was insignificant.
The Postoperative Morbidity
The values on the postoperative VAS are presented in Figure 3. Patients in the test group
reported significantly greater pain 24h after surgery than patients in the control group. On the
2nd and 4th days, they reported statistically greater pain and swelling, and on 7th day, only the
difference in pain score was higher in the test group.
Aesthetic Evaluation
The 6 month aesthetic assessment demonstrated no differences between groups in contour but
color match scores were higher for the test group (Table 3). After 6 months, keloid formation
was not observed in any patient.

DISCUSSION
The treatment of periodontal recessions has become an important therapeutic problem due to
the increasing number of aesthetic requests from patients. Dental hypersensitivity and the
prevention of caries and non-carious cervical lesions are other indications for root coverage
surgical procedures.3,20
The main advantages of the tunnel technique, which is a modification of the envelope
technique, are early initial healing and very good aesthetics and blood supply because no
external incisions are made on the surgical side. Among the main disadvantages of this
method is poor visibility of the inner recipient tissue which, results in greater difficulty in
6

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achieving optimal mobilization of the flap and stabilization of the graft in the wound.
Unfortunately, the efficacy of the tunnel technique is dependent on the application of a
connective tissue graft.
Because the amount of tissue that can be harvested at one time from patients palate is
limited, the number of teeth that can be treated in one appointment is also limited. Xenogenic
porcine collagen matrix could be useful as a soft tissue substitute in the treatment of multiple
recessions because the amount of this material is not limited by the patients palatal anatomy.
The purpose of the study was to compare the short-term clinical outcomes of the coverage of
multiple recessions of Miller Classes I and II using xenogenic matrix or connective tissue
graft with the tunnel technique. According to the medical databases, Aroca et al.15 conducted
the first randomized clinical trial comparing the use of xenogenic collagen matrix and CTGs
with the tunnel technique. The present study was likely the second trial, which is why the
results of this study could be discussed mostly with case series presenting the coverage of
multiple recessions with the tunnel technique and xenogenic matrix or acellular dermal matrix
or with RCTs using other surgical approaches, mostly coronally advanced flap (CAF).
In the present study, postoperative healing was uneventful in all of the patients. No
complications, such as allergic reactions, infections or matrix exfoliation, were noted. The
authors observed a higher incidence of swelling at the site of surgery in the test group than in
the control group. These observations were confirmed with the results of the patient survey.
Participants in the study group reported greater swelling on the 2nd and 4th days and more pain
from the 1st day to the 7th day after surgery.
The results of this study confirmed that both methods were effective in reducing clinical
parameters -- RD, RW, CAL, RA, and CEJ-MGJ -- at 3 and 6 months after surgery, compared
to the baseline measurements. The decreases in these parameters were similar for CTGs and
for the collagen matrix. The final results were favorable in the control group because the mean
RD was 0.18 mm greater in the test group, and the mean area of recession was 0.22 mm2
greater after the study period. The differences in these parameters between groups were
statistically significant. Aroca et al.15 obtained similar clinical outcomes but an even greater
difference (0.4 mm) between the test group (collagen matrix) and the control group (CTG) in
the mean recession depth after 12 months of observation. Similar results of clinical parameters
were reported by the same authors in their previous case series report.21 Compared with Aroca
et al.15 and Molnar et al.21, the mean percentage of root coverage (ARC) obtained in the
present study was high for both groups, while the difference between groups was significant.
Although the mean area of root coverage (95% - control group vs. 91% - test group) and the
percentage of completely covered recessions (83% - control group vs. 70% - test group) were
satisfactory for both groups, the number of patients with complete coverage of all recessions
(CRC) was low in the test group (2/14) compared to the control group (10/14) (Table 2). This
low percentage of complete root coverage in the test group is worrying because 100%
coverage could be expected for Miller Class I and II recessions. Aroca et al.15 obtained greater
CRC in the collagen matrix group (5/22) but a lower percentage of root coverage (ARC 71%). Similarly, a lower mean root coverage (84%) was achieved by Molnar et al.,21 and
moderately greater complete root coverage was attained in this case series with collagen
matrix combined with the tunnel technique (2/8 patients - 25%, 30/42 recessions - 71%). The
efficacy of recession coverage procedures also depends on the types of teeth included.
Covering recession at molars remains a major challenge because of anatomical considerations.
The test group in the present study included 8.9% molars, while the control group included
only 2.17%. In the study of Aroca et al.,15 molars were 16% of all of the included teeth. More
recently, factors other than the level of interproximal attachment and bone have been shown to
limit the efficacy of root coverage, including tooth rotation, extrusion, and occlusal abrasion.
7

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In all of these clinical situations, complete coverage sometimes cannot be achieved.22 The
results of the present study showed that the tunnel technique with collagen matrix could be
less predictable when these factors were not considered because they were not exclusion
criteria in the study.
Previously reported root coverage and CRC in clinical trials with collagen matrix but
other surgical approaches (mostly coronally advanced flaps) have not been homogeneous.
Jepsen et al.23 received similar results in a 6 month trial as in the present study. Better results
were obtained by McGuire and Scheyer24 in a 6 month study and by Cardaropoli et al.25 in a
12 month trial. Cardaropoli et al.25 achieved greater root coverage (93%) and higher
percentage of complete covered recessions (72%) in the group treated with collagen matrix
than in the control group treated with CAF alone.
Another substitute for connective tissue graft is acellular dermal matrix (ADM). The
results of previous randomized clinical trials 6 months in duration comparing the efficacy of
root coverage with coronally advanced flap and ADM or a CTG, did not confirm the
advantages of CTGs.26,27 Although CTGs provides a greater root coverage, the differences in
comparison with ADM were insignificant. However, twelve months of observation in another
study resulted in a greater increase in the width of keratinized tissue with CTGs but no
difference in the root coverage between CAF with a CTG or ADM.28 The authors of case
series of the tunneling procedure with acellular dermal matrix reported 93.5% root coverage
and 61% complete defect coverage.29
A very important point of discussion is also the width of keratinized tissue. It is preferable
to achieve a certain amount of attached gingiva for the maintenance of the integrity of the
dento-gingival junction.30-32 The mean increase of KTW obtained in the present study was
similar for CTG (1.0mm) and collagen matrix (0.8mm). This positive results confirm previous
reports of the use CM with CAF33 and might be explained with optimal stabilization of
collagen matrix achieved by suturing with absorbable suspensory sutures to each tooth
separately.34 A useful suture method for allografts in the tunnel technique was first described
by Allen and Cummings.34 In this method the graft is sutured first within the tunnel using a
subgingival continuous sling suture without penetrating any tissue other than the graft.
According to this method authors decided to suture separately collagen matrix and mucous
flap. Authors modification was in suturing collagen matrix to each tooth separately, not using
continuous suture like in the original method. Then, the mobilized mucous flap was advanced
coronally, and non-absorbable suspensory sutures were stitched with great care undertaken to
avoid placing non-absorbable stitches directly on the absorbable ones. This management
improved stabilization but also reduced the flap tension.

CONCLUSION
The study was the first to present the short-term effects of a randomized clinical trial of the
Mucoderm collagen matrix. Re-evaluation visits are planned 2 and 5 years after the surgery
and will indicate the stability of the results over the long term. The early results led the
researchers to conclude that collagen matrix combined with the tunnel technique could lead to
satisfactory average recession coverage of multiple Miller Class I and II, but it yields lower,
unsatisfactorily complete recession coverage. With regard to the aesthetic demands of
patients, collagen matrix (Mucoderm) used with the tunnel technique cannot serve as an
alternative to a CTG. However, optimal stabilization of collagen matrix provides a successful
increase in the width of keratinized tissue, similar to that of CTG.

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25. Cardaropoli D, Tamagnone L, Roffredo A, Gaveglio L. Coronally advanced flap with and without a
xenogenic collagen matrix in the treatment of multiple recessions: a randomized controlled clinical study.
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dermis for the treatment of human gingival recession. J Periodontol 2001;72:998-1005.
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recession. J Periodontol 2001;72:1477-1484.
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29. Modaressi M, Wang HL. Tunneling procedure for root coverage using acellular dermal matrix: a case series.
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Correspondence: M. Cielik-Wegemund, Pl. Traugutta 2, 41-800, Zabrze, Poland, e-mail:

martac07@interia.pl, Tel: +48505099206 The email address can be published
Submitted January 02, 2016; accepted for publication June 20, 2016.
Fig. 1
(A) pre-operative view of recession in test group, (B) immediate post-operative view, (C) 6 months postoperative view.
Fig. 2
(A) pre-operative view of recession in control group, (B) immediate post-operative view, (C) 6 months postoperative view.

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Fig. 3
The results of the evaluation of pain and swelling on a visual analog scale (cm) during the observation period
(14 days). *p<0.05 (Mann-Whitney U test).
Table 1
Clinical parameters at baseline and after 3 and 6 months. Data are shown as means and standard
deviation.
CONTROL
TEST
Before
3 months 6 months
PPPP6
intragroup
Paramet
intergrou
Before
3 months
intergroup
intergroup
months
compariso
er
p
compariso
compariso
ns
comparis
ns
ns
ons
1.2

CAL
3.8 0.8 1.2 0.4
p<0.001
4.0 0.8
1.4 0.3
1.4 0.3
0.4
0.4 0.3
0.4 0.3
0.2

p<0.001
3.0 0.8
RD
2.7 0.9 0.2 0.4
0.4
p=0.04
p=0.04
0.5

p<0.001
3.6 0.9
0.7 0.6
0.7 0.6
RW
3.1 0.6 0.5 0.9
0.9
0.5 0.5
0.5 0.5
0.3

RA
4.5 2.2 0.3 0.6
p<0.001
6.0 3.0
0.6
p=0.04
p=0.04
3.3

p<0.001
2.6 1.8
3.4 1.5
3.4 1.5
KTW
2.3 1.5 3.3 1.7
1.7
CEJ3.6

5.0 1.9 3.6 1.8

p<0.001
5.6 2.1
3.9 1.3
3.9 1.3
MGJ
1.8

Pintragroup
compariso
ns
p<0.001
p<0.001
p<0.001
p<0.001
p<0.001
p<0.001

Intragroup comparisons ANOVA Friedman test, Intergroup comparisons - Mann-Whitney U test. Statistically
significant differences between groups are bolded.
Table 2
The percentage of average recession coverage and complete root coverage at 6 months.
after 6
months
Mean SD
Average recession coverage
95 11%
Control group
Average recession coverage
91 13%
Test group
p-value
0.027
Complete root coverage
10/14
Control group
Complete root coverage
2/14
Test group
p-value
0.006
Comparison of ARC - Mann-Whitney U test,
Comparison of CRC Fisher exact test.

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Table 3
Independent periodontist evaluation of aesthetic outcomes after 6 months.
Control group (CTG) Test group (CM)
VAS (0 = very bad, 100 = excellent)
Color match 6 months
87.7 (18.0)
98.8 (1.9)*
Contour 6 months
82.7 (28.8)
88.3 (5.5)
*

Statistical significant difference between groups (p<0.01) - Mann-Whitney U test.

Carl Martin GmbH, Solingen, Germany

Mucoderm, Botiss Dental, Zossen, Germany

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