A Comparative Study of Modified Semilunar Coronally Advanced Flap and Coronally Advanced Flap in Clinical Practice for the Management of Multiple Gingival Recessions

Abstract

Multiple adjacent gingival recession-type defects (MARTDs) may require treatment to address aesthetic concerns and root sensitivity. Coronally advanced flap (CAF) procedures can treat multiple sites without requiring a palatal donor site, but comparative evidence for different flap designs is limited. To compare the clinical and patient-reported outcomes of a coronally advanced flap without vertical releasing incisions (CAF without VRIs) and a modified semilunar coronally advanced flap (MSCAF) for the treatment of multiple adjacent gingival recessions. This prospective, randomized split-mouth clinical trial included patients with bilateral Miller Class I adjacent gingival recessions. Participants received CAF without VRIs on one side and MSCAF on the other. Clinical measurements were recorded at baseline and six months after surgery. Patient-reported aesthetic outcomes—including overall satisfaction, perceived root coverage, and color match—were assessed at six months using a 0, 50, or 100 visual analog scale. Ten patients were enrolled, and eight completed follow-up. The CAF without VRIs group included 26 teeth, and the MSCAF group included 21 teeth. Mean root coverage at six months was 80.29%±18.28% with CAF without VRIs and 67.08% ± 15.08% with MSCAF. Complete root coverage was achieved in two patients in the CAF group and none in the MSCAF group. Between-group differences in clinical measurements were not statistically significant. Patient-reported overall satisfaction was higher with CAF without VRIs than with MSCAF (93.75±17.67 vs. 56.25±17.67; P=0.01), as was the perceived degree of root coverage (81.25±25.87 vs. 50.00±0.00; P=0.04). Color-match scores were 100 in both groups. One patient in the CAF group developed a postoperative hematoma. Conclusion: Both procedures were associated with clinical improvement at six months. CAF without VRIs showed numerically greater mean root coverage and higher patient-rated overall satisfaction and perceived root coverage than MSCAF. These findings should be interpreted cautiously given the small sample size and short follow-up.