Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a Meta-analysis

doi:10.7518/hxkq.2023.2023045

Abstract

Abstract:

Objective This study aimed to evaluate the efficacy and long-term stability of tunnel technique (TUN) and coronally advanced flap (CAF) combined with connective tissue graft (CTG) in treating gingival recession. Methods Databases including PubMed, Web of Science, Embase, and CNKI were electronically searched to collect randomized controlled trial (RCT) of CAF+CTG compared to TUN+CTG in the treatment of Miller class Ⅰ or Ⅱ gingival recession on September 1, 2022. Results There were 8 RCTs with 305 patients (454 recession sites) participating. The results of the Meta-analysis revealed that, in terms of mean root coverage (MRC) of main indicators, no significant difference was found between the CAF group and the TUN group in both short- and long-term results, which were [MD: 1.45%, 95%CI (-2.93%, 5.82%), P=0.52] and [MD: -0.70%, 95%CI (-6.41%, 5.00%), P=0.81]. However, the CAF group outperformed the TUN group in the long term [MD: 5.69%, 95%CI (0.87%, 10.50%), P=0.02], and the results of complete root coverage (CRC) analysis were similar to those of MRC. In the short term, the TUN group grew keratinized gingiva significantly faster than the CAF group [MD: -0.38 mm, 95%CI (-0.67 mm, -0.10 mm), P=0.008]. Long-term findings revealed no significant difference between the two groups [MD: -0.26 mm, 95%CI (-0.94 mm, 0.43 mm), P=0.46]. The TUN group’s secondary index root coverage esthetic score (RES) was statistically significantly higher than the CAF group’s [MD: 0.62, 95%CI (0.28, 0.96), P=0.000 3]. Given that there were few results included in the literature and the heterogeneity was too great, no significant difference was observed in the postoperative VAS pain index score [MD: 0.53, 95%CI (-1.96, 3.03), P=0.68]. Conclusion This study discovered that both CAF+CTG and TUN+CTG can achieve good root coverage in treating gingival recession, with CAF outperforming TUN and both groups achie-ving good long-term stability. After the operation, the TUN group had a higher RES than the CAF group. Given the limitations of this study, more high-quality studies are needed in the future to demonstrate the efficacy of TUN in gingival retraction surgery.

Key words: tunnel technique, coronally advanced flap, gingival recession, root coverage, connective tissue graft, Meta-analysis

CLC Number:

R 781.4⁺4

Cheng Xiaoming, Tang Rui, Ge Zili. Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a Meta-analysis[J]. West China Journal of Stomatology, 2023, 41(4): 450-462.

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纳入研究	研究设计	年龄/岁	受试人数（男/女）	纳入位点	试验组（位点）	对照组（位点）	牙龈退缩类型	退缩位点	退缩深度
Salhi等^[40]	半口对照	22~63	40（14/26）	40	TUN+CTG（20）	CAF+CTG（20）	MillerⅠ类	上颌切牙、尖牙、前磨牙	2~5 mm
Santamaria等^[29]	平行对照	24~59	42（15/27）	42	TUN+CTG（21）	CAF+CTG（21）	MillerⅠ、Ⅱ类	上颌尖牙、前磨牙	≥2 mm
Neves等^[30]	平行对照	>18	39（11/28）	39	TUN+CTG（20）	CAF+CTG（19）	MillerⅠ、Ⅱ类	上颌尖牙、前磨牙	NR
Salem等^[28]	平行对照	18~32	38（13/25）	38	TUN+CTG（19）	CAF+CTG（19）	MillerⅠ类	上颌切牙、尖牙、前磨牙	2~5 mm
Bherwani等^[39]	平行对照	18~55	20（NR）	75	TUN+CTG（36）	CAF+CTG（39）	MillerⅠ、Ⅱ类	上颌切牙、尖牙、前磨牙	NR
Bhatavadekar等^[45]	平行对照	22~54	36（20/16）	99	TUN+CTG（45）	CAF+CTG（54）	MillerⅠ、Ⅱ类	上颌切牙、尖牙、前磨牙	NR
Azaripour等^[38]	平行对照	19~64	40（15/25）	71	TUN+CTG（42）	CAF+CTG（29）	MillerⅠ、Ⅱ类	上下颌切牙、尖牙、前磨牙	NR
Gobbato等^[44]	平行对照	20~37	50（26/24）	50	TUN+CTG（25）	CAF+CTG（25）	MillerⅠ、Ⅱ类	上下颌切牙、尖牙、前磨牙	2~5 mm

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