Modified Coronally Advanced Tunnel (MCAT) Technique with or without Vestibular Incision for the Treatment of Multiple Gingival Recessions: A Case Series and Literature Review

Treatment of multiple gingival recessions with periodontal plastic surgery is challenging due to several factors that needed to be considered in one surgical session. The success and stability of root-coverage outcomes depend on gingival thickness (GT), defect characteristics and anatomical limitations addressing hard and soft tissue relationships and periodontal structures. Root coverage is less predictable in the presence of interproximal attachment loss. Evidence on the treatment of multiple recession-type defects, particularly Miller Classes III and IV, is scarce. The modified coronally advanced tunnel technique (MCAT) has been report-ed to exert root-coverage effects in Miller Class III cases via partial papilla elevation. To gain surgical access in challenging anatomies, the use of additional vestibular incisions (vestibular incision subperiosteal tunnel access, [VISTA]) has been proposed. In this case report, two patients who underwent surgeries for Miller Class II-III recessions with thin phenotypes are described. After non-surgical periodontal treatment, creeping attachment of 0.5-1 mm was observed in some teeth in case 1. Both patients underwent the treatment of MCAT technique combined with connective tissue grafting, whereas only the patient in case 2 underwent VIS-TA. Complete root coverage, increased GT and aesthetic outcomes with a follow-up period of at least 5 months were achieved in multiple teeth in both cases. The report and the literature review suggested that MCAT w/wo VISTA can predict root coverage and modify phenotypes for the treatment of multiple recessions.