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Tunneled coronally advanced flap for the treatment of isolated gingival recessions with deficient papilla.

BACKGROUND AND AIM
The coronally advanced flap (CAF) and the tunnel technique (TUN) are the most performed surgical approaches for treating gingival recessions (GRs). Nonetheless, these two approaches have commonly been regarded as substitutes for one another, and clinicians are often faced with the choice of performing only one during root coverage procedures. The aim of the present article is to describe a surgical design in which the benefits of both the CAF and the TUN are combined for the treatment of isolated type 2 (RT2) GRs with deficient papilla.


MATERIALS AND METHODS
Ten patients with isolated RT2 GRs were treated using the tunneled coronally advanced flap (TCAF) + connective tissue graft (CTG) technique.


RESULTS
The healing was uneventful, and patients consistently reported minimal discomfort. After 6 months, the TCAF + CTG resulted in an average mean root coverage of 86.5%, with six sites showing complete root coverage (60%). The mean increases in keratinized tissue width and gingival thickness were 1.40 and 0.92 mm, respectively. All the treated GRs showed an increased soft tissue phenotype. No significant changes were observed for midfacial probing depth, while a mean midfacial clinical attachment level gain of 3.05 mm was obtained after 6 months. The professional esthetic evaluation, according to the root coverage esthetic score, was 7.90 ± 1.66.


CONCLUSIONS
The present article suggests that the TCAF + CTG is a suitable technique for treating isolated RT2 GRs. The newly introduced technique may have the potential to enhance flap blood supply and graft vascularization and improve clinical-, esthetic-, and patient-reported outcomes of RT2 GRs with deficient papilla. Future studies with larger sample sizes and comparative groups are needed to support these preliminary results.