Modified tunnel technique with and without enamel matrix derivative for deep and narrow gingival recession in the mandibular anterior region: a 3-year longitudinal and retrospective cohort population-based study

Purpose: This study was conducted to evaluate the 3-year predictability and validity of the modified tunnel technique, both with and without the use of enamel matrix derivative (EMD), for treating deep and narrow gingival recession defects (GRDs) in the mandibular anterior region. Methods: Overall, 31 GRDs were treated using the modified tunnel technique combined with subepithelial connective tissue graft. The cohort was divided into 2 groups: one with the adjunctive use of EMD (n=16) and the other without EMD (n=15). Clinical outcomes, including recession depth (RD), keratinized tissue width (KTW), mean root coverage (MRC), and complete root coverage (CRC), were evaluated at baseline, as well as at 6 months, 1 year, and 3 years postoperatively. Patient discomfort was assessed with a self-report questionnaire 2 weeks after surgery. Results: At the 3-year follow-up, no statistically significant differences were observed between the 2 treatment modalities in clinical parameters, including RD (EMD, −6.47±2.23 mm; non-EMD, −5.10±3.23 mm), KTW (EMD, 1.03±0.96 mm; non-EMD, 1.00±1.02 mm), MRC (EMD, 86.62%±21.18%; non-EMD, 80.24%±38.73%), and CRC (EMD, 62.5%; non-EMD, 73.3%). Furthermore, no significant differences were found between the groups in terms of early and subjective postoperative discomfort, including pain and swelling. Conclusions: Within the limitations of this study, the modified tunnel technique, whether used alone or in conjunction with EMD, demonstrated benefits in the treatment and maintenance of deep and narrow GRDs.