A Case of Selecting the Tunnel Technique for Gingival Recession Considering the Interdental Papilla Dimension

Abstract

There are various methods of root coverage for gingival recession, and there are also various methods for recipient site formation in connective tissue graft (CTG), which is currently considered the gold standard for root coverage. Preoperative diagnosis is important to determine which technique to choose for the classification of gingival recession and to achieve a good prognosis. Herein, we report a 24-year-old female patient who visited our hospital because she was concerned about tooth loss following gingival recession of two mandibular central incisors. Both 31 and 41 were Maynard's classification Type 4, and the gingival recession was classified as Class III by Miller's classification and Recession Type (RT) 2 by Cairo's classification. Preoperative cone-beam computed tomography (CBCT) showed mild bone resorption on the labial side between 31 and 41, but no bone resorption on the lingual side. The distance between the roots near the alveolar crest was narrow between 41 and 42, and wide between 31 and 41, because of the centrifugal inclination of the 41 root. When performing CTG, there is no blood supply on the exposed root surface, so that it is important to ensure blood supply from the surrounding tissues. The interdental papilla plays an important role in this blood supply. In this case, for gingival recession of two mandibular central incisors according to Miller's classification Class III and Cairo's classification RT2, we used CBCT to determine the alveolar bone condition and measure the distance between the roots. Furthermore, considering the dimension of the interdental papilla, we selected the tunnel technique without incision into the interdental papilla for CTG, with good results. The results of this case are reported here.