MODIFIED CORONALLY ADVANCED TUNNEL TECHNIQUE (MCAT) FOR THE TREATMENT OF MULTIPLE ADJACENT GINGIVAL RECESSION (MAGR) USING SITE SPECIFIC DE-EPITHELIALIZED FREE GINGIVAL GRAFT (DGG): A CASE REPORT

N. Devkar¹, S. Pudke¹, D. Happy¹, A. Dhamapurkar², M. Deshpande² and A. Leggeri^3*

¹Department of Periodontology, Sinhgad Dental College and Hospital, Pune, India;
²Private Practitioner, Pune, Maharashtra, India;
³Department of Chemical Sciences and Technology, University of Rome Tor Vergata, Rome, Italy

*Correspondence to:
Andrea Leggeri, MD
Department of Chemical Sciences and Technology,
University of Rome Tor Vergata,
00133 Rome, Italy
e-mail: dr.andrealeggeri@gmail.com

Received: 26 October 2023 Accepted: 17 December 2023

ISSN 2975-044X (online) ISSN 2038-4106 (print) Copyright © by BIOLIFE 2024 This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article.

ABSTRACT

To evaluate the clinical outcomes of Multiple Adjacent Gingival Recession (MAGR) using Modified Coronally Advanced Tunnel (MCAT) technique in conjunction with site specific De-epithelized Gingival Graft (DGG). Root coverage of MAGR in Recession Type 2 (RT2) cases presents a treatment challenge due to papilla loss. There is a demand for interdisciplinary approach including surgical and restorative approach in RT2 cases especially when non carious cervical lesion (NCCL) is involved. Various surgical techniques have been described in the literature to treat MAGR. Coronally advanced flap with sub-epithelial connective tissue graft although efficacious, has its limitations. Tunneling techniques like MCAT are used due to their advantages like reduced morbidity and maintaining papillary blood supply. This case report aims to evaluate the clinical results in a patient with multiple adjacent RT2 gingival recession and NCCL using MCAT along with site specific DGG and restorative treatment. A 68-year-old male was referred for the treatment of MAGR on the buccal surfaces of teeth #21–25, with a diagnosis of RT2. MCAT surgery included the preparation of the recipient site with a tunnelling protocol, keeping the interdental papillae intact. A free gingival graft was harvested, de-epithelialized extra-orally, and the resulting connective tissue graft was sutured. Partial root coverage around 80% was achieved at 6 months, consistent with the initial diagnosis of RT2. There was also an appreciable increase in gingival thickness, gain in keratinized tissue as well as improved final aesthetic outcome. The results indicate that the use of MCAT may represent an alternative to conventional CAF by reducing surgical time and patient morbidity and yields root coverage in the treatment of MAGR defects (RT2) when used in conjunction with DGG.

KEYWORDS: connective tissue graft, gingival recessions, tunnel technique, de-epithelized gingival graft, coronally advanced flap