Multiple gingival recessions treated using the tunnel technique with a collagen matrix

Lead:

Francesco Cirillo

Numerous techniques have been described for root coverage such as CAF (coronally advanced flap), pedunculated flaps, free gingival grafts and the tunnel technique, using either the simple flap or xenografts, allografts or autologous connective grafts, depending on the clinical case.

In this case a 39 year old female patient presented herself with a white cleft (traumatic fissure at the apex of the recession with loss of attachment) on tooth #22 FDI (#10 US). A modified tunnel technique was used with a double papilla technique de-epithelializing the margins of the white cleft so that the two flaps could be sutured together.

Evaluation & Diagnosis

Intraoral initial situation in the upper second quadrant

Intraoral initial situation (close-up)
Intraoral initial situation showing recessions on teeth 21, 22 & 23 FDI (9, 10 & 11 US)

The aim of the treatment is the complete coverage of the recessions in the aesthetic zone on # 21, 22 and 23 FDI (# 9, 10, 11 US) despite the slightly unfavorable prognostic factors such as the rotation of #22 & # 23 (#10&11) and a slight extrusion. The prognosis of tooth 22 should also be improved as it showed, additional to the cleft, a recession that had caused a considerable loss of attachment on the vestibular aspect, associated with a rotation of the tooth itself. Also the ability of using a collagen matrix instead of a autologous connective graft was assessed, in order to improve the patient's morbidity while ensuring an optimal result.

The teeth present an intrinsic dyschromia due to an antibiotic therapy at a young age. In agreement with the patient, it was decided to treat only the mucogingival defect due to dentinal sensitivity, especially at #23 and #22 FDI (#10 and #11 US).