J Periodontal Implant Sci.  2021 Dec;51(6):398-408. 10.5051/jpis.2101400070.

Modified tunneling technique for root coverage of anterior mandible using minimal soft tissue harvesting and volume-stable collagen matrix: a retrospective study

• Lee Y
• Lee D
• Kim S
• Ku Y
• Rhyu ICC

• KMID: 2557518
• DOI: http://doi.org/10.5051/jpis.2101400070

Abstract

Purpose
In this study, we aimed to evaluate the clinical validity of the modified tunneling technique using minimal soft tissue harvesting and volume-stable collagen matrix in the anterior mandible.
Methods
In total, 27 anterior mandibular teeth and palatal donor sites in 17 patients with ≥1 mm of gingival recession (GR) were analyzed before and after root coverage. For the recipient sites, vertical vestibular incisions were made in the interdental area and a subperiosteal tunnel was created with an elevator. After both sides of the marginal gingiva were tied to one another, a prepared connective tissue graft and volume-stable collagen matrix were inserted through the vestibular vertical incision and were fixed with resorbable suture material. The root coverage results of the recipient site were measured at baseline (T 0 ), 3 weeks (T 3 ), 12 weeks (T 12 ), and the latest visit (T1 ). For palatal donor sites, a free gingival graft from a pre-decided area avoiding the main trunk of the greater palatine artery was harvested using a prefabricated surgical template at a depth of 2 mm after de-epithelization using a rotating bur. In each patient, the clinical and volumetric changes at the donor sites between T 0 and T 3 were measured.
Results
During an average follow-up of 14.5 months, teeth with denuded root lengths of 1–3 mm (n=12), 3–6 mm (n=11), and >6 mm (n=2) achieved root coverage of 97.01%±7.65%, 86.70%±5.66%, and 82.53%±1.39%, respectively. Miller classification I (n=12), II (n=10), and III (n=3) teeth showed mean coverage rates of 97.01%±7.65%, 86.91%±5.90%, and 83.19%±1.62%, respectively. At the donor sites, an average defect depth of 1.41 mm (70.5%) recovered in 3 weeks, and the wounds were epithelized completely in all cases.
Conclusions
The modified tunneling technique in this study is a promising treatment modality for overcoming GR in the anterior mandible.

Keyword

Gingival recessionGingival recession; Connective tissue; Gingivoplasty