Treatment of multiple gingival recessions with two different approaches

The objective of this controlled study was to evaluate the clinical effectiveness of tunnel technique (TUN) in combination with acellular dermal matrix graft (ADM) on defect coverage, aesthetics and patient satisfaction compared to coronally positioned flap (CAF) plus ADM for the treatment of Miller Class I multiple gingival recessions. A total of 20 patients (13 females and 7 males) with 58 Miller Class I multiple recessions ≥3 mm were included and divided into TUN+ADM and CAF+ADM groups. At baseline and 12 months after the surgery, plaque index, gingival index, bleeding on probing, probing depth (PD), clinical attachment level, recession height (RH), keratinized tissue height (KT), gingival thickness (GT), and mean and complete defect coverage were evaluated. Patient satisfaction and root coverage aesthetic scores (RES) were also assessed. Baseline RH in TUN+ADM and CAF+ADM groups was 3.23 ± 0.28 mm and 3.30 ± 0.35 mm, respectively. Intragroup comparisons revealed statistically significant differences at 12 months for all parameters, except PD (p<0.05). Gingival thickness increased from 0.82 ± 0.06 mm to 1.40 ± 0.07 mm in TUN+ADM group, and from 0.76 ± 0.06 mm to 1.38 ± 0.09 mm in CAF+ADM group. Mean defect coverage was 75.72% (RH reduction: 2.45 ± 0.20 mm) in TUN + ADM group, and 93.81% (RH reduction: 3.10 ± 0.57 mm) in CAF + ADM group. Complete defect coverage was achieved 37.36% of the teeth (12 out of 31 sites) for the TUN+ADM group, while it occurred 85% of the teeth (23 out of 27 sites) for the CAF+ADM group. Intergroup differences were found to be significant for RH reduction, KT increase, MRC, CRC, and RES (p<0.05). Both techniques were effective in root coverage of multiple recession defects, however better aesthetic results and clinical improvements were achieved with CAF and ADM combination.