Pouch and tunnel technique in conjunction with connective tissue graft-A Paramount for treating Miller’s class II gingival recession
Introduction : Gingival recession is both unpleasant and unesthetic, therefore demanding esthetic correction. Pouch and Tunnel technique with CTG is a minimally invasive quick healing alternative for recession coverage effectively.
Objective : The objective of this case was to achieve complete root coverage of exposed root using pouch and tunnel technique with connective tissue graft for optimal patient compliance.
Methodology- After local anesthesia, at the recipient site sulcular incision was made, pouch and tunnel was created, any remaining collagen fibres, muscle fibres were cut. Papillae were kept intact. Connective tissue graft was harvested from palate area using a single incision technique, which was then inserted into recipient pouch and tunnel.
Sutures were placed to hold graft in position, the entire gingivo-papillary complex was then coronally positioned and sutured, periodontal pack was applied. To hold gingivo-papillary complex in coronal position, composite stops were made pre-surgically.
Result : The surgical site appeared normal without any trace of sloughing, healing progressed uneventfuly and the gingival recession was partially covered with satisfactory aesthetic result.
Conclusion : Pouch and Tunnel technique proved to be minimally invasive technique showing optimal root coverage with good patient compliance.
2. Oates TW, Robinson M, Gunsolley JC. Surgical therapies for the treatment of gingival recession. A systemic review, Ann Periodontol 2003;8:303-320.
3. Chambrone L, Lima LA, Pustiglioni FE, Chambrone LA. Systemic review of periodontal plastic surgery in the treatment of multiple recession-type defects. J Can Dent Assoc 2009;75:203a-203f.
4. Santarelli GA. Ciancaglini R, Campanari F, Dinoi C, Ferraris S. Connective tissue grafting employing the tunnel technique: A case report of complete root coverage in the anterior maxilla. Int J Periodontics Restorative Dent 2001;21:77-83.
5. Raetzke PB. Covering Localized Areas of Root Exposure Employing the ‘Envelope technique’. J Periodontol 1985;56:397-402.
6. Chambrone L, Lima LA, Pustiglioni FE, Chambrone LA, Lima LA. Can subepithelial connective tissue grafts be considered the gold standard procedure in the Miller class I and class II recession –type defects? J Dent 2008;36:659-671.
7. Allen AL. Use of the supraperiosteal envelope in the soft tissue grafting for root coverage. Rationale and technique. Int J Periodontics Restorative Dent 1994;14:216-227.
8. Zabalequi I, Sicilia A. Combra J, Gil J, Sanz M. Treatment of multiple adjacent gingival recessions with tunnel subepithelial connective tissue graft: a clnical report. Int J Periodontics Restorative Dent 1999;19:199-206.
9. Tarnow DP. Seminular coronally repositioned flap. J Clin Periodontol 1986;13:182-185.