Clinical Case Study: Coverage of multiple gingival recessions in the maxilla with the use of modified coronally advanced tunnel technique with subepithelial connective tissue grafts.

When planning a surgical approach for the treatment of multiple gingival recessions, the type and size of the recession, the type of phenotype, the presence of the scleratinised zone, the condition of the gingival papillae and the positions of the teeth should be assessed. For recessions of similar dimensions, especially in the case of low and narrow gingival papillae, a modified tunnel technique is the preferred method. In this technique, the flap is prepared as a split-full-split (split flap in the area of the gingival papillae, full thickness up to the mucogingival line and then split flap). Where there is a thin phenotype, the scleratinised zone is narrow (or there is no scleratinised zone) and the position of the tooth deviates from the normal position, a sub-epithelial connective tissue graft (SCTG) should be used. In the case described, the SCTG was positioned in the area of the molars, premolars and canines. The flap displaced intracoronally should completely cover the autogenous grafts. The sutures are removed after 14 days. The modified tunnel technique allows optimum aesthetic results to be achieved, and significant improvements are already visible a few weeks after the procedure (the last images were taken after 6 months).