An interventional study of Coronally Advanced Flap with Connective Tissue Graft and Cross-linked Hyaluronic Acid Gel in Gingival Recession, Mucogingival Surgery, sponsored by Universidade do Porto. Not yet recruiting at 1 site in Portugal. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-04-20.
Sponsored by Universidade do Porto · Not applicable, Interventional, and Treatment
Gingival recession is a common condition in which the gum tissue recedes, exposing the root surface of the tooth. This can lead to tooth sensitivity, higher risk of root decay, and aesthetic concerns. A commonly used surgical treatment is the coronally advanced flap combined with a connective tissue graft (CAF + SCTG), which aims to cover the exposed root and improve gum health.
Hyaluronic acid (HA) is a naturally occurring substance in the body that plays an important role in wound healing. It may help improve tissue repair, reduce inflammation, and enhance healing after surgery.
This study aims to evaluate whether the use of hyaluronic acid (hyaDENT BG®) in addition to standard surgical treatment improves clinical outcomes in patients with gingival recession. Participants will be randomly assigned to receive either standard treatment alone or standard treatment with hyaluronic acid.
The main outcome is the proportion of sites with complete root coverage after 12 months. Additional outcomes include healing, gum tissue improvement, patient-reported pain and discomfort, and aesthetic results.
The study also includes a laboratory component to investigate how hyaluronic acid affects cells involved in gum healing.
Gingival recession (GR) is a common mucogingival condition characterized by apical displacement of the gingival margin beyond the cemento-enamel junction, leading to root exposure, dentin hypersensitivity, increased risk of root caries, and aesthetic impairment. The coronally advanced flap combined with a subepithelial connective tissue graft (CAF + SCTG) is considered the gold standard for the treatment of single gingival recession defects, providing predictable root coverage and long-term stability. However, postoperative morbidity, donor-site discomfort, and incomplete root coverage may still occur.
Hyaluronic acid (HA) is a key component of the extracellular matrix with biological properties that promote wound healing, including stimulation of angiogenesis, cell migration, proliferation, and modulation of inflammatory responses. Cross-linked HA formulations exhibit prolonged bioactivity and may enhance soft tissue healing and regeneration in periodontal surgery.
This study is a prospective, randomized, controlled, post-market clinical follow-up (PMCF) trial designed to evaluate the clinical effectiveness and safety of adjunctive cross-linked hyaluronic acid (hyaDENT BG®) in combination with CAF + SCTG for the treatment of single RT1 and RT2 gingival recession defects. A total of 34 patients will be enrolled and randomly allocated in a 1:1 ratio to either the test group (CAF + SCTG with adjunctive HA) or the control group (CAF + SCTG alone). Randomization will be stratified by recession type (RT1 vs RT2), and outcome assessors will be blinded to treatment allocation.
The primary endpoint is complete root coverage (CRC) at 12 months, defined as recession depth equal to 0 mm relative to the cemento-enamel junction. Secondary endpoints include mean root coverage, recession reduction, clinical attachment level gain, probing depth reduction, keratinized tissue gain, early wound healing (Early Wound Healing Score), patient-reported outcomes (pain, discomfort, and oral health-related quality of life), and aesthetic outcomes assessed using the Root Coverage Esthetic Score (RES).
Clinical assessments will be performed at baseline and at predefined follow-up visits up to 12 months post-surgery using standardized protocols and calibrated examiners. Patient-reported outcomes will be collected using validated instruments, including visual analog scales (VAS) and the OHIP-14 questionnaire.
In parallel, an in vitro component will be conducted using primary human gingival fibroblasts isolated from connective tissue grafts obtained during surgery. These cells will be used to evaluate the effects of HA on cell viability, proliferation, migration, gene expression related to wound healing and inflammation, and activation of intracellular signaling pathways.
This combined clinical and translational approach aims to provide comprehensive evidence on both the clinical performance and biological mechanisms of action of hyaluronic acid in periodontal plastic surgery.
402 studies on the registry are indexed under Gingival Recession; 98 are open to participants now.
This study's planned enrollment of 34 is above the median of 30 across 368 interventional studies indexed under Gingival Recession.
Browse Gingival Recession studies →Universidade do Porto is the lead sponsor of 170 studies on the registry; 52 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Participants undergo coronally advanced flap (CAF) surgery combined with a subepithelial connective tissue graft (SCTG) with adjunctive application of cross-linked hyaluronic acid (hyaDENT BG®). The graft is immersed in hyaluronic acid prior to placement, and the gel is applied to the recipient site before flap closure.
Procedure: Coronally Advanced Flap with Connective Tissue Graft · Device: Cross-linked Hyaluronic Acid Gel
Participants undergo coronally advanced flap (CAF) surgery combined with a subepithelial connective tissue graft (SCTG) without adjunctive hyaluronic acid. The graft is handled under standard conditions and hydrated with sterile saline prior to placement.
Procedure: Coronally Advanced Flap with Connective Tissue Graft
Standard periodontal plastic surgery procedure for root coverage involving coronally advanced flap (CAF) combined with a subepithelial connective tissue graft (SCTG). The technique aims to cover exposed root surfaces and improve soft tissue thickness and stability.
Also known as: CAF + SCTG
Application of cross-linked hyaluronic acid gel (hyaDENT BG®) as an adjunct to periodontal surgery. The gel is applied to the recipient site and used to immerse the connective tissue graft prior to placement, aiming to enhance soft tissue healing, promote cell proliferation and angiogenesis, and improve clinical outcomes.
Also known as: hyaDENT BG®
Complete Root Coverage (CRC)
Proportion of treated sites achieving complete root coverage, defined as recession depth equal to 0 mm relative to the cemento-enamel junction, assessed using a calibrated periodontal probe by a blinded examiner.
Time frame: 12 months
Mean Root Coverage (MRC)
Percentage of root coverage achieved relative to baseline recession depth at the treated site.
Time frame: 12 months
Recession Reduction (RecRed)
Change in gingival recession depth (mm) from baseline to follow-up, measured using a calibrated periodontal probe.
Time frame: 12 months
Clinical Attachment Level (CAL) Gain
Change in clinical attachment level (mm) from baseline to 12 months, measured using a periodontal probe.
Time frame: 12 months
Probing Depth (PD) Reduction
Reduction in probing depth (mm) from baseline to 12 months, measured using a periodontal probe.
Time frame: 12 months
Keratinized Tissue Width (KT) Gain
Increase in the width of keratinized gingiva (mm) from baseline to follow-up.
Time frame: 12 months
Early Wound Healing Score (EHS)
Assessment of early soft tissue healing using the Early Wound Healing Score at predefined postoperative time points.
Time frame: 3 days, 14 days, and 6 weeks
Postoperative Pain and Discomfort (VAS)
Patient-reported pain and discomfort assessed using a visual analog scale (VAS).
Time frame: 3 days, 14 days, and 6 weeks
Oral Health-Related Quality of Life (OHIP-14)
Patient-reported oral health-related quality of life measured using the OHIP-14 questionnaire.
Time frame: 3 days, 14 days, and 6 weeks
Root Coverage Esthetic Score (RES)
Esthetic outcome assessed using the Root Coverage Esthetic Score based on standardized clinical photographs.
Time frame: 12 months
Surgical and Postoperative Complications
Incidence of intraoperative and postoperative complications, including flap dehiscence, infection, or graft necrosis.
Time frame: up to 12 months
Documents are hosted by the registry — open the source record to download them.
Plan to share: Undecided — No final decision has been made regarding individual participant data sharing. Data sharing will be considered in accordance with applicable regulations and institutional policies.
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Universidade do Porto