Modified tunneling technique for root coverage of anterior mandible using minimal soft tissue harvesting and volume-stable collagen matrix: a retrospective study

다국어 초록 (Multilingual Abstract)

Purpose: In this study, we aimed to evaluate the clinical validity of the modified tunneling technique using minimal soft tissue harvesting and volume-stable collagen matrix in the anterior mandible.
Methods: In total, 27 anterior mandibular teeth and palatal donor sites in 17 patients with ≥1 mm of gingival recession (GR) were analyzed before and after root coverage. For the recipient sites, vertical vestibular incisions were made in the interdental area and a subperiosteal tunnel was created with an elevator. After both sides of the marginal gingiva were tied to one another, a prepared connective tissue graft and volume-stable collagen matrix were inserted through the vestibular vertical incision and were fixed with resorbable suture material. The root coverage results of the recipient site were measured at baseline (T0), 3 weeks (T3), 12 weeks (T12), and the latest visit (Tl). For palatal donor sites, a free gingival graft from a pre-decided area avoiding the main trunk of the greater palatine artery was harvested using a prefabricated surgical template at a depth of 2 mm after de-epithelization using a rotating bur. In each patient, the clinical and volumetric changes at the donor sites between T0 and T3 were measured.
Results: During an average follow-up of 14.5 months, teeth with denuded root lengths of 1–3 mm (n=12), 3–6 mm (n=11), and >6 mm (n=2) achieved root coverage of 97.01%±7.65%, 86.70%±5.66%, and 82.53%±1.39%, respectively. Miller classification I (n=12), II (n=10), and III (n=3) teeth showed mean coverage rates of 97.01%±7.65%, 86.91%±5.90%, and 83.19%±1.62%, respectively. At the donor sites, an average defect depth of 1.41 mm (70.5%) recovered in 3 weeks, and the wounds were epithelized completely in all cases.
Conclusions: The modified tunneling technique in this study is a promising treatment modality for overcoming GR in the anterior mandible.

참고문헌 (Reference)

1 Tonetti MS, "Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession : Randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life" 45 : 78-88, 2018

2 Allen AL, "Use of the supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique" 14 : 216-227, 1994

3 Eger T, "Ultrasonic determination of gingival thickness. Subject variation and influence of tooth type and clinical features" 23 : 839-845, 1996

4 Rebele SF, "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 II. Volumetric studies on healing dynamics and gingival dimensions" 41 : 593-603, 2014

5 Zuhr O, "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" 41 : 582-592, 2014

6 Stimmelmayr M, "Treatment of gingival recession in the anterior mandible using the tunnel technique and a combination epithelialized-subepithelial connective tissue graft-a case series" 31 : 165-173, 2011

7 Goaslind GD, "Thickness of facial gingiva" 48 : 768-771, 1977

8 Lorenzana ER, "The single-incision palatal harvest technique : a strategy for esthetics and patient comfort" 20 : 297-305, 2000

9 Cohen DW, "The double papillae repositioned flap in periodontal therapy" 39 : 65-70, 1968

10 Del Pizzo M, "The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site. A preliminary study" 29 : 848-854, 2002

11 Woodyard JG, "The clinical effect of acellular dermal matrix on gingival thickness and root coverage compared to coronally positioned flap alone" 75 : 44-56, 2004

12 Blanes RJ, "The bilateral pedicle flap-tunnel technique : a new approach to cover connective tissue grafts" 19 : 471-479, 1999

13 Farnoush A, "Techniques for the protection and coverage of the donor sites in free soft tissue grafts" 49 : 403-405, 1978

14 Paolantonio M, "Subpedicle acellular dermal matrix graft and autogenous connective tissue graft in the treatment of gingival recessions : a comparative 1-year clinical study" 73 : 1299-1307, 2002

15 Schmitt CM, "Soft tissue volume alterations after connective tissue grafting at teeth : the subepithelial autologous connective tissue graft versus a porcine collagen matrix-a pre-clinical volumetric analysis" 43 : 609-617, 2016

16 Song YW, "Soft tissue substitutes to increase gingival thickness : histologic and volumetric analyses in dogs" 46 : 96-104, 2019

17 da Silva RC, "Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft" 75 : 413-419, 2004

18 Grupe HE, "Repair of gingival defects by a sliding flap operation" 27 : 92-95, 1956

19 Yotnuengnit P, "Relative connective tissue graft size affects root coverage treatment outcome in the envelope procedure" 75 : 886-892, 2004

20 Zeltner M, "Randomized controlled clinical study comparing a volume-stable collagen matrix to autogenous connective tissue grafts for soft tissue augmentation at implant sites : linear volumetric soft tissue changes up to 3 months" 44 : 446-453, 2017

21 Zuhr O, "Plastic-esthetic periodontal and implant surgery: a microsurgical approach" Quintessence 2012

22 Zadeh HH, "Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet-derived growth factor BB" 31 : 653-660, 2011

23 Wennström JL, "Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study" 23 : 770-777, 1996

24 Moisa DH, "Impact of connective tissue graft thickness on surgical outcomes : a pilot randomized clinical trial" 90 : 966-972, 2019

25 McGuire MK, "Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 1: comparison of clinical parameters" 74 : 1110-1125, 2003

26 Raetzke PB, "Covering localized areas of root exposure employing the"envelope"technique" 56 : 397-402, 1985

27 Zucchelli G, "Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions : a comparative controlled randomized clinical trial" 80 : 1083-1094, 2009

28 Pini Prato G, "Coronally advanced flap procedure for root coverage. Flap with tension versus flap without tension: a randomized controlled clinical study" 71 : 188-201, 2000

29 Cordioli G, "Comparison of 2 techniques of subepithelial connective tissue graft in the treatment of gingival recessions" 72 : 1470-1476, 2001

30 Wang HL, "Comparison of 2 clinical techniques for treatment of gingival recession" 72 : 1301-1311, 2001

31 Borghetti A, "Comparative clinical study of a bioabsorbable membrane and subepithelial connective tissue graft in the treatment of human gingival recession" 70 : 123-130, 1999

32 Edel A, "Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva" 1 : 185-196, 1974

33 Chambrone L, "Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller Class I and II recessiontype defects?" 36 : 659-671, 2008

34 Zucchelli G, "Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study" 30 : 862-870, 2003

35 Hürzeler MB, "A single-incision technique to harvest subepithelial connective tissue grafts from the palate" 19 : 279-287, 1999

36 Harris RJ, "A short-term and long-term comparison of root coverage with an acellular dermal matrix and a subepithelial graft" 75 : 734-743, 2004

37 Harris RJ, "A comparison of three techniques to obtain root coverage on mandibular incisors" 76 : 1758-1767, 2005

38 Cheung WS, "A comparative study of root coverage with connective tissue and platelet concentrate grafts : 8-month results" 75 : 1678-1687, 2004