Tunnel vs coronally advanced flap with connective tissue graft for maxillary anterior gingival recessions. Esthetic outcomes of a 2- to 14-year patient-centered cross-sectional study.

Abstract

Objective: Maxillary anterior gingival recessions (GRs) are esthetically demanding. The aim of this study was to evaluate clinical and esthetic outcomes and tissue stability of mucogingival procedures performed by means of a coronally advanced flap (CAF) or tunnel (TUN) technique in combination with a subepithelial connective tissue graft (SCTG) at 2 to 14 years follow-up and to identify patients' esthetic perception.

Materials and methods: Individuals presenting with RT1 or RT2 GRs in the maxillary anterior sextant were recalled to evaluate clinical outcomes and patient satisfaction 2 to 14 years postoperatively. Visual analog scale (VAS) and recession esthetic score (RES) assessment was used for evaluation.

Results: Thirty-four consecutive individuals, 20 CAF and 14 TUN, participated in this study. Complete root coverage (CRC) was 90% and 92.8% for CAF (18/20) and TUN (13/14) individuals, respectively (P > 0.05). Mean root coverage was 98.5% ± 3.5 and 99.2% ± 2.7 for the CAF/TUN groups, respectively (P > 0.05). Mean recession depth (RD) at baseline was 4.9 ± 1.1 (range: 4 to 9 mm) and 4.4 ± 0.6 (range: 4 to 6 mm) for the CAF and TUN groups, respectively, and 0.05 ± 0.15 and 0.03 ± 0.13, respectively, at follow-up. Mean baseline RD difference (0.5 ± 0.3 mm) was not statistically significant (P > 0.05; confidence interval [CI]: 0.17 to 1.21). Keratinized tissue width (KTW) was significantly greater (0.7 ± 0.2) in TUN individuals at follow-up (4.9 ± 0.8 vs 4.2 ± 0.5; P = 0.007; CI: 0.22 to 1.21). Mean follow-up was 42.0 ± 32.9 and 44.2 ± 25.6 months (range: 24 to 168 months) for CAF/TUN groups, respectively. Patients' perception (VAS) of satisfactory esthetics was high for both CAF and TUN, but not statistically significantly higher than the professional RES assessment (P > 0.05). Mean VAS scores of CAF vs TUN were not statistically significant (P > 0.05). The lowest RES score attained was for RT2 defects, with a mean 9.5 points for both CAF and TUN, and was not statistically significantly different from the VAS score (P > 0.05).

Conclusions: Both CAF and TUN provided satisfactory long-term esthetics and tissue stability. Patients' esthetic perception of CAF and TUN was equally high and similar to the professional RES evaluation.

Clinical relevance: Greater keratinized tissue can be achieved with the TUN approach. Residual recessions of ≤ 0.5 mm after 2 years were absent for RT1 and unlikely for RT2 defects and did not significantly influence the overall VAS or RES esthetic scores.