Bilaminar technique for treatment of multiple Miller’s class III recession defects in the mandibular frontal area. A case report

Abstract

Introduction: Gingival recessions at anterior teeth can be an aesthetic problem for the patients who complain of crown lengthening and can be accompanied by lack of attached gingiva and tooth hypersensitivity. Different surgical techniques (pedicle and free soft-tissue grafting) are proposed for treatment of the exposed root surfaces in the aesthetic zone of dentition. The objective of mucogingival periodontal surgery in the treatment of recession type defects is a complete root coverage and fulfilment of the patient’s aesthetic demands. A bilaminar technique is a suitable technique that can be used for root coverage in the treatment of gingival recessions of a single tooth as well as for root coverage in multiple teeth. The literature survey reports that this technique shows good results in the treatment of Miller’s class I, class II and class III gingival recessions with adequate thickness and height of apical keratinized tissues to the exposed root surface and has high predictability for root coverage. Aim: The aim of this case report is to present the satisfactory aesthetic outcome of bilaminar technique for multiple recession defects of Miller’s class III in the frontal segment of the mandibula. Materials and Methods: Miller’s class III gingival recessions, affecting tooth 41 and tooth 31, were established. A bilaminar technique (connective tissue graft and coronally advanced flap) was used for root coverage of established recessions. Results: The bilaminar technique resulted in complete root coverage and gain of clinical attachment level and keratinized width of gingival tissues. Conclusion: The proposed bilaminar technique presents satisfactory aesthetic outcome in case of thin gingival tissues, interproximal attachment loss, and loss of interdental bone height in the zone between lower central incisors.