Mixed-Thickness Tunnel access (MiTT) through a linear vertical mucosal incision for a minimally invasive approach in root coverage procedure in anterior and posterior sites: technical description and case series with 1-year follow-up

Abstract

Purpose: The goal of this article was to introduce a new technique for root coverage (RC), the Mixed-Thickness Tunnel access (MiTT), approaching a full-split design, showing the results obtained in a case series and demonstrating it step-by-step. Methods: Healthy individuals, non-smokers, and non-diabetics, who were diagnosed with gingival recession (GR) type 1 or 2 (RT1 or RT2). After all necessary evaluations, prophylaxis was performed 14 days before the surgical procedure. Then, after the basics clinical conduct and anesthesia, one or two vertical incision(s) on the mucosa (around 1-2 mm apical to the MGJ), lateral to the papilla base, were done. Initial detachment of the mucosa from the muscles (split design); it was permitted (but not mandatory) to do intrasulcular incisions; from the MGJ to coronal, subperiosteal access was done to raise the full-thickness tunnel. It must communicate up to the gingival sulcus area and the papilla’s base, keeping the papilla’s tip intact. A connective tissue graft was harvested, which was inserted through the linear incision or intrasulcularly. Interrupted sutures were done and may be used as adjunctive material. Results: Nine healthy individuals (7 females and 2 males) aged 19 and 43 years were enrolled. They were treated following the MiTT steps. There were four cases with a single GR, 2 patients with 2 teeth involved, and three with 3 or 4 GR. Seven cases were RT1 and two RT2. All RT1 cases achieved 100% RC, while the mean RC obtained for RT2 was around 80%. Conclusion: MiTT can be considered a more straightforward approach for minimally invasive surgical technique, which is a feasible option to treat RC with a high success rate, predictability, and esthetic preservation. There is a technical sensitivity to performing the full-split design procedure.