Avaliação comparativa da técnica de túnel e do enxerto gengival livre no tratamento de recessões gengivais múltiplas: estudo clínico, controlado e randomizado

Abstract

The tunnel technique has been proposed as an alternative for free gingival graft (FGG) to improve the predictability of complete root coverage, the aesthetic appearance, and to ensure a more pleasant experience for the patient. However, lacking consensus about the best approach which ensures predictable results regarding root coverage and gain of keratinized gingiva. Based on that, this clinical, controlled and randomized study aims to evaluate the tunnel technique associated with connective tissue graft in comparison to FGG in multiple gingival recessions (GR) in the anterior mandible. Twenty-six patients with multiple GR (Recession type 1 or 2) in the anterior mandible were divided into: TUN group (n= 13): GR treated with tunnel technique associated with the connective tissue graft (obtained by the de-epithelialized FGG technique); and FGG group (n=13): GR treated with FGG. Periodontal clinical parameters were evaluated at baseline and after 1, 3, 6 and 12 months. Landry index, root coverage esthetic score (RES), visual analogic scale (VAS) for pain and esthetics were also assessed. A reduction in root coverage percentage (RC%), recession depth and recession width were observed for both groups after 12 months. However, no differences between the groups were observed for these variables, except for the RC% that was higher for the TUN group in comparison to the FGG group after 30 days. In addition, higher sites with complete root coverage (CRC) were observed for TUN group after 30 days and 3 months (p=0.010). Higher keratinized tissue width (p<0.0001) and gingival thickness(p<0.001) were observed for the FGG group in all periods analysed. Longer surgery time was spent in the TUN group (85.21±17.31 min) compared to the FGG group (61.08±11.11 min) (p=0.0004). Better healing patterns (p<0.0001) and esthetic scores (p<0.0080) were obtained in the TUN group. For patient‐reported outcomes, no differences were observed between the groups. It can be concluded that both treatment methods resulted in recession reduction, however, the FGG promoted higher KT gain and gingival thickness. On the other hand, higher CRC, better healing patterns and esthetic scores were obtained with the tunnel technique approach in the lower anterior region.