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

Objective: To clinically evaluate the healing of multiple adjacent maxillary Miller Class I, II, and III gingival recessions (MAGR) treated with the modified coronally advanced tunnel (MCAT) in conjunction with an enamel matrix derivative (EMD) and subepithelial connective tissue graft (SCTG). Method and Materials: Twelve systemically healthy patients (6 females) with a total of 54 adjacent maxillary Miller Class I, II, or III MAGR were consecutively treated with MCAT in conjunction with EMD and SCTG. Out of the 54 recessions, 44 were classified as Miller Class I, five as Miller Class II, and five as Miller Class III. Patients were included in the study if they presented at least two adjacent recessions with a depth of ≥ 3 mm. 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 without any complications such as postoperative bleeding, allergic reactions, abscesses, or loss of SCTG. At 12 months, statistically highly significant (P .0001) root coverage was obtained in all patients and recessions. CRC was obtained in 37 Miller Class I, three Miller Class II, and one Miller Class III recessions, respectively. Mean root coverage was 96%. Mean keratinized tissue width increased statistically highly significantly (P .004) from 2.04 ± 0.95 mm at baseline to 2.37 ± 0.89 mm at 12 months. Conclusion: The present findings indicate that the proposed treatment concept results in predictable coverage of multiple adjacent maxillary Miller Class I, II, and III MAGR. Keywords: enamel matrix derivative, modified coronally advanced tunnel, multiple adjacent maxillary Miller Class I/II/III recessions, root coverage, subepithelial connective tissue graft