Coronally advanced flap procedure for root coverage. Flap with tension versus flap without tension: A randomized controlled clinical study

Background: This clinical controlled study was designed to measure the tens ion of coronally advanced flaps (CAF) performed to treat shallow gingival r ecessions and to compare the recession reduction (Rec Red) achieved in a te st group (flaps with tension) and in a control group (flaps without tension ) 3 months after surgery. Methods: Eleven patients, aged, 22 to 41 years, with high levels of oral hy giene (full mouth plaque score <20%) were selected for the study. Each pati ent showed 2 bilateral Miller Class I maxillary or mandibular gingival rece ssions located on homologous teeth. A total of 22 recessions were treated. The recession depth at the right site was similar to that at the left site (difference less than or equal to 1 mm). For each patient, the 2 recessions underwent CAF procedure in the same surgical session. Before suturing, the residual tension (FTens) of both fight and left flaps was measured with a dynamometer. Then, one site was randomly assigned to the test group and the contralateral site to the control group. In the test site the flap was sut ured. In the control site the flap was further relaxed, the tension was mea sured again, and the flap was sutured. Results: In the test group (with tension) the initial mean recession depth was 2.82 +/- 0.64 mm and mean FTens was 6.5 g, while in the control group ( without tension) the initial mean recession depth was 2.68 +/- 0.81 mm and mean FTens was 0.4 g. Three months later, the test group showed a mean rece ssion reduction of 2.18 +/- 0.60 mm, a mean percent root coverage of 78 +/- 15%, and complete root coverage was achieved on 2 teeth (18%). In the cont rol group the mean recession reduction was 2.32 +/- 0.81 mm and mean percen t root coverage was 87 +/- 13%. Complete root coverage was obtained on 5 te eth (45%). The difference of recession reduction between the test and contr ol group was not statistically significant (P = 0.3911). In the test group, linear regression analysis showed a statistically significant association between recession reduction and both recession depth at baseline (P = 0.000 1) and mean of the 3 tensions recorded on the test side (MFTens) (P = 0.000 9). Conclusions: This study shows that minimal flap tension does not influence recession reduction after 3 months when shallow recessions are treated by m eans of CAE In the test group (with tension), the statistical analysis sugg ests that the higher the flap tension, the lower the recession reduction.