Evaluating Papilla Access Tunnel Technique with Platelet-Rich Fibrin and Amnion-Chorion Membrane for Management of Anterior Gingival Recessions: A Randomized Controlled Trial

Gingival recession, also known as soft tissue recession, is defined as the displacement of

the gingival margin apical to the cemento-enamel junction (CEJ) of a tooth or the platform

of a dental implant.This condition is associated with issues like dentine

hypersensitivity, non-carious cervical lesions (NCCLs), and compromised aesthetics.

Dealing with recession defects in the anterior region presents challenges due to various

anatomical factors, including the depth of the vestibule, position of the tooth, pull of

muscles and frenulum, and thickness of hard and soft tissues.

Several surgical techniques have been proposed over the years for treating mucogingival

defects in the aesthetic zone of the dentition. The Coronally Advanced Flap (CAF) along

with Subepithelial connective tissue graft (SCTG) is considered the gold standard for the

treatment of gingival recessions . Its advantages include a perfect color/contour match

with surrounding tissue and simplicity of execution.

The tunnel technique, introduced by Allen in 1994 , has evolved and the Papilla Access

tunnel technique, introduced by Edward P. Allen in 2019, is now suggested as a more

realistic option for gingival recession treatment in the anterior region. This technique

preserves papillary integrity and provides incision-free design, allowing improved surgical

access for site preparation and graft placement with reduced risk of perforation or injury to

thinner tissues

Intrasulcular approach for preparation of the tunnel site in Papilla Access tunnel technique

is accomplished easily when treating multiple tooth sites where a few of the teeth may

present with significant amount of recession by using the access provided by an elongated

sulcus associated with the recession defect.

Regarding the use of membranes. Choukroun’s platelet-rich fibrin (PRF), a secondgeneration

platelet concentrate developed in 2001 (Choukroun et al,2001), is an autologous

leukocyte and platelet-rich fibrin biomaterial. PRF offers advantages such as simplified

and efficient preparation in a single-step centrifugation process, without the need for

anticoagulants or other gelling agents.

Recently, placental-derived tissues, known for their immune privileged composition,

antibacterial properties, and facilitation of cell migration, have gained popularity in

dentistry for guided tissue regeneration . Amnion membrane, an allogenic substitute

for subepithelial connective tissue graft, is particularly used for cost-effective root coverage

.The amnion contains stem cell reserves, growth factors, and proteins that accelerate

healing and regeneration, while the chorion is rich in collagen proteins. Based on these

biological properties, amnion and chorion membranes are theorized to be effective in

managing gingival recession and are being employed in root coverage procedures.