Modified Tunnel Technique Combined with Enamel Matrix Derivative: A Minimally Invasive Treatment for Single or Multiple Class I Recession Defects

Abstract

This modified tunnel technique using enamel matrix derivative potentially represents a clinically and esthetically satisfactory treatment of Miller Class I recession defects.

Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta‐analysis

“…Search results based on the PRISMA guidelines are depicted in Figure . Twenty articles reporting on 1181 recessions treated with TUN, with a mean follow‐up of 11 months, were included in the present systematic review (Tables and ) . Among these, six RCTs comparing CAF to TUN were considered for the meta‐analysis.…”

“…Five articles focused on localized GR defects, three treated both single and multiple GR defects, and the remaining studies included only multiple GR defects . One article treated only Miller Class III GRs; three studies, Miller Class I, II, and III GR defects; and the remaining articles focused only on Miller Classes I and II GR defects . The general characteristics of the included studies are outlined in Table .…”

“…Two RCTs compared TUN + CTG to CAF + CTG, two RCTs compared TUN + acellular dermal matrix (ADM) to CAF + ADM, one RCT compared TUN + CTG to CAF + EMD, two RCTs compared TUN + CTG to TUN + xenogeneic collagen matrix (XCM), one RCT compared TUN + CTG to TUN + fascia lata (FL), one RCT compared TUN + CTG to TUN + CTG + EMD, one RCT compared TUN + ADM to TUN + ADM + platelet rich plasma (PRP), and one RCT compared TUN + CTG to CAF . Five case series investigated the outcomes of TUN + CTG, three compared TUN combined with a CTG substitute, and one compared TUN + EMD …”

Root Coverage Procedures for Multiple Recession Defects

“…Combination of CPF and EMD provided a comparable percent root coverage to that of CPF alone (75% for EMD and 71% for CPF alone) [39], and CPF + SCTG (89% for EMD and 93% for SCTG) [25], but a less promising outcome than tunnel technique with SCTG (72% for EMD and 98% for SCTG) [28], as discussed in previous paragraphs. In their case series report, Vincent-Bugnas et al evaluated the clinical results of the combination of tunnel technique and EMD in single and multiple gingival recession defects [50]. The results calculated from patients with multiple defects indicated that this procedure yielded mean root coverage of 92% at 24 months.…”

“…A total of four studies reported the clinical effectiveness of enamel matrix derivative (EMD) on multiple gingival recession defects, with mean percent root coverage ranging from 72 to 92% [25,28,39,50]. Comparison of EMD to another treatment procedure was made in three out of four studies.…”