Treatment of Multiple Gingival Recessions by Tunnel Technique and Acellular Dermal Matrix Graft: A Case Report

Year 2018, Volume: 1 Issue: 1, 1 - 9, 30.09.2018

İlknur Özenci Şebnem Dirikan İpçi Gökser Çakar Selçuk Yılmaz

Abstract

Abstract: Successful clinical outcomes have been achieved with various root coverage procedures for the treatment

of Miller Class I and II multiple gingival recessions. Regarding Miller Class III recessions, unpredictable success rate

was reported due to the loss of interproximal tissue support. Recently, it has been demonstrated that complete root

coverage is possible in Miller Class III defects, when the defects present mild interdental attachment loss. This case

report describes the application of acellular dermal matrix graft (ADM) and tunnel technique (TUN) combination,

for the treatment of Miller Class III multiple gingival recession defects. At 12-month, complete root coverage on

teeth #41 and partial root coverage on teeth #31 with mean root coverage of 83.3% were achieved. Root coverage

esthetic score was 7 with successful esthetic results. Besides significant defect coverage increase in keratinized tissue

height and gingival thickness were obtained. According to the present clinical case, Miller Class III multiple gingival

recessions can be predictably treated with TUN+ADM, if the attachment loss is not too severe.

Keywords

Acellular dermal matrix graft, Multiple gingival recessions, Tunnel technique, Miller Calss III recessions.

References

• Ahmedbeyli, C., Ipçi, Ş. D., Cakar, G., Kuru, B. E., & Yılmaz, S. (2014). Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment of multiple gingival recessions with thin tissue biotype. Journal of Clinical Periodontology, 41(3), 303–310.
• American Academy of Periodontology. (1996). Consensus report on mucogingival therapy. Proceedings of the World Workshop in Periodontics. Annals of Periodontology, 1(1), 702–706.
• Aroca, S., Keglevich, T., Nikolidakis, D., Gera, I., Nagy, K., Azzi, R., & Etienne, D. (2010a). Treatment of class III multiple gingival recessions: a randomized-clinical trial. Journal of Clinical Periodontology, 37(1), 88–97.
• Aroca, S., Keglevich, T., Nikolidakis, D., Gera, I., Nagy, K., Azzi, R., & Etienne, D. (2010b). Treatment of class III multiple gingival recessions: a randomized-clinical trial. Journal of Clinical Periodontology, 37(1), 88–97.
• Aroca, S., Molnár, B., Windisch, P., Gera, I., Salvi, G. E., Nikolidakis, D., & Sculean, A. (2013). Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial. Journal of Clinical Periodontology, 40(7), 713–720.
• Baldi, C., Pini-Prato, G., Pagliaro, U., Nieri, M., Saletta, D., Muzzi, L., & Cortellini, P. (1999). Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19- case series. Journal of Periodontology, 70(9), 1077–1084.
• Cairo, F. (2017). Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontology 2000, 75(1), 296–316.
• Cairo, F., Rotundo, R., Miller, P. D., & Pini Prato, G. P. (2009). Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. Journal of Periodontology, 80(4), 705–710.
• Cortellini, P., & Pini Prato, G. (2012). Coronally advanced flap and combination therapy for root coverage. Clinical strategies based on scientific evidence and clinical experience. Periodontology 2000, 59(1), 158–184.
• Esteibar, J. R. V., Zorzano, L. A. A., Cundín, E. E., Blanco, J. D. M., & Medina, J. R. O. de G. (2011). Complete root coverage of Miller Class III recessions. The International Journal of Periodontics & Restorative Dentistry, 31(4), e1-7.
• Felipe, M. E. M. C., Andrade, P. F., Grisi, M. F. M., Souza, S. L. S., Taba, M., Palioto, D. B., & Novaes, A. B. (2007). Comparison of two surgical procedures for use of the acellular dermal matrix graft in the treatment of gingival recessions: a randomized controlled clinical study. Journal of Periodontology, 78(7), 1209–1217.
• Graziani, F., Gennai, S., Roldán, S., Discepoli, N., Buti, J., Madianos, P., & Herrera, D. (2014). Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions. Journal of Periodontology, 41(Suppl 15), 63-79.
• Harris, R. J. (2004). A short-term and long-term comparison of root coverage with an acellular dermal matrix and a subepithelial graft. Journal of Periodontology, 75(5), 734–743.
• Mahajan, A., Dixit, J., & Verma, U. P. (2007). A patient-centered clinical evaluation of acellular dermal matrix graft in the treatment of gingival recession defects. Journal of Periodontology, 78(12), 2348–2355.
• Mahn, D. H. (2010). Use of the tunnel technique and an acellular dermal matrix in the treatment of multiple adjacent teeth with gingival recession in the esthetic zone. The International Journal of Periodontics & Restorative Dentistry, 30(6), 593–599.
• Miller, P. D. (1985). A classification of marginal tissue recession. The International Journal of Periodontics & Restorative Dentistry, 5(2), 8–13.
• Modaressi, M., & Wang, H.-L. (2009). Tunneling procedure for root coverage using acellular dermal matrix: a case series. The International Journal of Periodontics & Restorative Dentistry, 29(4), 395–403.
• Moslemi, N., Mousavi Jazi, M., Haghighati, F., Morovati, S. P., & Jamali, R. (2011). Acellular dermal matrix allograft versus subepithelial connective tissue graft in treatment of gingival recessions: a 5-year randomized clinical study. Journal of Clinical Periodontology, 38(12), 1122–112d9.
• Mounssif, I., Stefanini, M., Mazzotti, C., Marzadori, M., Sangiorgi, M., & Zucchelli, G. (2018). Esthetic evaluation and patient-centered outcomes in root-coverage procedures. Periodontology 2000, 77(1) 1-35.
• Moussa, E. W., Bissada, N.F. (2017) Comperative outcomes of Miller Class III gingival recession treatment using the tunnel or coronally advanced flap approach: a case report. Clinical Advances in Periodontics, 7(1), 35-41.
• Novaes, A. B., Grisi, D. C., Molina, G. O., Souza, S. L., Taba, M., & Grisi, M. F. (2001). Comparative 6-month clinical study of a subepithelial connective tissue graft and acellular dermal matrix graft for the treatment of gingival recession. Journal of Periodontology, 72(11), 1477–14dddd84.
• Ozenci, I., Ipci, S. D., Cakar, G., & Yilmaz, S. (2015). Tunnel technique versus coronally advanced flap with acellular dermal matrix graft in the treatment of multiple gingival recessions. Journal of Clinical Periodontology, 42(12), 1135–1142.
• Papageorgakopoulos, G., Greenwell, H., Hill, M., Vidal, R., & Scheetz, J. P. (2008). Root coverage using acellular dermal matrix and comparing a coronally positioned tunnel to a coronally positioned flap approach. Journal of Periodontology, 79(6), 1022–1030.
• Sculean, A., Cosgarea, R., Katsaros, C., Arweiler, N. B., Miron, R. J., & Deppe, H. (2017). Treatment of single and multiple Miller Class I and III gingival recessions at crown-restored teeth in maxillary esthetic areas. Quintessence International (Berlin, Germany: 1985), 48(10), 777–782.
• Sculean, A., Cosgarea, R., Stähli, A., Katsaros, C., Arweiler, N. B., Miron, R. J., & Deppe, H. (2016). Treatment of multiple adjacent maxillary Miller Class I, II, and III gingival recessions with the modified coronally advanced tunnel, enamel matrix derivative, and subepithelial connective tissue graft: A report of 12 cases. Quintessence International (Berlin, Germany: 1985), 47(8), 653-659.
• Serino, G., Wennström, J. L., Lindhe, J., & Eneroth, L. (1994). The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene. Journal of Clinical Periodontology, 21(1), 57-63.
• Stefanini, M., Marzadori, M., Aroca, S., Felice, P., Sangiorgi, M., Zucchelli, G. (2018). Decision making in rootcoverage procedures for the esthetic outcome. Periodontology 2000, 77(1), 1-11.
• Tal, H. (1999). Subgingival acellular dermal matrix allograft for the treatment of gingival recession: a case report. Journal of Periodontology, 70(9), 1118–1124.
• Thombre, V., Koudale, S. B., & Bhongade, M. L. (2013). Comparative evaluation of the effectiveness of coronally positioned flap with or without acellular dermal matrix allograft in the treatment of multiple marginal gingival recession defects. International Journal of Periodontics and Restorative Dentistry, 33(3), e88-94.
• Zabalegui, I., Sicilia, a, Cambra, J., Gil, J., & Sanz, M. (1999). Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report. The International Journal of Periodontics & Restorative Dentistry, 19(2), 199–206.
• Zucchelli, G., Mele, M., Mazzotti, C., Marzadori, M., Montebugnoli, L., & De Sanctis, M. (2009). Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. Journal of Periodontology, 80(7), 1083–1094.
• Zucchelli, G., Mounssif, I., Mazzotti, C., Montebugnoli, L., Sangiorgi, M., Mele, M., & Stefanini, M. (2014). Does the dimension of the graft influence patient morbidity and root coverage outcomes? A randomized controlled clinical trial. Journal of Clinical Periodontology, 41(7), 708–716.
• Zuhr, O., Rebele, S. F., Cheung, S. L., Hürzeler, M. B., & Research Group on Oral Soft Tissue Biology and Wound Healing. (2018). Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery. Periodontology 2000, 77(1), 1-27.