Coverage of Miller class 3 (RT2 Class A+) recession with CTG + HA using modified Tunneling technique | PARADENT
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Case Provided By Prof. Dr. Anton Friedman Orcid (Chair and Head Department of Periodontology, School of Dentistry, Faculty of Health, University of Witten, Germany)

Baseline situation

Non-smoking female aging 45 years

History of active periodontitis therapy / ≈ 10 years of SPT

Tooth 12 disclosed recession >3mm on the buccal and ≈ 2mm at mesial aspect

Generalized loss of papillae across maxillary anterior mention

Interest in harmonizing the gingival contour due to the burden of gummy smile

Baseline

Soft tissue handling avoiding vertical access

Sulcular incisions Sulcular incisions
Submucosal tunneling preparation lifting papillae on both sides of the defect Submucosal tunneling preparation lifting papillae on both sides of the defect

Connective tissue graft (CTG) handling

CTG retrieved from the palate using trap-door preparation CTG retrieved from the palate using trap-door preparation
Sliding suture for moving the graft into the tunnel Sliding suture for moving the graft into the tunnel

HA application

HA (hyaDENT BG, Regedent, Germany) is applied using sterile carpule topically at the donor and into the tunnel at recipient site before suture

HA (hyaDENT BG, Regedent, Germany) is applied using sterile carpule topically at the donor and into the tunnel at recipient site before suture
HA (hyaDENT BG, Regedent, Germany) is applied using sterile carpule topically at the donor and into the tunnel at recipient site before suture

Suture fixation

Suture with 5.0 PTFE monofilament suture (BioTex, Regedent, Germany) Suture with 5.0 PTFE monofilament suture (BioTex, Regedent, Germany)
Slinging suture and modified vertical mattress suture Slinging suture and modified vertical mattress suture

Post-op follow-up

Day 7 visit - uncomplicated healing

Day 7 visit - uncomplicated healing
Day 7 visit - uncomplicated healing

Post-op follow-up

Day 12 - no signs of swelling, nice coloration of the gingiva

Day 12 - no signs of swelling, nice coloration of the gingiva

Day 12 post-op

Suture removal Suture removal
MH re-instruction MH re-instruction

Monitoring of the result

Harmonization of the gingiva line obvious after 6 months

Harmonization of the gingiva line obvious after 6 months

Monitoring after 6 months

Monitoring after 6 months

Before and after

Baseline vs. 6 months result

Before
After
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