Causes for gingival recessions include primary morphogenetic aspects and secondary influences involving incorrect tooth brushing, parafunctional habits such as grinding or clenching teeth, inflammatory periodontal diseases or orthodontic treatment.
In this case, multiple recessions in the upper jaw reaching from one premolar region to the other need to be treated. First existing tooth neck fillings are recontoured and root surfaces are cleaned. To begin with, an intrasulcular incision is made along the facial side of the teeth to be treated and the marginal gingiva is detached. The tunneling technique involves the careful undermining and elevating of the papillae with full mobilization of their basis, while not damaging the tip and maintaining an intact blood supply in the latter area.
The vestibular tissue is detached and mobilized beyond the mucogingival junction. Following the tunneling and gingival mobilization, the interproximal tooth contacts are splinted with a light curing flowable material which is needed for the suturing process later on. After an EDTA gel is applied onto the exposed root surfaces and carefully rinsed off an enamel matrix protein gel is inserted in order to support and stimulate the regeneration of periodontal structures.
Finally the tunneled flap is repositioned coronally aiming to reach the cementoenamel junction. Modified suspension sutures and auxiliary sutures are applied going around the interproximal splint – a technique that facilitates the fixation and stabilization of the coronally positioned flap.