Modified Coronally Advanced Tunnel for Mandibular Lingual Root Coverage

Clinical Outcomes of Modified Coronally Advanced Tunnel Technique With Deepithelialized Connective Tissue Graft for Mandibular Lingual Root Coverage: A Case Series

This study will follow adults who have gum recession on the tongue side of the lower teeth. Participants will receive a gum surgery called the Modified Coronally Advanced Tunnel technique with a connective tissue graft taken from the roof of the mouth. The study will include 20 participants and will follow them for up to 24 months after surgery. The main outcome is how much of the exposed root is covered 6 months after surgery. The study will also measure gum thickness, gum width, tooth sensitivity, healing, patient comfort, satisfaction, and three-dimensional soft tissue changes using intraoral scans.

This is a single-site prospective case series at the University of Pittsburgh School of Dental Medicine. Adults with single or multiple Cairo RT1 lingual gingival recessions of at least 3 mm on mandibular incisors, canines, or premolars will be enrolled if they meet the study eligibility criteria.

All participants will receive the same surgical treatment. During the procedure, the surgeon will create a tunnel under the gum tissue on the tongue side of the affected lower tooth or teeth. A small piece of tissue will be taken from the palate, prepared as a connective tissue graft, placed under the gum tissue, and stabilized with sutures to help cover the exposed root surface.

Participants will have study visits before surgery, on the day of surgery, during early healing, and at scheduled follow-up visits through 24 months after surgery. The primary outcome will be assessed at 6 months after surgery.

At follow-up visits, the study team will collect gum measurements, assess tooth sensitivity, record healing or post-operative complications, and collect patient-reported outcomes about pain, discomfort, function, appearance, and satisfaction. Intraoral photographs and intraoral scans will also be collected to document healing and measure three-dimensional soft tissue changes over time.

Inclusion Criteria:

• Age 18-65 years
• Single or multiple Cairo RT1 lingual gingival recessions ≥3 mm on mandibular incisors, canines, or premolars
• Identifiable CEJ on the lingual aspect
• Vital uniradicular teeth
• Full-mouth plaque score <20%
• Smokes less than 10 cigarettes per day
• Adequate mouth opening for lingual access
• Sufficient palatal donor tissue thickness (≥2 mm at 2-3 mm from gingival margin)

Exclusion Criteria:

• Positive urine pregnancy test or self-reported lactation
• Smoker more than 10 cigarettes per day
• Uncontrolled systemic diseases, at the discretion of the PI (diabetes HbA1c >7%, cardiovascular disease, immunocompromised)
• Use of medications affecting periodontal tissues (phenytoin, calcium channel blockers, immunosuppressants)
• Use of blood thinners
• Previous root coverage surgery at treated sites
• Teeth with cervical restorations or caries on lingual surfaces
• Inadequate attached gingiva (<1 mm)
• Prominent lingual frenum attachment requiring frenectomy