Effectiveness of Hyaluronic Acid on Multiple Adjacent Gingival Recessions Using a Coronally Advanced Flap

The thickness of the keratinized tissue will be measured intraoperatively at each teeth midline point from vestibular part of keratinized tissue during flap elevation using a digital caliper (Fervi® monoblock stainless steel electronic digital caliper Art. C041/150 0.01 mm)

The width of the keratinized gingiva will be measured intraorally using a periodontal probe (UNC 15, Hu Friedy®,Chicago IL, SAD) baseline and at follow-up examinations after 1 month, 3 months and 6 months postoperatively

periodontal pocket probing depth (PPD) is the distance from the gingival margin to the apical portion of the gingival sulcus and will be measured at 3 points; mesial, buccal, distal part of the tooth using a periodontal probe (UNC 15, Hu Friedy®,Chicago IL, SAD) at baseline and follow-up examinations after 3 months and 6 months postoperatively

clinical attachment level (CAL) is measured with the periodontal probe (UNC 15, Hu Friedy®,Chicago IL, SAD) as the distance from the cemento-enamel junction (CEJ) to the free gingival margin at baseline and follow-up examinations 3 months and 6 months postoperatively

Gingival recession is measured clinically as the distance from the cemento-enamel junction to the depth of the free gingival margin using the millimeter markings on the periodontal probe (UNC 15, Hu Friedy®,Chicago IL, SAD) baseline and at follow-up examinations after 1 month, 3 months and 6 months postoperatively

The presence of plaque will be measured at baseline and at follow-up examinations using a periodontal probe (UNC 15, Hu Friedy®, Chicago IL, USA) at 3 vestibular sites; mesial, buccal, distal. It is recorded using the value + or - and it is calculated afterwards as the number of tooth sites where plaque is recorded, divided by a total number of available sites multiplied by 100 (expressed as a percentage) baseline and at follow-up examinations after 1 month, 3 months and 6 months postoperatively

The presence of bleeding sites will be measured at baseline and at follow-up examinations using a periodontal probe (UNC 15, Hu Friedy®, Chicago IL, USA) at 3 vestibular sites; mesial, buccal, distal after the PPD (periodontal pocket depth) measurements. Presence or absence of bleeding will be marked using a value of + or -. The number of sites where bleeding is recorded is divided by the total number of available sites in the mouth and multiplied by 100 to express the bleeding index as a percentage baseline and at follow-up examinations after 1 month, 3 months and 6 months postoperatively

RES scale (eng. Root coverage esthetic score) in 5 categories;

• changes evaluated based on the position of the gingival margin (GM); score 0,3,6
• evaluation of marginal tissue contour changes (MTC); score 0 or 1
• soft tissue texture evaluation (STT); score 0 or 1
• evaluation of the alignment of the mucogingival junction (MGJ); score 0 or 1
• gingival color evaluation (GC); score 0 or 1

To assess tooth hypersensitivity (scale from 0 to 3) on vestibular surface of the tooth; It is determined by using an air stimulus from the dental unit in such way that the air is directed at an angle of 90 degrees to the vestibular surface of the tooth for 1 second duration from a distance of 1 centimeter. Adjacent teeth are protected with gloves on fingers. Score 0; the patient does not respond to the air stimulus, Score 1; the patient responds to the air stimulus but does not require interruption of the stimulus, Score 2; the patient reacts to the air stimulus and requires interruption or spontaneously withdraws from the stimulus, Score 3; the patient reacts to the stimulus, considers it painful and requests its termination.

Using the OHIP-14 questionnaire; it has been used to assess the impact of oral health problems on an individual's life. It consists of 14 questions, and patients complete it at baseline and at follow-up appointments 1 month, 3 months, 6 months postoperatively. Patients answer the offered 14 questions by circling the stated values: 0; never, 1; almost never, 2; occasionally, 3; often, 4; very often. OHIP-14 scores can range from 0 to 56 and are calculated by summing the ordinal values for the 14 items. Higher OHIP-14 scores indicate worse, and lower scores indicate better OHRQol (Oral Health-related Quality of Life)

By using the VAS scale and keeping a pain diary during the first 7 days postoperatively.

The Visual Analogue Scale (VAS) measures pain intensity. The VAS consists of a line with graphical display and two end points representing 0 ('no pain') and 10 ('pain as bad as it could possibly be'). Patients will take the printed measurements scales with them at home and will be asked to mark pain intensity on the scale for the first seven days. Patients will also keep a pain diary where they will be asked to write the name of a painkiller they took, dosage, frequency of taking it and indication. The completed medication diary and the VAS scale are brought with them to the appointment 14 days after the surgery.