Treatment of single and multiple Miller Class I and III gingival recessions at crown-restored teeth in maxillary esthetic areas

Objective: To clinically evaluate the outcomes following surgical coverage of single and multiple Miller Class I and III gingival recessions at crown-restored teeth in the esthetic area by means of the modified coronally advanced tunnel (MCAT). Method and Materials: Eight systemically healthy patients (5 females) with a total of 23 single or multiple maxillary Miller Class I or III gingival recessions were consecutively treated with MCAT in conjunction with a subepithelial connective tissue graft (SCTG). Out of the 23 recessions, 16 were classified as Miller Class I and seven as Miller Class III. All patients presented at least one facial gingival recession at a crown-restored tooth, located in the maxillary anterior area. In all cases, the facial recession was associated with an impaired esthetic appearance. Clinical measurements were made at baseline (immediately before reconstructive surgery) and at 12 months postoperatively. The primary outcome variable was complete root coverage (CRC) (ie, 100% root coverage). Results: Healing was uneventful in all cases. At 12 months, statistically highly significant (P .0001) root coverage was obtained in all patients and defects. CRC was obtained in 22 out of the 23 recessions (in 16 Miller Class I and in six out of the seven Miller Class III recessions). In one Miller Class III recession, root coverage measured 89.10%. The treatment yielded a mean root coverage of 92.62% and 3.75 mm, respectively, and was associated with a mean gain of keratinized tissue width of 0.62 ± 1.15 mm (P .05). Conclusion: Within their limits, the present findings indicate that MCAT in conjunction with SCTG represents a valuable option for treating single and multiple gingival recessions at crown-restored teeth in the maxillary esthetic area thus avoiding the replacement of the prosthetic restorations. Keywords: crown-restored teeth, gingival recession, Miller Class I and III recessions, modified coronally advanced tunnel, root coverage, subepithelial connective tissue graft