Enhancing graft stability in coronally advanced tunnel with connective tissue graft for Cairo RT1 and RT2 gingival...

Gingival recession (GR) in the mandibular anterior region presents a clinical challenge because factors such as shallow vestibular depth, frenal pull, and limited soft tissue thickness may compromise graft stability during root coverage procedures. This case series describes the management of Cairo RT1 and RT2 GR defects using a modified coronally advanced tunnel technique combined with subepithelial connective tissue grafting and tooth-anchored encircling sutures for graft stabilization. Five systemically healthy patients presenting with eleven recession defects were treated. At the 3-month follow-up, a high level of root coverage was achieved, with complete root coverage observed in most sites, including all RT1 defects and the majority of RT2 defects. Increased gingival thickness was also observed in several treated sites. The modified technique, emphasizing graft stabilization and passive flap mobility, may enhance clinical outcomes in mandibular anterior GRs.