Modified Tunnel Double Papilla Procedure for Root Coverage in the Anterior Mandible

Sebaoun, Alon; Nemcovsky, Carlos E.; Beitlitum, Ilan; Moses, Ofer

doi:10.11607/prd.3784

Cited by 7 publications

(7 citation statements)

References 15 publications

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“…This group includes all the treatment arms using a tunnel procedure (and its variants) and a connective tissue graft, with or without the additional use of adjuncts. In particular, 6 study arms were included in this category (Harris et al 2005; Nunez et al 2018; Sculean and Allen 2018; Sculean et al 2014; Sebaoun et al 2019; Thalmair et al 2016), with a total number of 105 patients and 171 defects.…”

Section: Resultsmentioning

confidence: 99%

Root Coverage Predictability in the Treatment of Gingival Recessions on Mandibular Anterior Teeth

Agusto

Salman

Parker

et al. 2021

JDR Clinical & Translational Research

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Introduction: Mandibular anterior teeth are most frequently affected by gingival recession. However, data regarding mucogingival treatment aimed at root coverage in this specific location are limited. Objective: The purpose of this study was to systematically review the scientific literature and to use the meta-analytic approach to address the following focused question: “What is the effectiveness of different surgical approaches on clinical and patient-related outcomes in the treatment of buccal gingival recessions on mandibular anterior teeth?” Methods: Studies were located by searching 3 electronic databases (Medline, Scopus, and Cochrane databases) and cross-referencing. Randomized and nonrandomized studies including at least 1 arm involving the use of pedicle flaps and/or free soft tissue grafts in the treatment of gingival recessions (recession type [RT] 1 and RT2) located on the buccal aspects of mandibular centrals, laterals and canines, were included in the analysis. Primary outcome was mean root coverage (mRC), expressed in percentage, based on a 3- to 12-mo follow-up observation. A Bayesian single-arm network meta-analysis was performed to identify a treatment hierarchy of the different surgical techniques. Results: Sixteen studies, with a total of 23 arms, were included in the quantitative analysis. The greatest mRC is associated with laterally positioned flap (LPF) + connective tissue graft (CTG) (91.2%) and tunnel (TUN) + CTG (89.4%), whereas LPF alone, coronally advanced flap (CAF) + CTG, and free gingival graft (FGG) showed lower mRC (79.1%, 78.9%, and 68.5% respectively). TUN + CTG provides significantly greater mRC compared to CAF+CTG. No difference among the procedures could be observed in terms of keratinized tissue width gain. Conclusions: Treatment hierarchy generated by an arm-based network meta-analysis model suggested that tunnel and laterally positioned flap, both in combination with connective tissue graft, may provide the greatest mean root coverage in the treatment of mandibular anterior recessions. Knowledge Transfer Statement: The results of the present systematic review can be used by clinicians when deciding which approach to adopt when treating buccal gingival recessions on mandibular anterior teeth. In particular, procedures based on a laterally positioned flap or a tunneling technique, both in combination with connective tissue graft, seem to be the most predictable therapeutic decision.

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Section: Resultsmentioning

confidence: 99%

Root Coverage Predictability in the Treatment of Gingival Recessions on Mandibular Anterior Teeth

Agusto

Salman

Parker

et al. 2021

JDR Clinical & Translational Research

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“…Several variations to this surgical approach were suggested later on: horizontal mattress sutures to mesially and distally anchor the CTG underneath the envelope [38], muco-periosteal-mucosal tunnel where a coronally positioned flap was anchored at the contact area with mattress sutures to cover the CTG [39] and the modified microsurgical tunnel technique [40]. It was suggested that in the case of post-orthodontic lower incisor recessions, the modified tunnel double papilla procedure should be used to obtain maximal root coverage [41].…”

Section: Discussionmentioning

confidence: 99%

Post-Orthodontic Lower Incisors Recessions: Combined Periodontic and Orthodontic Approach

Beitlitum

Barzilay

Rayyan

et al. 2020

IJERPH

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The bonded lingual retainer (BLR) is considered a favorable choice for retaining lower incisors’ alignment post-orthodontic treatment; however, it may cause some unwanted effects such as inadvertent tooth movement and torque changes. These often result in gingival recession (Miller class III-type) with exposure of the root surface, which compromises the esthetics and hinders the comfort of the patient. Fifteen post-orthodontic patients presenting Miller class III-type recessions with BLR were examined. Two protocols were used: the first included the removal of the BLR prior to surgery and the second included only a surgical approach. All patients underwent the same surgery of a modified tunnel double papilla procedure for root coverage. The gingival recession was measured using a dental probe before, and three to six months post-surgery. The average improvement in recession depth was significantly greater (p = 0.008) for the protocol that included removal of the BLR (4.0 ± 0.83 mm) with an improvement of 87.2% as compared to the second protocol that showed an improvement of 43.8% (1.88 ± 1.29 mm). Removing the BLR prior to surgery is beneficial for predictable root coverage in post-orthodontic Miller class III recessions.

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“…Although numerous surgical approaches for root coverage have been reported, the coronally advanced flap (CAF) together with connective tissue graft (CTG) is still considered the gold standard in Miller Class I or II buccal recessions in terms of clinical outcomes [ 17 , 18 , 19 ]. However, limited data is available regarding the Miller Class III recessions [ 20 ], particularly in orthodontic-associated GRs of the lower incisors.…”

Section: Introductionmentioning

confidence: 99%

Coronally Advanced Flap with Connective Tissue Graft for Treating Orthodontic-Associated Miller Class III Gingival Recession of the Lower Incisors: A One-Year Retrospective Study

Weinberg

Kolerman

Kats

et al. 2022

JCM

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(1) Background: To assess the clinical outcome of coronally advanced flap combined with connective tissue graft for the treatment of orthodontic-associated Miller Class III gingival recession of the lower incisors. (2) Methods: This study included 15 patients who had undergone orthodontic treatment prior to development of recession. Measurements of recession depth, recession width, probing depth, and width of keratinized tissue were performed clinically immediately before surgery and after one year. In addition, digital measurements of recession depth, recession width, and root coverage esthetic score were performed on intraoral photographs. (3) Results: Significant reduction was observed for probing depth, recession depth, and recession width at one year, with significant increase in width of keratinized tissue. Mean root coverage was 83 ± 24% for recession depth, while complete root coverage was achieved in 10 out of 21 recessions (48%). The average root coverage esthetic score at 12 months was 7.1 ± 2.6. An interaction was found between initial recession depth and mean root coverage. (4) Conclusions: Within the limitations of this study, our results confirm that combination of coronally advanced flap and connective tissue graft is effective in reducing post-orthodontic Miller Class III recessions of the mandibular incisors, even when the correction of the tooth malposition, is unattainable.

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Modified Tunnel Double Papilla Procedure for Root Coverage in the Anterior Mandible

Cited by 7 publications

References 15 publications

Root Coverage Predictability in the Treatment of Gingival Recessions on Mandibular Anterior Teeth

Root Coverage Predictability in the Treatment of Gingival Recessions on Mandibular Anterior Teeth

Post-Orthodontic Lower Incisors Recessions: Combined Periodontic and Orthodontic Approach

Coronally Advanced Flap with Connective Tissue Graft for Treating Orthodontic-Associated Miller Class III Gingival Recession of the Lower Incisors: A One-Year Retrospective Study

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