Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient-centred outcomes

J Clin Periodontol. 2014 Jun;41(6):582-92. doi: 10.1111/jcpe.12178. Epub 2013 Nov 10.


Aim: The aim of this randomized clinical trial (RCT) was to introduce 3D digital measuring methods for evaluating the outcomes after surgical root coverage (RC) and to assess the clinical performance of the tunnel technique with subepithelial connective tissue graft (TUN) versus the coronally advanced flap (CAF) with enamel matrix derivative in the treatment of shallow localized gingival recession defects.

Material and methods: Twenty-four patients contributed a total of 47 Miller class I or II recessions for scientific evaluation. Clinical outcomes were evaluated at 6 and 12 months. Precise study models gained at baseline and follow-up examinations were optically scanned and virtually superimposed for digital evaluation of clinical outcome measures including percentage of RC and complete root coverage (CRC). Patient-centred outcomes were evaluated with questionnaires. Final aesthetic outcomes were assessed using the root coverage esthetic score (RES).

Results: At 12 months, RC was 98.4% for TUN-treated and 71.8% for CAF-treated defects (p = 0.0004). CRC was observed in 78.6% (TUN) and 21.4% (CAF) of the cases (p = 0.0070). Results for patient-centred outcomes were equivalent for both groups but evaluation of the final aesthetic outcomes using the RES revealed a significant difference (9.06 versus 6.92, p = 0.0034) in favour of TUN.

Conclusions: TUN resulted in significantly better clinical outcomes compared with CAF. The new measuring method provided high accuracy and unforeseen precision in the evaluation of treatment outcomes after surgical RC.

Keywords: aesthetic outcomes; digital measurements; gingival recession; patient-centred outcomes; randomized controlled trial; root coverage; tunnel technique.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cephalometry / methods*
  • Connective Tissue / transplantation
  • Dental Enamel Proteins / therapeutic use*
  • Esthetics, Dental
  • Female
  • Follow-Up Studies
  • Gingiva / surgery
  • Gingiva / transplantation*
  • Gingival Recession / classification
  • Gingival Recession / surgery*
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Imaging, Three-Dimensional / methods*
  • Male
  • Middle Aged
  • Models, Dental
  • Optical Imaging / methods
  • Patient Satisfaction
  • Periodontal Attachment Loss / classification
  • Periodontal Pocket / classification
  • Surgical Flaps / surgery*
  • Tooth Cervix / pathology
  • Tooth Root / surgery*
  • Treatment Outcome
  • User-Computer Interface
  • Young Adult


  • Dental Enamel Proteins
  • enamel matrix proteins