Coronally advanced tunnel technique and enamel matrix derivative for the management of deep gingival recessions in a patient with type 2 diabetes: a case report

Abstract

Gingival recessions represent a frequent aesthetic and functional challenge in clinical practice, particularly in older adult patients with a thin gingival phenotype and systemic conditions such as type 2 diabetes. This case report presents the management of multiple gingival recessions using the coronally advanced flap-tunnel technique (CAF-T) combined with enamel matrix derivative (EMD), without grafting, in a 70-year-old male patient systemically diagnosed with type 2 diabetes (blood glucose: 110 mg/dL) under treatment with metformin 750 mg daily. Upon clinical examination, the patient presented RT2 and RT3 recessions in the anteroinferior segment and a thin gingival phenotype. The patient rejected a connective tissue graft (CTG); thus, the CAF-T surgical technique plus EMD was selected as the sole adjuvant approach. Root conditioning was performed using EDTA gel, followed by EMD application (Emdogain®, Straumann, Switzerland) prior to primary closure. Suturing was executed using vertical mattress stitches, and clinical and radiographic follow-up was conducted at 7 months. The assessment revealed recession reduction, gain in gingival thickness, radiographic evidence of marginal bone neoformation, and aesthetic improvement. This case concludes that CAF-T plus EMD without grafting can be considered a valid, conservative regenerative alternative in patients with a thin phenotype and controlled diabetes, provided that adequate plaque control and clinical follow-up are maintained.