Efficacy of modified coronally advanced tunnel technique combined with resin restoration for the treatment of multiple gingival recession with non-carious cervical lesions

doi:10.3969/j.issn.1674-8115.2022.11.018

Abstract

Abstract:

Objective ·To observe the clinical efficacy of modified coronally advanced tunnel technique (MCAT) combined with resin restoration in treating multiple gingival recession with non-carious cervical lesion (NCCL). Methods ·Subjects with multiple gingival recession and NCCL were enrolled in the trial. All the patients were treated with MCAT with subepithelial connective tissue graft (sCTG) and resin restoration to repair the soft and hard tissue defect. Probing depth (PD), bleeding index (BI), plaque index, (PLI), recession height (RH), keratinized tissue width (KTW), gingival thickness (GT), and interdental papilla height were measured at baseline and 6-month follow-up. Root coverage esthetic score (RES) was also evaluated 6 months postoperatively. Results ·Three patients were treated in this study, including 9 sites. The mean BI, PLI and RH were significantly decreased at 6 months after treatment compared with the baseline. The augment of KTW, GT and interdental papilla height was achieved at follow-up, and interdental papilla height increased by (0.67±0.75) mm compared with the baseline. The mean RES was 8.56±1.33, postoperatively. Conclusion ·The MCAT combined with resin restoration could be a promising treatment for multiple gingival recession, resulting in ideal esthetic effect by the augment of buccal and interdental soft tissue.

Key words: modified coronally advanced tunnel technique, non-carious cervical lesion, gingival recession, resin restoration

CLC Number:

R781.4

LIAO Yue, DONG Jiachen, SONG Zhongchen. Efficacy of modified coronally advanced tunnel technique combined with resin restoration for the treatment of multiple gingival recession with non-carious cervical lesions[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(11): 1638-1643.

Figures/Tables 4

Tab 1 General information of patients with multiple gingival recession associated with NCCL

No.	Gender	Age	Tooth position	Classification of gingival recession	Gingival biotype
1	Female	33	23，24	Miller Ⅱ	Thin
2	Male	30	12，11，21	Miller Ⅲ	Thin
2	Male	30	22	Miller Ⅲ	Thick
3	Male	31	22，23，24	Miller Ⅲ	Thin

Fig 1 Surgical procedure and follow-up of case 1

Fig 2 Surgical procedure and follow-up of case 2

Fig 3 Surgical procedure and follow-up of case 3

TrendMD

References 19

1	CORTELLINI P, BISSADA N F. Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations[J]. J Periodontol, 2018, 89 :S204-S213.
2	TEIXEIRA D N R, THOMAS R Z, SOARES P V, et al. Prevalence of noncarious cervical lesions among adults: asystematic review[J]. J Dent, 2020, 95:103285.
3	JEPSEN S, CATON J G, ALBANDAR J M, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions[J]. J Periodontol, 2018, 89 : S237-S248.
4	ZUCCHELLI G, GORI G, MELE M, et al. Non-carious cervical lesions associated with gingival recessions: a decision-making process[J]. J Periodontol, 2011, 82(12): 1713-1724.
5	ZUCCHELLI G, TESTORI T, DE SANCTIS M. Clinical and anatomical factors limiting treatment outcomes of gingival recession: a new method to predetermine the line of root coverage[J]. J Periodontol, 2006, 77(4): 714-721.
6	AROCA S, KEGLEVICH T, NIKOLIDAKIS D, et al. Treatment of class III multiple gingival recessions: a randomized-clinical trial[J]. J Clin Periodontol, 2010, 37(1): 88-97.
7	MILLER P D J. A classification of marginal tissue recession[J]. Int J Periodontics Restorative Dent, 1985, 5(2): 8-13.
8	GONÇALVES D F M, SHINOHARA M S, CARVALHO P R M A, et al. Three-year evaluation of different adhesion strategies in non-carious cervical lesion restorations: a randomized clinical trial[J]. J Appl Oral Sci, 2021, 29: e20210192.
9	FERNÁNDEZ-JIMÉNEZ A, GARCÍA-DE-LA-FUENTE A M, ESTEFANÍA-FRESCO R, et al. Complete root coverage in the treatment of Miller class Ⅲ or RT2 gingival recessions: a systematic review and meta-analysis[J]. BMC Oral Health, 2021, 21(1): 145.
10	OLIVEIRA L M L, SOUZA C A, CUNHA S, et al. Treatment efficacy of gingival recession defects associated with non-carious cervical lesions: a systematic review[J]. J Periodontal Implant Sci, 2022, 52(2): 91-115.
11	SILVEIRA C A, MATHIAS I F, DA SILVA NEVES F L, et al. Connective tissue graft and crown-resin composite restoration for the treatment of gingival recession associated with noncarious cervical lesions: case series. Int J Periodontics Restorative Dent[J]. 2017, 37(4):601-607.
12	CAIRO F, CORTELLINI P, NIERI M, et al. Coronally advanced flap and composite restoration of the enamel with or without connective tissue graft for the treatment of single maxillary gingival recession with non-carious cervical lesion. A randomized controlled clinical trial[J]. J Clin Periodontol, 2020, 47(3): 362-371.
13	范雅丹, 董家辰. 树脂充填结合多牙位冠向复位瓣技术治疗非龋性牙颈部病变合并牙龈退缩的临床疗效[J]. 口腔医学, 2021, 41(10): 893-899.
	FAN Y D, DONG J C. Long-term clinical outcome of the resin restoration plus multiple coronally advanced flap technique for the treatment of gingival recession associated with non-carious cervical lesion[J]. Stomatology, 2021, 41(10): 893-899.
14	STEFANINI M, MARZADORI M, AROCA S, et al. Decision making in root-coverage procedures for the esthetic outcome[J]. Periodontol 2000, 2018, 77(1): 54-64.
15	GÓRSKI B, SZERSZEŃ M. Effect of root surface biomodification on multiple recession coverage with modified coronally advanced tunnel technique and subepithelial connective tissue graft: a retrospective analysis[J]. Gels, 2022, 8(1): 31.
16	SCULEAN A, COSGAREA R, STÄHLI A, et al. Treatment of multiple adjacent maxillary Miller Class Ⅰ, Ⅱ, and Ⅲ gingival recessions with the modified coronally advanced tunnel, enamel matrix derivative, and subepithelial connective tissue graft: a report of 12 cases[J]. Quintessence Int, 2016, 47(8): 653-659.
17	SCULEAN A, COSGAREA R, KATSAROS C, et al. Treatment of single and multiple Miller Class Ⅰ and Ⅲ gingival recessions at crown-restored teeth in maxillary esthetic areas[J]. Quintessence Int, 2017, 48(10): 777-782.
18	KAHN S, ALMEIDA R A, DIAS A T, et al. Clinical considerations on the root coverage of gingival recessions in thin or thick biotype[J]. Int J Periodontics Restorative Dent, 2016, 36(3): 409-415.
19	HWANG D, WANG H L. Flap thickness as a predictor of root coverage: a systematic review[J]. J Periodontol, 2006, 77(10): 1625-1634.

[1]	SUN Wentao, SUN Mengjun, XIE Yufeng, SHU Rong. Comparison of the root coverage and esthetic outcomes of 3 different techniques for gingival recession [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(11): 1550-1556.
[2]	FAN Yan-dan, GONG Yin, DONG Jia-chen, SHU Rong. Clinical outcomes of modified lateral advanced flap combined with tunnel technique for the treatment of maxillary isolated soft tissue defect [J]. , 2020, 40(1): 139-.
[3]	LIN Zhi-kai, SHU Rong, QIAN Jie-lei, XIE Yu-feng . Clinical outcomes of a modified laterally moved and coronally advanced flap combined with a connective tissue graft for the treatment of severe recession defects [J]. , 2017, 37(5): 656-.
[4]	NI Jing, SHU Rong. Treatment of multiple gingival recession with coronally advanced modified tunnel technique combined with connective tissue graft [J]. , 2015, 35(12): 1937-.