Diş Eti Çekilmesi Tedavisinde Tünel Tekniği ile Birlikte Çift Çapraz Sütur Uygulaması: Olgu Serisi

Abstract

Diş eti çekilmesi (DÇ) tedavi edilirken birçok tekniğin başarısından söz etmek mümkündür. Bu tekniklerden özellikle minimal invaziv bir teknik olan tünel tekniği, post-operatif olarak daha ağrısız, morbiditesi daha az ve başarılı bir tekniktir. Bununla birlikte tünel operasyonu sırasında kök yüzeyi kapanmasının sağlanabilmesi için serbestleştirilen flep koronale yer değiştirmelidir. Bu noktada sütur tekniği de son derece önemlidir. Özellikle hem greftin stabilizasyonunu sağlamak hem de flebi koronale ilerletmek için çift-çapraz sütur tekniği başarılı bir yöntemdir. Bu olgu serisinin amacı; tünel operasyonları sırasında çift-çapraz sütur tekniği uygulanmasının kısa dönem etkinliğinin araştırılmasıdır. Cairo DÇ tip 1 ve 2 DÇ’ye sahip sistemik olarak sağlıklı üç hastada tünel tekniği uygulanırken palatinal sahadan de-epitelize serbest diş eti grefti elde edilmiş ve serbestleştirilen flep içerisine yerleştirilmiştir. Yerleştirilen greft çiftçapraz sütur tekniği ile hem flebe sabitlenmiş hem de koronale ilerletilmiştir. Hastalar iki ay takip edilmiştir. Bu vaka serisinde DÇ’lerin tedavisinde post-operatif ağrı minimal düzeyde olmuştur. Uygulanan teknik ile hastaların estetik beklentileri karşılanmıştır. Bu sütur tekniği ile papil bütünlüğünün bozulmadığı görülmüş ve dokunun beslenmesi sırasında erken dönemde bir komplikasyonla karşılaşılmamıştır. Bu vaka sersinin sonuçları dahilinde çift-çapraz sütur tekniğiyle uygulanan tünel operasyonu ile DÇ tedavisinde etkili sonuçlar verdiği söylenebilir.

Keywords

• Bağ dokusu grefti
• diş eti çekilmesi
• sütur tekniği

Application of Double Cross Suture with Tunnel Technique in the Treatment of Gingival Recession: Case Series

Abstract

It’s possible to talk about the success of many techniques when treating gingival recession (GR). The tunnel technique, which is a minimally invasive technique, is a more painless, less morbid and successful post-operative technique. However, the released flap must be coronally displaced to ensure root surface closure during tunnel operation. At this point, the suture technique is also extremely important. In particular, the double-cross suture technique (DCST) is a successful method for both stabilizing the graft and advancing the flap coronally. The aim of this case series is; the aim of this study is to investigate the short-term effectiveness of applying the DCST during tunnel operations. While performing the tunnel technique in three systemically healthy patients with Cairo type 1-2 GR, a de-epithelialized free gingival graft was obtained from the palatal area and placed in the liberated flap. The implanted graft was both fixed to the flap and advanced coronally with the DCST. The patients were followed for two months. Post-operative pain was minimal in the treatment of GR in this case series. The aesthetic expectations of the patients were met with the applied technique. With this suture technique, it’s observed that the integrity of the papilla wasn’t impaired and no early complications were encountered during the feeding of the tissue. Within the results of this case series, it can be said that the tunnel operation applied with the DCST gives effective results in the treatment of GR.

Keywords

• Connective tissue graft
• gingival recession
• suture technique

References

1. 1. Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000 2015;68(1):333–68.
2. 2. Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol. 2015;86(2):8–51.
3. 3. Francetti L, Weinstein R, Taschieri S, Corbella S. Coronally Advanced Flap With or Without Subepithelial Connective Tissue Graft for the Treatment of Single Recession: 5-Year Outcomes from a Comparative Study. Int J Periodontics Restorative Dent. 2018;38(6):819–25.
4. 4. Xue F, Zhang R, Zhang Y, Liu J, Cai Y, Cao P, et al. Treatment of multiple gingival recessions with concentrated growth factor membrane and coronally advanced tunnel technique via digital measurements: A randomized controlled clinical trial. J Dent Sci. 2022;17(2):725.
5. 5. Rasperini G, Codari M, Limiroli E, Acunzo R, Tavelli L, Levickiene A. Graftless Tunnel Technique for the Treatment of Multiple Gingival Recessions in Sites with Thick or Thick Biotype: A Prospective Case Series. Int J Periodontics Restorative Dent. 2019 ;39(6):203–10.
6. 6. Elangovan S. Tunneling Technique in Conjunction With Autogenous Graft or Graft Substitutes Is a Predictable Surgical Approach to Achieve Root Coverage in Isolated or Multiple Gingival Recession Defects. J Evid Based Dent Pract. 2019;19(2):189–91.
7. 7. Santamaria MP, Neves FL da S, Silveira CA, Mathias IF, Fernandes-Dias SB, Jardini MAN, et al. Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions: a randomized clinical trial. J Clin Periodontol. 2017;44(5):540–7.
8. 8. Zuhr O, Rebele SF, Cheung SL, Hürzeler MB. Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery. Periodontol 2000. 2018;77(1):123–49.

9. 9. Yadav V, Singh N, Bhatia A, Kamra P, Yadav R. A Modified Suturing Protocol for Tripod Stabilization of Connective Tissue Graft and Coronal Advancement of Tunnel Flap for Treatment of Isolated Gingival Recession. Int J Periodontics Restorative Dent. 2022;42(1):9– 14.
10. 10. 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 ClinPeriodontol. 2011;38(7):661–6.
11. 11. Baker P. Gingival Recession - Causes and Management. Prim Dent J. 2020;8(4):40–7.
12. 12. Sullivan HC, Atkins JH. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics 1968;6(3):121–9.
13. 13. Miller PD. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985;5(2):8–13.
14. 14. Chapple ILC, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89:74–84.
15. 15. McLeod DE, Reyes E, Branch-Mays G. Treatment of multiple areas of gingival recession using a simple harvesting technique for autogenous connective tissue graft. J Periodontol. 2009;80(10):1680–7.
16. 16. 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(9):1075–90.