This study aims to evaluate whether the method of root surface preparation influences surgical outcomes. It will assess whether manual root instrumentation can be replaced by a less invasive erythritol air-polishing technique.
Multiple RT1 and/or RT2 gingival recessions, symmetrical and bilateral, with a minimum height of ≥ 1 mm
Full-mouth plaque score (FMPS) < 15% (assessed on four surfaces per tooth)
Full-mouth bleeding on probing (FMBOP) < 15% (assessed on four surfaces per tooth)
Detectable cemento-enamel junction (CEJ)
RT3 gingival recessions
Gingival recessions affecting second and third molars
Systemic or infectious diseases that may impair wound healing, including active malignancy, diabetes mellitus with HbA1c > 7.0%, history of head and neck radiotherapy, true xerostomia, and HIV/AIDS
Cervical caries, non-carious cervical lesions, or Class V restorations interfering with the CEJ
Parallel
Erythritol Air-Polishing
Procedure/SurgeryRoot surface preparation performed using erythritol powder air-polishing (EMS AIRFLOW PLUS) prior to root coverage surgery with a modified tunnel technique and subepithelial connective tissue graft.
Manual Root Instrumentation
Procedure/SurgeryMechanical root surface preparation performed using manual Gracey curettes before root coverage surgery with a modified tunnel technique and subepithelial connective tissue graft.
Mean Root Coverage (MRC, %)
Mean root coverage (MRC), expressed as a percentage (%), assessed at 6 and 12 months post-surgery. MRC is calculated as (GR₀ - GR₆) / GR₀ × 100% and (GR₀ - GR₁₂) / GR₀ × 100%, respectively. Gingival recession (GR), measured in millimeters (mm) as the distance from the cemento-enamel junction (CEJ) to the gingival margin at the mid-buccal aspect of the tooth, is used solely as an input parameter for the calculation of MRC.
Gingival recession height (GRH, mm)
Distance from the cemento-enamel junction (CEJ) to the gingival margin measured at the mid-buccal aspect of the tooth.
Gingival recession width (RW, mm)
Horizontal distance measured at the level of the cemento-enamel junction (CEJ) between the mesial and distal margins of the gingival recession.
Clinical Attachment Level (CAL, mm)
Distance from the cemento-enamel junction (CEJ) to the bottom of the gingival sulcus.
Probing Pocket Depth (PPD, mm)
Distance from the gingival margin to the bottom of the gingival sulcus.
Procedure-related stress (VAS, 0-10)
Patient-reported procedure-related stress assessed using the Visual Analogue Scale (VAS; 0 = no stress, 10 = extreme stress).
Treatment satisfaction (VAS, 0-10)
Patient-reported treatment satisfaction assessed using the Visual Analogue Scale (VAS; 0 = not satisfied at all, 10 = completely satisfied).
Willingness to choose the treatment again (yes/no)
Patient-reported willingness to choose the same treatment again assessed using a dichotomous (yes/no) question.
Willingness to recommend the treatment (yes/no)
Patient-reported willingness to recommend the treatment to others assessed using a dichotomous (yes/no) question.
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