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Background: The aim of this controlled randomized split-mouth study was to evaluate whether a modified tunnel/connective tissue graft (CTG) technique - enamel matrix derivative (EMD) combination will improve the treatment of multiple class III recession when compared with the same technique alone., Materials and Methods: Twenty healthy subjects with a mean age of 31.7 years, were enrolled for the trial in a university periodontal clinic. Patients with at least three adjacent gingival recessions on both sides of the mouth were treated with a modified tunnel/CTG technique. On the test side, an EMD was used in addition. Clinical parameters were measured at baseline, 28 days, 3, 6 and 12 months after the surgery. Results are presented at the subject level., Results: The mean root coverage from baseline to 1 year post-surgery was 82% for the test group and 83% for the control group. Complete root coverage was achieved at 1 year in eight (38%) of the 20 surgeries (experimental and control group)., Conclusions: One-year results indicate that the modified tunnel/CTG technique is predictable for the treatment of multiple class III recession-type defects. The addition of EMD does not enhance the mean clinical outcomes.

Several surgical techniques, such as the papilla preservation flap, the modified papilla preservation flap, and the sulcular incision flap, have attempted to achieve clot stabilization and graft coverage in an attempt to regenerate lost tissue due to periodontal disease. This case report focuses on soft tissue root coverage and bone regeneration in a one-wall osseous defect using the pouch-and-tunnel surgical procedure. The pouch-and-tunnel surgical technique is a minimally invasive periodontal plastic surgical procedure that uses subepithelial connective tissue as a free graft in a pouch beneath the gingival margin, created by sulcular incisions around the involved teeth. The autogenous bone graft placed in this one-wall osseous defect through a sulcular incision after root planing is protected in a stable pouch-like recipient site with an abundant blood supply. The free connective tissue graft also prevents epithelial migration into the recipient site. The use of Emdogain may help with cementogenesis around the planed root surface. This technique warrants further evaluation of cases with similar defects using this surgical procedure. (Int J Periodontics Restorative Dent 2009;29:515-521.).

Several reasons contribute to the loss of interdental papillae and the establishment of "black triangles" between teeth. The most common reason in the adult population is loss of periodontal support because of plaque-associated lesions. However, abnormal tooth shape, improper contours of prosthetic restorations, and traumatic oral hygiene procedures may also negatively influence the outline of the interdental soft tissues. Several surgical and nonsurgical techniques have been proposed to treat soft tissue deformities and manage the interproximal space. The nonsurgical approaches (orthodontic, prosthetic, and restorative procedures) modify the interproximal space, thereby inducing modifications to the soft tissues. The surgical techniques aim to recontour, preserve, or reconstruct the soft tissue between teeth and implants. This review categorizes the various approaches in different clinical situations.

With the present knowledge of osseointegration and implants, it seems reasonable to hope that implants will be placed in a way that provides optimal function, esthetics, and phonetics. The esthetic objectives of implant dentistry should be similar to those of conventional prosthodontics, and the esthetics for implants begins with implant placement. Often, because of limitations in position and/or quality of bone, implants may have to be placed in locations that are not ideal in the axial position. Preangulated and customized abutments have been used in some situations primarily to salvage poorly placed implants. An adequate zone of attached gingiva is also necessary around these restorations to hide the periimplant restoration boundary and provide for a good soft tissue profile, which is the essence of esthetics. There are numerous situations where implants have been placed in areas of minimal keratinized gingiva. The crown margin around these areas of thin gingiva is usually supragingival; therefore, the esthetic appearance is poor Three case reports, which are part of a preliminary study, outline a plastic surgical technique of tunneling/pouching and the use of submerged connective tissue grafts. This technique allows the thickening of the existing gingiva but is also useful for reconstructing interdental papillae around implant-supported restorations.