Free reverse rotated papillary connective tissue graft and coronally advanced envelope flap technique: A novel surgical approach for treatment of gingival recession

Abstract

A palatal wound becomes when palatal premolar region is used for obtaining connective tissue graft. To overcome this disadvantage, connective tissue graft is obtained from interdental papilla; as a result, there is no palatal wound. Envelope flap has blood supply by both sides because it contains no vertical incisions. Therefore, the purpose of this case report was to evaluate the free reverse rotated papillary connective tissue graft (CTG) and coronally advanced envelope flap (CAEF) technique for the treatment of gingival recession. A patient with the gingival recession of 5 mm depth and 3 mm width was treated by free reverse rotated papillary CTG and CAEF technique. A partial-thickness envelope flap was made on the underlying alveolar mucosa. The recipient bed was prepared by de-epithelialization of adjacent papillae to gingival recession. The donor papilla was de-epithelialized on facial aspect, and CTG was harvested. The papillary CTG was then placed on recipient bed in a reverse manner that is base toward cementoenamel junction and the tip toward the base of gingival recession and sutured. The envelope flap was coronally advanced to fully cover the papillary CTG and sutured. After 1 year, 100% root coverage obtained. The histologic studies will be required to confirm the type of attachment obtained by free reverse rotated papillary CTG and CAEF technique on the root surface.