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

Abstract

Objective To evaluate the efficacy of the partial-thickness non-advanced tunnel technique (TUN) versus the coronally advanced flap (CAF), both combined with a connective tissue graft, in the treatment of multiple gingival recessions. Materials and methods Twenty-nine patients (83 teeth) affected by multiple gingival recessions were treated in two clinical centers with either the test (TUN) or the control (CAF) intervention combined with a connective tissue graft. Outcomes at 3 and 6 months after surgery included complete root coverage (CRC—primary outcome), mean root coverage (mRC), changes in recession depth (RD), probing pocket depth (PPD), and keratinized tissue height (KT). Root sensitivity and root coverage esthetic score (RES) were also evaluated at 6-month examination. Surgery duration, wound healing index (WHI), and patient-reported outcome measures (PROMs) were additionally considered. Results At 6 months, CRC was observed in 80.9% and 79.5% of the teeth treated with TUN and CAF, respectively (odds ratio = 1.2; p = 0.802). No differences between groups were also observed in terms of mRC (TUN = 94.0%; CAF = 91.1%), RD and PPD reductions, root sensitivity, RES, and WHI. KT increase was significantly higher in teeth treated with TUN (Difference in Means – MD = − 1.0 mm; p = 0.001). Surgery duration was shorter (MD = − 19.3 min; p = 0.001), and patients reported less intra-surgical pain (MD = − 16.4; p = 0.028) as well as postoperative morbidity in TUN compared with CAF. Conclusions Both surgical interventions showed a similar efficacy in terms of root coverage, albeit TUN was associated with a higher increase in KT and with a milder patient’s surgical experience. Clinical relevance Both techniques have shown similar efficacy for the coverage of exposed root surfaces, although clinicians may consider TUN as less invasive. Trial registration Clinicaltrials.gov (NCT05122468)

Mixed-Thickness Tunnel Access (MiTT) through a Linear Vertical Mucosal Incision for a Minimally Invasive Approach for Root Coverage Procedures in Anterior and Posterior Sites: Technical Description and Case Series with 1-Year Follow-Up

“…Similarly, contrasting the modified-CAF (MCAF), without vertical incisions [27], to coronally positioned TUN for the treatment of single or multiple Miller class I and II GR defects, both with SCTG [31][32][33], showed an efficient mean RC ranging from 80 to 98%, with no significant results between groups at 6 and 12 months. These findings agree with Toledano-Osorio et al [34], who reported no differences between techniques, and with González-Febles et al [35], who evaluated TUN versus CAF in combination with a CTG for the treatment of multiple GRs. These studies found that both groups had similar efficacy in terms of RC; however, TUN demonstrated a higher increase in keratinized tissue (KT), with a milder patient surgical experience.…”

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

“…Similarly, contrasting the modified-CAF (MCAF), without vertical incisions [23], to coronally positioned TUN for the treatment of single or multiple Miller class I and II GR defects, both with SCTG [27][28][29], efficient mean RC ranging from 80 to 98%, with no significant results between groups at 6 and 12 months. These findings agree with Toledano-Osorio et al [30], who reported no differences between techniques, and with González-Febles et al's conclusions [31], who evaluated TUN versus CAF in combination with a CTG for the treatment of multiple GRs; both groups had similar efficacy in terms of RC; however, TUN demonstrated a higher increase in keratinized tissue (KT), with a milder patient's surgical experience. On the other hand, another study showed that TUN resulted in thicker gingiva and better clinical outcomes compared to CAF regarding recession reduction and root coverage [32].…”

Acellular dermal matrix for the treatment of multiple gingival recession defects associated with carious and previously restored cervical lesions: A case report with 10 years of follow‐up

“…Several randomized clinical trials and meta-analyses have investigated and confirmed the high effectiveness of various treatment approaches using both tunneling and CAF for recession coverage. 15,[26][27][28][29] The authors do not exclude that other approaches, such as the modified CAF for multiple recessions, 30 in combination with connective tissue grafting or site-specific application of connective tissue graft, 31 could have equally accomplished satisfactory results. This case report of GRDs complicated by cervical lesions was ultimately treated with MCAT with ADM, and the favorable outcomes after therapy represented a proof of the effectiveness of this technique.…”