Guided Creeping Technique (GCT) as a Novel Minimally Invasive Approach in Treating Limited Gingival Recession – Case Series

Gamal AY and Destawy MT

Department of Periodontology, Ain Shams University and Misr University for Science and Technology, Egypt
Department of Periodontology, Al Azhar University, Egypt

^*Correspondance to: Ahmed Y Gamal 

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Abstract:

Background: Patients with limited gingival recessions may not justify treatment with extensive procedures such as coronally advanced flap with natural or synthetic grafting or even minimally invasive tunneling approaches. In an attempt to maximize patient acceptance, the present novel minimally invasive Guided Creeping Technique (GCT) is suggested.
Methods: Thirteen patients each contributed one or 2 adjacent Cairo RT1 GR defect of ≤ 3 mm in depth were treated by GCT and completed a 6-months follow up period. Micro-periosteal elevator was used to elevate vertical full thickness blind tunnel of 2 mm to 3 mm width starting apically from the horizontal incision and coronally up to the apical border of the junctional epithelium. Small pieces of collagen membrane (1 mm × 2 mm) were prepared and inserted through the apical tunnel aperture using blunt instrument supporting the coronal level of the displaced gingival margin. Single periosteal interrupted suture was placed in order to close the apical tunnel border. The following clinical parameters were assessed at baseline, 3 and 6 months: Gingival Index (GI), Plaque Index (PI), Probing Depth (PD), Clinical Attachment Loss (CAL), Gingival Recession (GR) at the midbuccal aspect of the affected tooth, Keratinized Tissue Width (KTW) and Complete Root Coverage (CRC). On days 1, 3, 7 and 15, patients were asked to complete a visual analogue scale pain scoring.
Results: At 3 and 6 months, mean root coverage significantly reduced from 3.41 ± 1.03 to 0.43 ± 0.52 and 0.17 ± 0.41 respectively (P=0.0001 and 0.0041). The corresponding complete root coverage prevalence was 58.43% and 83.33%. Between baseline and 3 months statistically significant Keratinized Tissue Thickness (KTT) increase from 0.650 ± 0.187 to 1.283 ± 0.392 (P=0.0269). Keratinized Tissue Width (KTW) was significantly increased from baseline to 3 and 6 months from 2.50 ± 0.84 to 3.17 ± 0.98 and 3.33 ± 0.82 respectively.
Conclusion: Guided creeping technique in treating limited RT1 recession resulted in significant clinical improvements and provided a simple minimally invasive approach that could maintain maximum soft tissue support.
Clinical Relevance: Satisfactory minimally invasive approach is required in dealing with limited gingival recession. Developing a treatment option that is minimally invasive based on maximum maintenance of soft tissue support required in order to get a wide acceptance by our patients.

Keywords:

Minimally invasive surgery; Tunneling techniques; Gingival recession; Creeping attachment

Cite the Article:

Gamal AY, Destawy MT. Guided Creeping Technique (GCT) as a Novel Minimally Invasive Approach in Treating Limited Gingival Recession – Case Series. World J Surg Surgical Res. 2023; 6: 1462..