Comparação da técnica de túnel fechado lateralmente e do enxerto gengival livre em recessões gengivais unitárias na região anterior da mandíbula: estudo piloto

Abstract

The present study aimed to compare the laterally closed tunnel (LCT) technique combined with subepithelial connective tissue graft (SCTG) to Free gingival graft (FGG) in the treatment of isolated gingival recessions in the anterior mandibular region. Twenty- one patients with single gingival recessions (Recession Type 1 or 2 according to Cairo's classification) in the anterior mandible were divided into two groups: LCT group (n=10): recession treated with the LCT technique combined with SCTG; and FGG group (n=11): recession treated with FGG. Periodontal clinical parameters were evaluated at baseline and at 1, 3, 6, and 12 months after the surgical procedure. The Landry healing index, root coverage esthetic score (RES), visual analog scale (VAS) for pain and esthetics, and total surgery time were also assessed. The impact of treatment and clinical factors on the percentage of root coverage at 12 months was evaluated, with scenario-based predictions generated to support personalized planning. A progressive increase in the mean percentage of root coverage was observed in both groups, with the LCT group reaching 64.80% and the FGG group 79.45% at 12 months, although no statistically significant differences were found between treatments. Reductions in the gingival recessions height and width and increases in the keratinized tissue thickness were observed in both groups, with no significant differences between them. However, greater keratinized tissue height was consistently observed in the FGG group at all periods (p<0.05). No significant differences were found in healing pattern, esthetic evaluation by professionals (RES), or patient-reported esthetic outcomes (VAS). Patients in the FGG group reported higher pain levels 7 days after the surgical procedure (p<0.05). A reduction in dentin hypersensitivity was observed in both groups. Total surgery time was longer in the LCT group (82.30± 13.89 min) compared to the FGG group (56.55±3.93 min) (p<0.05). The percentage of root coverage at 12 months was influenced by tooth type, with a trend toward better outcomes for the FGG technique and aligned teeth. In conclusion, both techniques proved effective for the treatment of isolated gingival recessions in the mandible, promoting root coverage and increasing keratinized tissue. Although FGG showed greater gain in keratinized tissue and shorter surgical time, LCT resulted in less postoperative discomfort.