الفهرس 
Assessment of Postoperative discomfort following Inverted Periosteal Pedicle Flap versus Coronally Advanced Flap with Subepithelial Connective Tissue Graft in Treatment of Gingival Recession Types 1 and 2 (RT1 & RT2) . A Randomized Controlled Clinical Trial.
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Abstract
Coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) has been established as the most predictable root coverage procedure during the past decade. However, post-operative discomfort due to the graft harvesting from a second surgical site, most commonly the palate, in addition to the limited amount of graft tissue in cases of large defects pose the need for further research aiming to find alternative techniques to obtain autogenous graft tissue from an area adjacent to the defect site.
In periodontal plastic literature, limited studies have been reported to evaluate the use of periosteal pedicle grafts (iPPG) for root coverage. Therefore, the contemporary study was conducted to compare the periosteal pedicle graft to subepithelial connective tissue graft for treatment of gingival recession.
The present study included 18 patients with gingival recession of both types RT1 and RT2. Patients were randomly assigned to undergo either inverted periosteal graft (n=9) subepithelial connective tissue graft (n=9). Post-operative discomfort was assessed using visual analogue scale (VAS) questionnaire. Recession depth was measured at baseline, 3 months and 6 months post-operatively, to calculate amount of root coverage. The esthetic outcome was also assessed by root coverage esthetic score (RES), in addition to patient’s satisfaction assessment that was based on a 3-point rating scale.
The results of the present study showed that post-operative discomfort (VAS) showed no statistically significant difference between both groups; iPPG recorded VAS score of mean 2.28±0.83 and SCTG 3.11±1.17. Both groups reported significant increase in amount of root coverage after 6 months (mean 3.22±0.67 in iPPG and 3.56±0.53 in SCTG); a significant decrease in mean recession depth from baseline 3.78±0.67 to 0.56±0.53 in iPPG group and from 3.89±0.78 at baseline to 0.33±0.5 in SCTG group; with achievement of mean root coverage % of 85.74% by iPPG and 92.78% by SCTG. However, inter-group comparisons revealed lack of statistically significant difference. iPPG group revealed mean RES 7.33 ±1.58 and SCTG recorded 8.67±1.58 but with no statistically significant difference. There was statistically significant difference between the two groups regarding patients’ satisfaction; iPPG owed higher level of satisfaction compared to SCTG.
In conclusion, the inverted periosteal pedicle flap might be considered as a promising alternative to SCTG for root coverage with significantly increased patient’s satisfaction after 6 months with comparable clinical root coverage parameters