Abstract
The laterally positioned flap (LPF) has been proposed as a promising treatment for isolated gingival recessions (GRs) in mandibular incisors. Several modifications have been proposed to reduce the risk of gingival recession (GR) at the donor tooth site. Therefore, the aim of this was to describe a modified one-stage procedure of performing the LPF associated with the subepithelial connective tissue graft (LPF + SCTG) with the modifications for the treatment of deep isolated GR in mandibular incisors. The modified one-stage technique (LPF + SCTG) is unique because it was presented being bilaminar with tunneled connective tissue graft (CTG) in the adjacent tooth and extended to the flap donor site, without a submarginal incision in the adjacent tooth, taking the entire band of the keratinized tissue (KT) into the flap. In addition, 3 clinical cases were described using this surgical technique. Three healthy patients with Cairo RT1 or RT2 GRs on teeth 31 or 41 were treated with the LPF + SCTG technique. Probing depth (PD), clinical attachment level (CAL), complete root coverage (CRC), mean root coverage (MRC), recession depth (RD), and keratinized tissue width (KTW) were assessed at baseline and in the follow-up periods of 18, 24, and 48 months, in the cases 1, 2, and 3, respectively. The LPF + SCTG with the modifications presented is a predictable approach for the treatment of deep isolated RT1 and RT2 GRs in mandibular incisors that are well positioned in the bone envelope with the presence of KTW adjacent to GR and adequate vestibule depth in the donor area of the flap.
Highlights
Gingival recession (GR) is the apical shift of the gingival margin with respect to the cementoenamel junction (CEJ), with exposure of the root surface to the oral environment [1]
More predictable prognosis was associated with gingival thickness (GT) of 0.8–1.2 mm [16] and a thickness < 1 mm that could affect the percentage of complete root coverage (CRC) [17]
In the laterally positioned flap (LPF) + subepithelial connective tissue graft (SCTG) technique described, the graft is inserted into the created tunnel and extended distally to protect the donor area of the flap, even if a small portion of it is exposed in that area [27]
Summary
Gingival recession (GR) is the apical shift of the gingival margin with respect to the cementoenamel junction (CEJ), with exposure of the root surface to the oral environment [1]. More predictable prognosis was associated with gingival thickness (GT) of 0.8–1.2 mm [16] and a thickness < 1 mm that could affect the percentage of complete root coverage (CRC) [17] In this context, the modified one-stage technique (LPF + SCTG) is unique because it was presented being bilaminar [18], with tunneled CTG in the adjacent tooth and extended to flap donor site, without a submarginal incision in the adjacent tooth, taking the entire band of the keratinized tissue (KT) into the flap and the inversion of bevels in relation to Parkinson et al [13]. The aim of this manuscript was to describe a modified one-stage procedure of performing the laterally positioned flap with subepithelial connective tissue graft (LPF + SCTG) with the modifications for the treatment of deep isolated GR in mandibular incisors
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