İzole Dişeti Çekilmesinin Yönetiminde Minimal İnvaziv Yaklaşım: 26 Ay Takipli Bir Vaka Raporu

Öz

Amaç: Bu vaka raporunun amacı dişeti çekilmesine bağlı gelişen kök yüzey açıklığının, minimal invaziv yaklaşımla bağ doku grefti kullanarak kapatılmasıdır. Olgu: Dişeti çekilmesi, dişeti marjininin apikal yönde yer değiştirmesiyle, kök yüzeyinin açığa çıkmasına neden olur. Bağ doku grefti kullanarak koronale ilerletilmiş flep tekniği dişeti çekilmesinin yönetiminde altın standarttır. Dişeti çekilmesi ve hassasiyet şikâyeti olan hastada 33 nolu diş bölgesinde cairo sınıflamasına göre RT1 çekilme, 3-4 mm keratinize dişeti miktarı ve kole bölgesinde yaklaşık 1mm derinliğinde aşınma tespit edildi. De-epitelize edilerek bağ dokusu elde edildi. Tünel tekniği ile alıcı alan hazırlanarak bağ doku yerleştirildi ve koronale çekilerek süture edildi. 13. günde süturlar alındı ve 1. ayda 33 nolu dişin kök yüzeyinin tamamen kapandığı gözlendi. 26. ayda dişeti çekilmesinin olmadığı gözlemlendi. Sonuç: RT1 dişeti çekilmesinin tedavisinde bağ dokusu grefti kullanılarak uygulanan tünel tekniği kök kapamada yüksek oranlarda başarı sağlayabilen bir tekniktir.

Anahtar Kelimeler

• Bağ doku grefti
• Kök kapama
• Minimal invaziv yaklaşım
• Tünel tekniği

MANAGEMENT OF ISOLATED GINGOVAL RECESSION USING A MINIMALLY INVASIVE TECHNIQUE: A 26-MONTH FOLLOW-UP CASE REPORT

Öz

This case report aims to describe the management of root surface exposure due to gingival recession using a connective tissue graft with a minimally invasive approach. Gingival recession, characterized by the apical displacement of the gingival margin and subsequent exposure of the root surface, remains a prevalent clinical condition in periodontology. The coronally advanced flap combined with a connective tissue graft continues to represent the gold standard for achieving predictable root coverage. This case report presents the management of an isolated RT1 gingival recession defect in the mandibular canine (tooth #33) associated with dentin hypersensitivity. The site exhibited 3–4 mm of keratinized tissue width and a shallow cervical abrasion of approximately 1 mm. A connective tissue graft was obtained through de-epithelialization of a free gingival graft and placed using a minimally invasive tunneling approach, followed by coronal advancement and tension-free suturing. Postoperative healing was uneventful, and complete root coverage was achieved within the first month. At the 26-month follow-up, the treated site demonstrated stable soft tissue integration without any recurrence of recession. Supporting the conclusion that the tunnel technique with connective tissue graft achieved successful root coverage in RT1 gingival recession.

Anahtar Kelimeler

• Connective tissue graf
• Minimally invasive approach
• Root coverage
• Tunnel technique

Kaynakça

1. Nair V, Sabarish R, Ravindran D, Sk B. A minimally invasive approach to managing isolated gingival recession. Cureus. 2023;15(4):e37195. doi:10.7759/cureus.37195.
2. Papapanou PN, Sanz M, Buduneli N, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89(Suppl 1):S173-S182. doi:10.1002/JPER.17-0721.
3. Cong Z, Liu Y, Zhao J. Treatment of multiple adjacent gingival recessions with an acellular dermal matrix or a connective tissue graft: A meta-analysis. Hua Xi Kou Qiang Yi Xue Za Zhi. 2022;40(6):690-697. doi:10.7518/hxkq.2022.06.010.
4. Molnár B, Aroca S, Dobos A, et al. Treatment of multiple adjacent RT1 gingival recessions with the modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: 9-year results of a split-mouth randomized clinical trial. Clin Oral Investig. 2022;26(12):7135-7142. doi:10.1007/s00784-022-04674-9.
5. Tejedo JR, Jara RA, Caceres LZ, et al. De-epithelialized free gingival graft versus subepithelial connective tissue graft in the treatment of gingival recession: A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2025:e690-e699. doi:10.4317/medoral.27184.
6. Bakhishov H, Isler SC, Bozyel B, Yıldırım B, Tekindal MA, Ozdemir B. De-epithelialized gingival graft versus subepithelial connective tissue graft in the treatment of multiple adjacent gingival recessions using the tunnel technique: 1-year results of a randomized clinical trial. J Clin Periodontol. 2021;48(7):970-983. doi:10.1111/jcpe.13452.
7. Yılmaz G, FÖKF. Dişeti estetiğinde kök kapama teknikleri. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2011;2(2):112-124.
8. Tavelli L, Ravidà A, Lin GH, Del Amo FSL, Tattan M, Wang HL. Comparison between subepithelial connective tissue graft and de-epithelialized gingival graft: A systematic review and meta-analysis. J Int Acad Periodontol. 2019;21(2):82-96.

9. Xue F, Zhang R, Cai Y, Zhang Y, Kang N, Luan Q. Three-dimensional quantitative measurement of buccal augmented tissue with modified coronally advanced tunnel technique and de-epithelialized gingival graft: A prospective case series. BMC Oral Health. 2021;21(1):157. doi:10.1186/s12903-021-01522-2.
10. Mashaly M, Ghallab NA, Elbattawy W, Elarab AE. Soft tissue augmentation using de-epithelialized free gingival graft compared to single-line incision subepithelial connective tissue graft in the management of Miller class I and II gingival recession. Contemp Clin Dent. 2022;13(3):227-235. doi:10.4103/ccd.ccd_763_20.
11. 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):1075-1090. doi:10.1002/JPER.18-0066.
12. Cairo F, Rotundo R, Miller PD, Pini Prato GP. Root Coverage Esthetic Score: A system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol. 2009;80(4):705-710. doi:10.1902/jop.2009.080565.
13. Salem S, Salhi L, Seidel L, Lecloux G, Rompen E, Lambert F. Tunnel/pouch versus coronally advanced flap combined with a connective tissue graft for the treatment of maxillary gingival recessions: Four-year follow-up of a randomized controlled trial. J Clin Med. 2020;9(8):2641. doi:10.3390/jcm9082641.
14. Khursheed DA, Zardawi FM. Minimally invasive intrasulcular tunneling technique for treatment of gingival recessions: A case series. Clin Case Rep. 2022;10(4):e5699. doi:10.1002/ccr3.5699.
15. Zucchelli G, Mele M, Stefanini M, et al. Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: A comparative randomized-controlled clinical trial. J Clin Periodontol. 2010;37(8):728-738. doi:10.1111/j.1600-051X.2010.01550.x.
16. Müller HP, Heinecke A, Schaller N, Eger T. Masticatory mucosa in subjects with different periodontal phenotypes. J Clin Periodontol. 2000;27(9):621-626. doi:10.1034/j.1600-051X.2000.027009621.x.
17. Harris RJ. Histologic evaluation of connective tissue grafts in humans. Int J Periodontics Restorative Dent. 2003;23(6):575-583.
18. Solderer A, Kaufmann M, Hofer D, Wiedemeier D, Attin T, Schmidlin PR. Efficacy of chlorhexidine rinses after periodontal or implant surgery: A systematic review. Clin Oral Investig. 2019;23(1):21-32. doi:10.1007/s00784-018-2761-y.
19. Gartenmann SJ, Dörig I, Sahrmann P, Held U, Walter C, Schmidlin PR. Influence of different post-interventional maintenance concepts on periodontal outcomes: An evaluation of three systematic reviews. BMC Oral Health. 2017;17(1):19. doi:10.1186/s12903-016-0244-6.
20. Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000. 2015;68(1):333-368. doi:10.1111/prd.12059.