Professor Dr. Wachtel, Munich/Germany, demonstrates the gingiva thickening and coverage of gingival recession defects in the lower anterior region using the modified tunnel technique. In this case, an extended Miller class II recession defect has developed at tooth 41. For treatment planning as a whole, the patient's thin gingiva must be taken into consideration. The aim of this surgical procedure is to modify the existing thin gingival phenotype using a subepithelial connective tissue graft, so that a thicker gingiva is established.
The secondary aim is the recession coverage which possibly has to be completed in a further treatment session. The patient’s thin gingiva needs to be considered for the successful coverage of recession defects in the lower anterior region, especially at tooth 41, where an extended Miller II defect is noticeable. In this case, the modified tunnel technique is used to thicken the gingiva and cover recession defects. For this purpose, Professor Wachtel applies a subepithelial connective tissue graft, which is taken from the palate and inserted into a tunnel flap in the lower anterior jaw area.
The surgeon first establishes access to the palatal donor tissue using a single-incision technique. Professor Wachtel then performs a marginal incision in the lower anterior jaw and lifts the interdental papillae as a whole using an elevator. Undermining, labial preparation is conducted to lift a split flap apical of the recessions, for which greater mobility is achieved by continuing beyond the mucogingival junction. Following conditioning of the exposed root surfaces using Straumann PrefGel (EDTA-Gel) and the application of Straumann Emdogain onto the root surfaces and into the tunnel, the graft is inserted into the recipient bed using auxiliary Gore-sutures, which will be removed after graft fixation.
The flap and graft are secured using modified sling sutures that go around the contact points of the anterior dentition. These sutures secure flap and graft in a coronally advanced position allowing for the coverage of the recession defects. To ensure proper healing conditions the sutures should be placed without any tension. Another session may be needed to completely cover the extended defect on tooth 41. The thickening of the gingiva achieved through this surgery provides the basis if subsequent coverage of recession defects is needed.