Clinical efficacy of tunnel flap combined with de-epithelialized connective tissue graft in treating gingival recession: a case-series study.

To evaluate the clinical efficacy and influencing factors of the tunnel flap (TUN) combined with de-epithelialized connective tissue graft (DCTG) in the treatment of gingival recession (GR) from patient- and site-specific perspectives. Patients treated with the TUN + DCTG technique for GR between August 2020 and December 2023 were included. Baseline and follow-up periodontal measurements were recorded, including gingival recession depth (GRD), keratinized gingival width (KGW), and clinical attachment loss (CAL). Paired sample t-test was performed to assess the clinical efficacy. Moreover, primary outcome metrics, such as complete root coverage rate (CRC), mean root coverage rate (MRC), root coverage esthetic score (RES), and patient satisfaction, were calculated. Patient- and site-specific influencing factors were analyzed using a generalized linear mixed model regression (GLMM). A total of 34 patients with 201 affected teeth were included, comprising 78 cases of Cairo RT1, 86 of RT2, and 37 of RT3. Significant clinical improvements were observed over an average follow-up of 11.97 ± 4.11 months, including reductions in GRD (from 2.13 ± 1.14 mm to 0.48 ± 0.73 mm, P < 0.001) and CAL (from 3.22 ± 1.16 mm to 1.64 ± 0.90 mm, P < 0.001) and increases in KGW (from 2.58 ± 1.28 mm to 3.72 ± 1.66 mm, P < 0.001), with a CRC of 59.2% and MRC of 77.26% ± 33.48%. The mean RES was 8.21 ± 1.74, with 83.3% of patients reporting an improved quality of life. GLMM identified recession type, age, and tooth arch as predictable factors for clinical outcomes (P < 0.001). Within its limitations, this study suggests that the TUN + DCTG technique is a promising approach for managing GR, yielding favorable clinical and aesthetic outcomes. Clinical decision-making for GR treatment should consider a range of influencing factors to optimize individualized patient care.Clinical relevance: The TUN + DCTG technique is a reliable and effective option for GR treatment, providing consistent clinical and aesthetic benefits. Understanding predictive factors enables clinicians to tailor treatment strategies, improving success rates and patient satisfaction.