Mandibular Anterior Bölgede İzole Dişeti Çekilmesinin Laterally Closed Tunnel Tekniği ile Tedavisi: Olgu Sunumu

Abstract

Diş eti çekilmeleri, özellikle mandibula anterior bölgede estetik problemler ve dentin hassasiyetine yol açabilen yaygın periodontal defektlerdir. Bu tür izole çekilmelerin tedavisinde minimal invaziv ve öngörülebilir cerrahi tekniklerin kullanımı önem kazanmaktadır. Bu olgu sunumunun amacı, laterally closed tunnel (LCT) tekniğinin klinik etkinliğini değerlendirmektir. Yirmi yedi yaşında sistemik olarak sağlıklı kadın hasta, estetik kaygı ve hassasiyet şikayetleri ile Akdeniz Üniversitesi Diş Hekimliği Fakültesi Periodontoloji Anabilim Dalı’na başvurmuştur. Klinik muayenede mandibular anterior bölgede, 31 numaralı dişte 7 mmlik derin ve izole diş eti çekilmesi saptanmıştır. Çekilme defekti, Cairo RT1 ve Miller Sınıf II olarak sınıflandırılmıştır. Başlangıç periodontal tedavi kapsamında hastaya diş yüzeyi temizliği uygulanmış ve oral hijyen eğitimi verilmiştir. Cerrahi tedavi aşamasında laterally closed tunnel tekniği ile bağ dokusu grefti uygulanmıştır. Tünel hazırlanarak papil bütünlüğü korunmuş, greft materyali yerleştirildikten sonra yumuşak dokular lateral olarak pozisyonlandırılarak kök yüzeyi örtülmüştür. Hastanın 6 aylık takibi sonucunda herhangi bir komplikasyon gözlenmemiştir. Klinik değerlendirmede tam kök yüzeyi örtülmesi (%100 root coverage) sağlanmış, çekilme derinliği tamamen elimine edilmiş ve keratinize doku genişliğinde artış gözlenmiştir. Ayrıca, hastanın estetik beklentileri karşılanmış ve dentin hassasiyetinde azalma bildirilmiştir. Laterally closed tunnel tekniği, özellikle derin ve izole mandibular diş eti çekilmelerinin tedavisinde minimal invaziv, öngörülebilir ve başarılı klinik sonuçlar sağlayan etkili bir yöntemdir.

Keywords

• Diş eti çekilmesi
• Laterally closed tunnel tekniği
• Bağ dokusu grefti
• Mandibular anterior bölge
• Mukogingival cerrahi

Treatment of Isolated Gingival Recession in the Mandibular Anterior Region Using the Laterally Closed Tunnel Technique: A Case Report

Abstract

Gingival recessions are common periodontal defects that may lead to aesthetic concerns and dentin hypersensitivity, particularly in the mandibular anterior region. The use of minimally invasive and predictable surgical techniques has gained increasing importance in the treatment of such isolated recessions. The aim of this case report is to evaluate the clinical effectiveness of the laterally closed tunnel (LCT) technique. A 27-year-old systemically healthy female patient was referred to the Department of Periodontology at Akdeniz University Faculty of Dentistry with complaints of aesthetic concerns and sensitivity. Clinical examination revealed a deep and isolated gingival recession of 7 mm on tooth #31 in the mandibular anterior region. The recession defect was classified as Cairo RT1 and Miller Class II. As part of the initial periodontal therapy, scaling and root surface debridement were performed, and oral hygiene instructions were provided. During the surgical phase, a connective tissue graft was applied using the laterally closed tunnel technique. A tunnel was prepared while preserving the papillary integrity, and after placement of the graft material, the soft tissues were repositioned laterally to achieve root coverage. At the 6-month follow-up, no complications were observed. Clinical evaluation demonstrated complete root coverage (100%), total elimination of the recession depth, and an increase in the width of keratinized tissue. Additionally, the patient’s aesthetic expectations were met, and a reduction in dentin hypersensitivity was reported. The laterally closed tunnel technique is an effective method that provides minimally invasive, predictable, and successful clinical outcomes, particularly in the treatment of deep and isolated gingival recessions in the mandibular region.

Keywords

• Gingival recession
• Laterally closed tunnel technique
• Connective tissue graft
• Mandibular anterior region
• Mucogingival surgery

References

1. 1Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000. 2015; 68: 333-8. doi: 10.1111/prd.12059
2. Tugnait A, Clerehugh V. Gingival recession - its significance and management. J Dent. 2001; 29: 381-94. doi: 10.1016/s0300-5712(01)00035-5
3. Miller PD. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985; 5: 8-13.
4. Cairo F, Nieri M, Cincinelli S. The interproximal clinical attachment level to classify gingival recessions. J Clin Periodontol. 2011; 38: 661-6. doi: 10.1111/j.1600-051X.2011.01732.x
5. Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol. 2015; 86: S8-51. doi: 10.1902/jop.2015.130674
6. Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol. 2000; 71: 1506-14. doi: 10.1902/jop.2000.71.9.1506
7. Aroca S, Keglevich T, Barbieri B, et al. Treatment of multiple adjacent gingival recessions with the tunnel technique. J Clin Periodontol. 2010; 37: 88-97. doi: 10.1111/j.1600-051X.2009.01492
8. Sculean A, Allen EP. The laterally closed tunnel technique for the treatment of isolated gingival recessions. Periodontol 2000. 2018; 77: 147-56.

9. Hürzeler MB, Weng D. A single-incision technique to harvest subepithelial connective tissue grafts. Int J Periodontics Restorative Dent. 1999; 19: 279-87.
10. Sculean A, Allen EP. The laterally closed tunnel for the treatment of deep isolated mandibular recessions: surgical technique and a report of 24 cases. Int J Periodontics Restorative Dent. 2018; 38: 479-87. doi: 10.11607/prd.3680