MULTIPLE RECESSION TREATMENT USING THE MODIFIED TUNNELLING TECHNIQUE

(Clinical case by courtesy of Dr Aymeric Courval, France)

Following the first round of mechanical cleaning a slight gingival recession was visible on teeth 21 and 23, which was more pronounced on tooth 23. Tooth 21, 22 and 23 carried a tooth borne prosthesis.

A 1mm recession was apparent on teeth 21 and 23. The largest recession was observed on tooth 22 with a sulcus depth of 3 mm.

The tunnel was prepared by subgingival detachment of the periodontal ligaments from the tooth using a microblade. The distal tunnel was prepared as shown.

The soft tissue was completely released, and the gingiva could be moved freely without tension.

Hyaluronic acid (HYADENT BG) was applied into the tunnel and on to the exposed tooth root.

A soft tissue graft, taken from the patients’ palate, was placed into the tunnel and fixed. Additional hyaluronic acid (HYADENT BG) was applied into the tunnel to cover the soft tissue graft.

The gingiva was coronally advanced and kept in place with sutures. The soft tissue was free of tension.

Good wound healing and no swelling of the tissue seven days after the procedure.

The sutures were removed 14 days after the surgical intervention. Very good healing of the tissue was achieved. The patient did not have any pain.

9 months after the surgical treatment: A healthy and thick gingiva was visible and the recessions were successfully treated.

Surgical treatment of multiple gingival recessions in the esthetic zone with CTG and hyaDENT using the tunnel technique.

(Case by PD Dr Stefan Fickl, Germany)

PRE-OPERATIVE

Patient presented with two severe gingival recessions Miller class II in the esthetic zone (regio 1-2 and 1-3).

SURGERY

Incision-free mobilization of the gingiva in the recipient site (left). CTG was harvested in the appropriate size and the graft surface was conditioned with HYADENT.

Submucoseous positioning of the CTG using the tunnel technique. Graft stabilization with sutures. HYADENT was applied underneath the flap before suturing to achieve accelerated post-operative wound healing.

7 DAYS POST-OPERATIVE

Situation before removal of sutures: accelerated wound healing without signs of infections or irritations.

3 MONTHS POST-OPERATIVE

Excellent reconsolidation of the soft tissue indicated by complete recession coverage and sufficient presence of keratinized gingiva, both in height and in width, thus providing an esthetically highly pleasing result for the patient.

PATIENT WITH A DEEP MILLER CLASS II RECESSION

(Clinical case by courtesy of Prof Anton Sculean)

Baseline

Tunnel

Mobilized Tunnel

Connective tissue graft (CTG)

Application of HYADENT

Applied Hyadent in the tunnel

Connective tissue graft fixed in the tunnel

Application of Hyadent on the connective tissue graft

Laterally closed tunnel

Outcome