Button anchored coronally advanced flap: Perio-ortho continuum

Abstract

Periodontal plastic surgical procedures aimed at the coverage of exposed root surface have evolved into routine treatment modalities. Coronally advanced flap (CAF) was the most frequently used mucogingival procedure to achieve root coverage. Gingival recession resulting in root exposure is a common problem faced by clinicians. The continuous endeavor for innovation of newer interdisciplinary treatment modalities has resulted in the use of a passive object such as the orthodontic button being used to provide the initial stabilization in cases of root coverage using a CAF. The objective of this case report is to evaluate the effectiveness of a new treatment approach which consists of CAF procedure combined with orthodontic button application for the stabilization of flap for the treatment of Miller's Class I recession defects. After the application of orthodontic buttons in the middle third of the tooth surface, a split-full-split flap was raised for tooth number 43, and the flap was sutured 3-4 mm coronal to cementoenamel junction, and the central part of flap was suspended with sutures to the orthodontic button to maximize the stabilization of the immediate postoperative flap location. Clinical parameters such as probing depth and clinical attachment level were recorded at 1 month postoperatively. Complete root coverage was achieved when evaluated from baseline to 3 months along with gain in clinical attachment level and keratinized tissue. The final esthetics, both color match and tissue contours, were highly acceptable. One-month postoperative results showed that the CAF combined with the orthodontic button for stabilization is a very effective approach even in the treatment of Miller's Class I recession defects.