Two‐ to six‐year outcomes of tunnel technique with connective tissue graft in multiple mandibular anterior recessions

Abstract

Abstract Background The purpose of this study is to report the 2–6 year outcomes of the tunnel technique with a connective tissue graft (TUN+CTG) in treating multiple Cairo recession type 1 and 2 recessions over a 2–6 year follow‐up, and the influence of CTG exposure on treatment effects. Methods Seventeen patients with 73 multiple recession sites were treated with TUN+CTG (27 of RT1 vs. 46 of RT2). A total of 32 sites exhibited CTG exposure. The average extent of exposure was 2.21 ± 0.95 mm. The recession depth (RD), keratinized gingival width (KGW), percentage of root coverage (RC), percentage of complete root coverage (CRC), root exposure score (RES), and mucosal scarring index (MSI) were assessed at 6 months and 2–6 year follow‐up. Results At 6 months, the mean RC was 86.92% and the CRC was 69.86%; After 2–6 years, the mean RC was 84.49% and the CRC was 63.01%. The KGW increased significantly (1.82 mm). There was a considerable difference of CRC at 2–6 years between RT1 and RT2 defects (74.07% vs. 56.52%), which did not reach statistical significance. There was a statistically significant reduction of CRC in RT2 defects from 6 months to 2–6 year follow‐up (from 67.39%–56.52%). Both the RES and the MSI score reached a high esthetic value in all sites. No statistical difference was observed in terms of RC, CRC, and KGW gain between the CTG partial‐exposed sites and full‐covered sites, except for the RES and the MSI score. Conclusions In the mandibular anterior region, multiple RT1 and 2 gingival recessions could be treated successfully by the TUN+CTG procedure with relative long‐term stable clinical and esthetic effects. A partially exposed CTG does not appear to compromise the treatment outcomes. Plain language summary Gum recession is a highly prevalent dental problem, most frequently affecting the lower front teeth. The tunnel technique is a modern surgical approach that treats gum recession. It preserves the blood supply to the gums by carefully lifting them without cutting the small triangles of gum tissue between the teeth. Underneath the lifted gum tissue, a gum graft that is usually taken from the roof of the mouth is placed. There is limited evidence about the long‐term effects of the above techniques in treating multiple recessions on the lower front teeth. Additionally, in some cases, a small portion of the gum graft may remain exposed after surgery. Whether this exposure affects the treatment result was controversial. In this study, 17 patients with 73 recession sites were treated and followed for 2 to 6 years. We found that 84.5% of the exposed tooth roots were covered by gum tissue. In some cases, a small part of the graft was intentionally left visible to help create a more natural‐looking gum line. It did not harm the treatment outcome. This study provided practical, evidence‐based guidance for optimizing both functional and esthetic outcomes in periodontal plastic surgery of the lower front dentition.