Esthetic and Functional Treatment of Gingival Recessions in the Mandible: A Micro-Surgical and Mini-Invasive Concept Based on Tunneling Procedure and Controlled Connective Tissue Graft Exposure: Case Reports

This article, via two clinical cases, describes a micro-surgical treatment protocol that combines a connective tissue graft with a supra-periosteal tunnel technique for correction of recession defects in the mandible. We propose a treatment rationale where the connective tissue graft is voluntarily exposed on the root surface using controlled exposure, resulting in predictable keratinized tissue creation. The graft is left uncovered on the whole recession height, which triggers the biomimetic target of recreating the initial muco-gingival situation. After healing, this treatment rationale can achieve both functional and esthetic outcomes: increased gingival height and thickness, stable location of the muco-gingival line, preservation of buccal vestibule depth, root coverage, and color and texture matching between the native and the newly created soft tissue. The technique may be a suitable alternative for the treatment of single and multiple Miller class I, II and III recession defects in the mandible, especially in challenging situations when the initial amount of keratinized tissue is low and/or gingival biotype is thin.