MCAF and EMD With and Without CTG Wall Technique for the Treatment of Class III and IV Gingival recessions-a Randomized Control Trial

Research is to compare and evaluate the clinical outcomes of the Connective tissue graft wall technique with modified coronally advanced flap to improve root coverage and clinical attachment levels in Miller's class III and IV gingival recession. The objectives is to assess the probing pocket depth reduction, clinical attachment level gain, patient esthetic evaluation, complete root coverage and mean root coverage. the control group will be treated with modified coronally advanced flap with connective tissue graft and enamel matrix derivative and the study group will be treated with modified coronally advanced flap with connective tissue graft wall and enamel matrix derivative. The total number of participants included will be 24 (Control-12; Study-12) with a 6 month follow up.

Inclusion criteria

• Participants aged 18-60 years
• Systemically healthy individuals
• Participants with Miller's Class III and IV or Cairo's RT3 gingival recession in maxillary and mandibular anteriors.
• Participants with Nordland and Tarnow's papillary recession of either I, II or III.
• Presence of interdental PPD, CAL and recession
• Radiographic evidence of interdental bone loss
• No prior experience of root coverage procedures
• Able to achieve good oral hygiene and control gingivitis in the whole of the dentition (FMPS < 25% and FMBS < 25%).

Exclusion criteria

• Grade III mobile teeth
• Pathologically migrated teeth
• Endodontically treated teeth
• Open contacts
• Pregnancy and lactating women
• Participants with systemic conditions
• Untreated periodontitis
• Persistence of uncorrected gingival trauma from tooth brushing
• Self-reported current smoking
• Presence of medical contraindications to elective surgery