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Gingival RecessionRecession typeNCT05844254

Comparison of Root Coverage Outcomes by NORD Flap Versus Subepithelial Connective Tissue Graft in RT1 Gingival Recession

A study testing novel overlapping rotated double (NORD) flap in people with Gingival Recession, run by Postgraduate Institute of Dental Sciences Rohtak at 1 site in India.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Management of GR in the initial stages (when there is no inter proximal attachment and bone loss involved) has better clinical outcomes and reduces the chances of further progression of recession. Read more about this study

Who is it for?
Ages 18 to 45 yearsHealthy volunteers can take part
Conditions the study is for
Gingival Recession
What is being tested?
novel overlapping rotated double (NORD) flap
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
55 participants
Where
1 siteIndia
Study dates
2 Apr 2023to 30 Dec 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 45 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • • Age 18-45 years
  • Non smokers (current and past smokers
  • Plaque index ≤1,Gingival index≤1
  • RT1(Miller's class I and class II)gingival recession, that is, GR with no loss of inter proximal attachment
  • Probing depth ≤3 mm
  • Width of attached gingiva≥3 mm on the mesial and distal sides of the recipient tooth.
  • Adequate vestibular depth

Who cannot join

  • • Patients with a history of any systemic condition that might alter the course of disease and
  • or wound healing such as diabetes mellitus, immunologic disorders, cardio-vascular disease etc.
  • Pregnant and lactating women.
  • Patients with immature tooth.
  • Patients with tooth fracture or tooth mobility
  • Patients receiving treatment with antibiotics, statins, glucocorticoids, bisphosphonates or any other modulatory drug.
  • Patients undergoing orthodontic treatment

Trial locations and contacts

1 site in 1 country.

India1 site
  • Post graduate institute of dental sciences

    Rohtak, Haryana, 110015

Other trials in India

About this study

Official title: Patient Centered Outcomes and Stability of Root Coverage by Novel Overlapping Rotated Double (NORD) Flap as Compared to Sub Epithelial Connective Tissue Graft in Isolated Recession type1 Gingival Recession-A Randomized Controlled Trial

Management of GR in the initial stages (when there is no inter proximal attachment and bone loss involved) has better clinical outcomes and reduces the chances of further progression of recession. Surgical treatment of recession involves techniques like pedicle grafts and free soft tissue grafts and their modifications. Sub epithelial connective tissue graft is considered as the gold standard in root coverage techniques. However this procedure involves a second surgical site increasing surgical time, complexity and patient morbidity. So there is a need of a technique which overcomes these limitations, is easier to perform and helps to achieve comparable root coverage with stable results over a long term. Novel overlapping rotated double (NORD) flap is a novel technique which offers a solution to this problem. This may help to achieve greater thickness of gingiva in the region of GR after healing and may reduce the risk of future recession. This technique is being compared with the bilaminar technique utilizing the sub epithelial connective tissue graft at the control sites, both the test and control groups will be treated using a microsurgical approach. If there is no significant difference in the root coverage achieved between the two techniques, this may reduce the need of harvesting connective tissue graft from a second surgical site. This

technique is also expected to have better patient reported outcomes and will benefit the patients and operator both. This technique may also help to modify the phenotype of the affected tooth, thus making the results more stable.

Read the detailed description

Gingival recession (GR) is a very frequent finding in the general population with a prevalence ranging from 50-90% in different populations. Patients with GR may experience hypersensitivity, pain, poor esthetics and difficulty in maintaining oral hygiene. Among the predisposing factors for GR, most common are improper tooth brushing, gingival inflammation, thin periodontal phenotype, aberrant frenum, areas with inadequate keratinized gingiva, orthodontic movement leading to buccal tooth displacement and direct trauma. Literature suggests that untreated gingival recession has a high probability of undergoing further progression even in the presence of good oral hygiene. From an epidemiological point of view, localized facial gingival recessions affect more than 60% of individuals and account for a significant amount of periodontal attachment loss in subjects with good oral hygiene; therefore there is a need for predictable root coverage techniques. Many surgical techniques have been shown to be effective in correcting gingival recession by covering the exposed root with soft tissue; however, the thickness of the gingival tissue over the root surface probably plays an important role in preventing the recurrence of tissue recession. To cover the exposed root surfaces numerous techniques with various modifications have been attempted with the main focus in the recent decades being on complete root coverage. Pedicle grafts are usually considered superior to free soft tissue grafts due to intact blood supply from the donor site. Laterally positioned flap and double papilla grafts are examples of pedicle grafting techniques that obtain advantage of available keratinized tissue from the neighboring teeth. However, there is a risk of developing recession on the donor tooth or in case of double papilla flap, an inadequate coverage due to wound edges being sutured over an avascular surface. This is especially important in cases of thin periodontal phenotype. Sub epithelial connective tissue graft, though considered as a gold standard among the soft tissue grafting techniques involves a second surgical site increasing surgical time, complexity and patient morbidity. . To overcome these limitations, a novel technique is being proposed here.

  1. Methodology
  2. Study design- This randomized controlled trial will be conducted in the department of Periodontics, Post graduate institute of dental sciences (PGIDS), Rohtak in accordance with the ethical standards outlined in the declaration of Helsinki 1975, as revised in 2013.The study design was approved by Institutional review board, PGIDS, Rohtak and ethical acceptance applied for from the Ethical committee of PGIDS, Rohtak.
Being tested
novel overlapping rotated double (NORD) flap
Keywords
Sub epithelial connective tissue graft, patient centered outcomes, phenotype
Medical subject headings
Gingival Recession

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • novel overlapping rotated double (NORD) flapProcedure or surgery

    After undergoing phase one of periodontal therapy, patients will be recalled after four weeks for root coverage surgery. Patients will be randomly allotted to either group by stratified block randomization after taking baseline measurement with respect to periodontal phenotype(PP) [using transparency of periodontal probe through the gingival margin, when probe is visible, thin PP and when not visible, thick PP] so that patients with thick and thin PP get an equal chance of being allocated to NORD and Sub epithelial connective tissue group.

    1. Group 1(NORD group)- Patients treated with NORD flap
    2. Group 2 (Sub epithelial connective tissue group)- Patients treated with sub epithelial connective tissue graft Patients will be followed up after 1 month,6, 12 and 15 months. 30 patients belonging to thin phenotype will be followed up as separate cohort for period of one year to evaluate phenotype modification.
Study groups in NCT05844254
Study groupRoleWhat they receive
NORD groupExperimentalAfter undergoing phase one of periodontal therapy, patients will be recalled after four weeks for root coverage surgery. NORD group will undergo NORD flap for root coverage. Patients will be followed up after 1 month,6, 12 and 15 months. Patients belonging to thin phenotype will be followed up as separate cohort for period of one year to evaluate phenotype modification.
Receives: Procedure: novel overlapping rotated double (NORD) flap
Sub epithelial connective tissue groupActive comparatorAfter undergoing phase one of periodontal therapy, patients will be recalled after four weeks for root coverage surgery. Sub epithelial connective tissue group will receive sub epithelial connective tissue graft. Patients will be followed up after 1 month,6, 12 and 15 months. Patients belonging to thin phenotype will be followed up as separate cohort for period of one year to evaluate phenotype modification.
Receives: Procedure: novel overlapping rotated double (NORD) flap

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Recession depth

    change in recession depth from baseline at 1month will be assessed. The unit of measurement is millimeter.

    Measured: 1month

  2. Change in Recession depth

    change in recession depth from baseline at 6months will be assessed. The unit of measurement is millimeter.

    Measured: 6months

  3. Change in Recession depth

    change in recession depth from baseline at 12months will be assessed. The unit of measurement is millimeter.

    Measured: 12months

  4. Change in Recession depth

    change in recession depth from baseline at 15months will be assessed. The unit of measurement is millimeter.

    Measured: 15months

  5. Root coverage (%)- Change in recession depth/RD at baseline × 100

    change in recession depth from baseline to 1month will be assessed. The obtained value would be divided by recession depth at baseline. The value obtained would be multiplied by 100. The unit of measurement is millimeters.

    Measured: 1month

  6. Root coverage (%)- change in recession depth/RD at baseline × 100

    change in recession depth from baseline to 6months will be assessed. The obtained value would be divided by recession depth at baseline. The value obtained would be multiplied by 100. The unit of measurement is millimeters.

    Measured: 6 months

  7. Root coverage (%)-Change in recession depth/RD at baseline × 100

    change in recession depth from baseline to 12months will be assessed. The obtained value would be divided by recession depth at baseline. The value obtained would be multiplied by 100. The unit of measurement is millimeters.

    Measured: 12months

  8. Root coverage (%)- change in recession depth/RD at baseline × 100

    change in recession depth from baseline to 15months will be assessed. The obtained value would be divided by recession depth at baseline. The value obtained would be multiplied by 100. The unit of measurement is millimeters.

    Measured: 15months

  9. Visual analog scale

    Patients will be asked to record their pain using Visual analog scale (VAS) from 0 to 100, with 0 representing no pain and 100 representing pain as bad as it could be.

    Measured: 24 hours after surgery

  10. Visual analog scale

    Patients will be asked to record their pain using Visual analog scale (VAS) from 0 to 100, with 0 representing no pain and 100 representing pain as bad as it could be.

    Measured: 10 days after surgery

  11. Visual analog scale

    Patients will be asked to record their pain using Visual analog scale (VAS) from 0 to 100, with 0 representing no pain and 100 representing pain as bad as it could be.

    Measured: 1month

  12. Visual analog scale

    Patients will be asked to record their pain using Visual analog scale (VAS) from 0 to 100, with 0 representing no pain and 100 representing pain as bad as it could be.

    Measured: 6months

  13. Visual analog scale

    Patients will be asked to record their pain using Visual analog scale (VAS) from 0 to 100, with 0 representing no pain and 100 representing pain as bad as it could be.

    Measured: 12 months

  14. Visual analog scale

    Patients will be asked to record their pain using Visual analog scale (VAS) from 0 to 100, with 0 representing no pain and 100 representing pain as bad as it could be.

    Measured: 15 months

  15. Patient centered outcomes

    All Patient centered outcomes would be recorded in the questionnaire

    Measured: 10 days after surgery

  16. Patient centered outcomes

    All Patient centered outcomes would be recorded in the questionnaire

    Measured: 1month

Secondary outcomes (38)
  1. Probing depth

    Probing depth (in millimeter) would be measured from gingival margin to the base of pocket at six sites per tooth.

    Measured: baseline

  2. Probing depth

    Probing depth (in millimeter) would be measured from gingival margin to the base of pocket at six sites per tooth.

    Measured: 1month

  3. Probing depth

    Probing depth (in millimeter) would be measured from gingival margin to the base of pocket at six sites per tooth.

    Measured: 6 months

  4. Probing depth

    Probing depth (in millimeter) would be measured from gingival margin to the base of pocket at six sites per tooth.

    Measured: 12 months

  5. Probing depth

    Probing depth (in millimeter) would be measured from gingival margin to the base of pocket at six sites per tooth.

    Measured: 15 months

  6. Clinical attachment level

    Probing depth (in millimeter) would be measured from cemento-enamel junction to base of the pocket at six sites per tooth.

    Measured: baseline

  7. Clinical attachment level

    Probing depth (in millimeter) would be measured from cemento-enamel junction to base of the pocket at six sites per tooth.

    Measured: 1month

  8. Clinical attachment level

    Probing depth (in millimeter) would be measured from cemento-enamel junction to base of the pocket at six sites per tooth.

    Measured: 6 months

  9. Clinical attachment level

    Probing depth (in millimeter) would be measured from cemento-enamel junction to base of the pocket at six sites per tooth.

    Measured: 12 months

  10. Clinical attachment level

    Probing depth (in millimeter) would be measured from cemento-enamel junction to base of the pocket at six sites per tooth.

    Measured: 15 months

  11. Recession depth- at recipient tooth only

    recession depth (in millimeter) would be measured as a distance from the cemento-enamel junction to the most apical point of the buccal gingival margin

    Measured: baseline

  12. Recession depth- at recipient tooth only

    recession depth (in millimeter) would be measured as a distance from the cemento-enamel junction to the most apical point of the buccal gingival margin

    Measured: 1month

  13. Recession depth- at recipient tooth only

    recession depth (in millimeter) would be measured as a distance from the cemento-enamel junction to the most apical point of the buccal gingival margin

    Measured: 6months

  14. Recession depth- at recipient tooth only

    recession depth (in millimeter) would be measured as a distance from the cemento-enamel junction to the most apical point of the buccal gingival margin

    Measured: 12months

  15. Recession depth- at recipient tooth only

    recession depth (in millimeter) would be measured as a distance from the cemento-enamel junction to the most apical point of the buccal gingival margin

    Measured: 15months

  16. Recession width- at recipient tooth only

    recession width (in millimeter) would be measured by placing the periodontal probe horizontally at the most apical point of buccal cemento-enamel junction. The distance from the gingival margin mesial to a point distal of the recession will be measured.

    Measured: baseline

  17. Recession width- at recipient tooth only

    recession width (in millimeter) would be measured by placing the periodontal probe horizontally at the most apical point of buccal cemento-enamel junction. The distance from the gingival margin mesial to a point distal of the recession will be measured.

    Measured: 1month

  18. Recession width- at recipient tooth only

    recession width (in millimeter) would be measured by placing the periodontal probe horizontally at the most apical point of buccal cemento-enamel junction. The distance from the gingival margin mesial to a point distal of the recession will be measured.

    Measured: 6months

  19. Recession width- at recipient tooth only

    recession width (in millimeter) would be measured by placing the periodontal probe horizontally at the most apical point of buccal cemento-enamel junction. The distance from the gingival margin mesial to a point distal of the recession will be measured.

    Measured: 12months

  20. Recession width- at recipient tooth only

    recession width (in millimeter) would be measured by placing the periodontal probe horizontally at the most apical point of buccal cemento-enamel junction. The distance from the gingival margin mesial to a point distal of the recession will be measured.

    Measured: 15months

  21. width of keratinised gingiva

    Distance would be measured from gingival margin to muco-gingival junction at mid-buccal site to calculate width of keratinized gingiva. From the calculated width of keratinized gingiva, subtract the Probing depth at mid-buccal site.

    Measured: baseline

  22. Width of keratinised gingiva

    Distance would be measured from gingival margin to muco-gingival junction at mid-buccal site to calculate width of keratinized gingiva. From the calculated width of keratinized gingiva, subtract the Probing depth at mid-buccal site.

    Measured: 1month

  23. Width of keratinised gingiva

    Distance would be measured from gingival margin to muco-gingival junction at mid-buccal site to calculate width of keratinized gingiva. From the calculated width of keratinized gingiva, subtract the Probing depth at mid-buccal site.

    Measured: 6months

  24. Width of keratinised gingiva

    Distance would be measured from gingival margin to muco-gingival junction at mid-buccal site to calculate width of keratinized gingiva. From the calculated width of keratinized gingiva, subtract the Probing depth at mid-buccal site.

    Measured: 12months

  25. Width of keratinised gingiva

    Distance would be measured from gingival margin to muco-gingival junction at mid-buccal site to calculate width of keratinized gingiva. From the calculated width of keratinized gingiva, subtract the Probing depth at mid-buccal site.

    Measured: 15months

  26. Gingival thickness

    Gingival thickness will be measured 1.0mm apical to gingival margin using an injection needle, perpendicular to tissue surface, and a silicon stop over gingival surface. The silicon disc stop will be placed in tight contact with soft tissue. After needle removal, the distance between needle tip and silicon stop will be estimated using a digital caliper with 0.01mm of accuracy.

    Measured: baseline

  27. Gingival thickness

    Gingival thickness will be measured 1.0mm apical to gingival margin using an injection needle, perpendicular to tissue surface, and a silicon stop over gingival surface. The silicon disc stop will be placed in tight contact with soft tissue. After needle removal, the distance between needle tip and silicon stop will be estimated using a digital caliper with 0.01mm of accuracy.

    Measured: 1month

  28. Gingival thickness

    Gingival thickness will be measured 1.0mm apical to gingival margin using an injection needle, perpendicular to tissue surface, and a silicon stop over gingival surface. The silicon disc stop will be placed in tight contact with soft tissue. After needle removal, the distance between needle tip and silicon stop will be estimated using a digital caliper with 0.01mm of accuracy.

    Measured: 6 months

  29. Gingival thickness

    Gingival thickness will be measured 1.0mm apical to gingival margin using an injection needle, perpendicular to tissue surface, and a silicon stop over gingival surface. The silicon disc stop will be placed in tight contact with soft tissue. After needle removal, the distance between needle tip and silicon stop will be estimated using a digital caliper with 0.01mm of accuracy.

    Measured: 12 months

  30. Gingival thickness

    Gingival thickness will be measured 1.0mm apical to gingival margin using an injection needle, perpendicular to tissue surface, and a silicon stop over gingival surface. The silicon disc stop will be placed in tight contact with soft tissue. After needle removal, the distance between needle tip and silicon stop will be estimated using a digital caliper with 0.01mm of accuracy.

    Measured: 15 months

  31. Change in Recession width

    Change in recession width would be measured from baseline to 1month.

    Measured: 1month

  32. Change in Recession width

    Change in recession width would be measured from baseline to 6months.

    Measured: 6 months

  33. Change in Recession width

    Change in recession width would be measured from baseline to 12months.

    Measured: 12 months

  34. Change in Recession width

    Change in recession width would be measured from baseline to 15months.

    Measured: 15 months

  35. Root coverage-esthetic score

    According to Root coverage-esthetic score system 5 variables will be assessed. The variables are: level of gingival margin, marginal tissue contour, soft tissue texture, muco-gingival junction alignment, gingival colour.

    A score of 0,3, or 6 will be used for the evaluation of gingival margin position, whereas a score of 0-1 will be used for each of the other variables. The highest and best aesthetic score to be achieved for complete root coverage is 10.

    Measured: 1month

  36. Root coverage-esthetic score

    According to Root coverage-esthetic score system 5 variables will be assessed. The variables are: level of gingival margin, marginal tissue contour, soft tissue texture, muco-gingival junction alignment, gingival colour.

    A score of 0,3, or 6 will be used for the evaluation of gingival margin position, whereas a score of 0-1 will be used for each of the other variables. The highest and best aesthetic score to be achieved for complete root coverage is 10.

    Measured: 6 months

  37. Root coverage-esthetic score

    According to Root coverage-esthetic score system 5 variables will be assessed. The variables are: level of gingival margin, marginal tissue contour, soft tissue texture, muco-gingival junction alignment, gingival colour.

    A score of 0,3, or 6 will be used for the evaluation of gingival margin position, whereas a score of 0-1 will be used for each of the other variables. The highest and best aesthetic score to be achieved for complete root coverage is 10.

    Measured: 12 months

  38. Root coverage-esthetic score

    According to Root coverage-esthetic score system 5 variables will be assessed. The variables are: level of gingival margin, marginal tissue contour, soft tissue texture, muco-gingival junction alignment, gingival colour.

    A score of 0,3, or 6 will be used for the evaluation of gingival margin position, whereas a score of 0-1 will be used for each of the other variables. The highest and best aesthetic score to be achieved for complete root coverage is 10.

    Measured: 15 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 May 2023
  2. Study start2 Apr 2023
  3. Primary completion1 Nov 2025
  4. Study completion30 Dec 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
55 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05844254
Sponsor's protocol ID
Dr. Ritika Arora perio 2023
Acronym
Recession type
Status last verified
May 2026
First submitted
1 Feb 2023
Last updated
27 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing novel overlapping rotated double (NORD) flap in people with Gingival Recession, run by Postgraduate Institute of Dental Sciences Rohtak at 1 site in India.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 27 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in India. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Recession depth (time frame: 1month). The study lists 16 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 May 2026.

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