Graftless Tunnel Technique for the Treatment of Multiple Gingival Recessions in Sites with Thick or Very Thick Biotype: A Prospective Case Series.

Tunnel (TUN) technique is normally performed in combination with soft tissue grafts, either autogenous connective tissue graft (CTG) or substitutes, regardless of a patient's biotype. The aim of this study was to investigate the efficacy of graftless TUN in the treatment of multiple gingival recessions (GRs) characterized by thick or very thick biotype. Twenty-seven GRs were treated in seven patients using graftless TUN. At 6-month postoperative evaluations, the mean root coverage (mRC) was 84.57% ± 31.1%, while complete root coverage (CRC) was achieved in 77.8% of treated GR sites and in six out of seven patients. On average, the esthetic evaluation performed using the root coverage esthetic score (RES) resulted in a final score of 9.1 ± 1.4. Sixteen sites achieved the maximum RES score, and in six patients, an RES ≥ 9 was observed in all sites. Graftless TUN showed predictable root coverage and improved esthetics in treating GRs in patients with a thick or very thick biotype. Nevertheless, further studies with a large number of subjects are needed to support these preliminary outcomes.