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.

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.