Treatment of Multiple Cairo RT2 Gingival Recessions with the Tunnel Technique and a Subepithelial Connective Tissue Graft: A Case Report

Abstract

Multiple Cairo RT2 gingival recessions present esthetic and functional challenges in periodontal therapy. This case report describes the treatment of multiple Cairo RT2 gingival recessions using the tunnel technique combined with a subepithelial connective tissue graft in a 42-year-old woman. Clinical evaluation at 6 and 12 months demonstrated complete root coverage at most treated sites, increased keratinized tissue width, shallow probing depths, and complete resolution of dentin hypersensitivity. The patient was satisfied with the esthetic outcome. These findings suggest that the tunnel technique combined with a subepithelial connective tissue graft is a predictable and effective treatment option for appropriately selected cases.

Keywords

• gingival recession
• tunnel technique
• subepithelial connective tissue graft

References

1. Miller PD. Root coverage grafting for regeneration and aesthetics. Periodontol 2000 1993; 1:118-127.
2. Wennström JL. Mucogingival therapy. Ann Periodontol 1996; 1:671-701.
3. Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000 2015; 68:333-368.
4. Sangnes G, Gjermo P. Prevalence of oral soft and hard tissue lesions related to mechanical toothcleansing procedures. Community Dent Oral Epidemiol 1976; 4:77-83.
5. Wennström JL, Lindhe J, Sinclair F, Thilander B. Some periodontal tissue reactions to orthodontic tooth movement in monkeys. J Clin Periodontol 1987; 14:121-129.
6. Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 2002; 29 Suppl 3:178-194.
7. Miller PD. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985; 5:8-13.
8. Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 2011; 38:661-666.

9. Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 2015; 86(2 Suppl):S8-S51.
10. Aroca S, Molnár B, Windisch P, et al. 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. J Clin Periodontol 2013; 40:713-720.
11. Aroca S, Keglevich T, Nikolidakis D, et al. Treatment of class III multiple gingival recessions: a randomized clinical trial. J Clin Periodontol 2010; 37:88-97.
12. Cheng X, Tang R, Ge Z. Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a meta-analysis. Hua Xi Kou Qiang Yi Xue Za Zhi 2023; 41:450-462.
13. Zabalegui I, Sicilia A, Cambra J, Gil J, Sanz M. Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report. Int J Periodontics Restorative Dent 1999; 19:199-206.
14. Ozenci I, Ipci SD, Cakar G, Yilmaz S. Tunnel technique versus coronally advanced flap with acellular dermal matrix graft in the treatment of multiple gingival recessions. J Clin Periodontol 2015; 42:1135-1142.
15. Zuhr O, Rebele SF, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient-centred outcomes. J Clin Periodontol 2014; 41:582-592.
16. Chauca-Bajaña L, Vásquez González PS, Alban Guijarro MJ, et al. Comparative effectiveness of tunneling vs. coronally advanced flap techniques for root coverage: a 6-12-month randomized clinical trial. Bioengineering (Basel) 2025; 12:824.
17. González-Febles J, Romandini M, Laciar-Oudshoorn F, et al. Tunnel vs. coronally advanced flap in combination with a connective tissue graft for the treatment of multiple gingival recessions: a multi-center randomized clinical trial. Clin Oral Investig 2023; 27:3627-3638.
18. Tavelli L, Barootchi S, Nguyen TVN, Tattan M, Ravidà A, Wang HL. Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: a systematic review and meta-analysis. J Periodontol 2018; 89:1075-1090.
19. Mayta-Tovalino F, Barboza JJ, Pasupuleti V, Hernandez AV. Efficacy of tunnel technique (TUN) versus coronally advanced flap (CAF) in the management of multiple gingival recession defects: a meta-analysis. Int J Dent 2023; 2023:8671484.