A novel approach of combining the tunnel technique with a double papilla flap or a coronally positioned flap for the treatment of multiple adjacent gingival recessions: report of two cases

The treatment of multiple gingival recessions (GRs) is often challenging for clinicians, mainly due to a larger avascular surface, limited blood supply, differences in recession depth, and residual keratinized tissue. Considering these factors, it may be prudent to take advantage of one surgical technique and overcome its limitations by combining it with another technique in certain clinical situations. The present clinical report describes the treatment of multiple GRs of different depths with a combination of the tunnel technique (TUN) and pedicle flap (PED) – double papilla flap (DPF) or coronally positioned flap (CPF) – in conjunction with deepithelialized connective tissue grafts in two patients. The TUN was considered as it allows faster wound healing and improved esthetics due to the avoidance of visible incisions on the surface. However, to achieve complete coverage of the exposed root surface in the deep recession of the terminal tooth, the DPF or CPF were performed. Healing was uneventful, and no postoperative complications were observed. Complete root coverage was achieved in the treated teeth of both patients at the 12-month follow-up. The combination techniques described in this article can be utilized when there is a deep recession on one of the terminal teeth and the remaining teeth exhibit shallow to moderate recession depths. Clinicians should consider the amalgamation of surgical techniques to achieve the goals of complete root coverage in order to meet patients’ esthetic and functional demands while at the same time minimizing postsurgical morbidity.