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 II. Volumetric studies on healing dynamics and gingival dimensions

J Clin Periodontol. 2014 Jun;41(6):593-603. doi: 10.1111/jcpe.12254.


Aim: The aim of this randomized clinical trial (RCT) was to compare the clinical performance of the tunnel technique with subepithelial connective tissue graft (TUN) versus a coronally advanced flap with enamel matrix derivative (CAF) in the treatment of gingival recession defects. The use of innovative 3D digital measuring methods allowed to study healing dynamics at connective tissue (CT)-grafted sites and to evaluate the influence of the thickness of the root covering soft tissues on the outcome of surgical root coverage.

Material & methods: Twenty-four patients contributed a total of 47 Miller class I or II recessions for scientific evaluation. Precise study models collected at baseline and follow-up examinations were optically scanned and virtually superimposed for digital evaluation of clinical outcome measures including mean marginal soft tissue thickness (THK). Healing dynamics were measured in a defined region of interest at CT-grafted sites where volume differences between time points were calculated.

Results: At 12 months, recession reduction as well as mean root coverage were significantly better at CT-grafted sites treated in the TUN group (1.94 mm and 98.4% respectively) compared to the non-augmented sites of the CAF group (1.17 mm and 71.8% respectively) and statistical analysis revealed a positive correlation of THK (1.63 mm TUN versus 0.91 mm CAF, p < 0.0001) to both these variables. Soft tissue healing following surgical root coverage with CT-grafting was mainly accomplished after 6 months, with around two-thirds of the augmented volume being maintained after 12 months.

Conclusions: The TUN resulted in thicker gingiva and better clinical outcomes compared to CAF. Increased gingival thickness was associated with better surgical outcomes in terms of recession reduction and root coverage.

Keywords: gingival thickness; randomized controlled trial; root coverage; soft tissue volume; subepithelial connective tissue graft; volumetric measurements.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cephalometry / methods*
  • Cohort Studies
  • Connective Tissue / pathology
  • Connective Tissue / transplantation
  • Dental Enamel Proteins / therapeutic use*
  • Female
  • Follow-Up Studies
  • Gingiva / pathology
  • 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
  • Organ Size
  • Surgical Flaps / surgery*
  • Tooth Cervix / pathology
  • Tooth Root / pathology
  • Tooth Root / surgery*
  • Treatment Outcome
  • User-Computer Interface
  • Wound Healing / physiology
  • Young Adult


  • Dental Enamel Proteins
  • enamel matrix proteins