Aesthetic Evaluation after Application of a Modified Tunnel Technique for Root Coverage

Introduction: Several root coverage (RC) procedures capable of meeting the patient's aesthetic demands have been proposed. Therefore, methods were developed to allow the postoperative aesthetic evaluation of obtained results, in an objective and reproducible manner. Aims: To systematically review and assess the applicability of objective aesthetic evaluation indexes after RC procedures. To evaluate retrospectively the aesthetic results after a modified tunnel technique (MTT) in the treatment of gingival recessions (GR), using the Root Coverage Esthetic Score (RES). Materials and methods: Electronic search in primary (PubMed) and secondary (b-on) databases using the search terms: "soft tissue evaluation"; "aesthetic index"; "esthetic score"; "esthetic assessment"; "esthetic outcomes"; "root coverage procedure" + bolean conector "AND", selecting only human studies between 2005 and 2015. 10 examiners evaluated 25 photographs (21 treated GR + 4 negative controls) using RES. Descriptive statistical analysis was used. Results: This review identified 9 objective aesthetic indexes. RES is the sole specifically centered on aesthetic results after RC procedures. The MTT allowed 93,45% mean RC in single or multiple Miller's classe I and II GR, with good esthetics (RES= 7.4±2.270) and 62% of the cases obtaining RES≥7. Conclusion: The MTT allowed a quantitative and qualitative improvement of clinical parameters. The RES seems to be a useful tool for assessing the aesthetic outcomes of RC procedures. However, RES may not be representative of clinical aesthetic reality. Clinical implications: New objective esthetic indexes with a balanced appreciation of parameters are desirable. Keywords: root coverage esthetic score, gingival recession, periodontal surgery, objective aesthetic assessment