PMC8363451_01
Case 1. (a) Frontal view, gingival recession of 4 mm high by 3 mm wide. (b) Right lateral view. (c) Periapical radiograph, 2 mm radiographic interproximal bone loss mesial and distal.
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According to the clinical and radiographic examination, a RT2 RG was observed on the vestibular surface of the right mandibular central incisor (4 mm high and 3 mm wide at the height of the CEJ), with a probing depth (PD) of 3 mm in the proximal and 2 mm of 2 mm measured on the on free surfaces, clinical attachment level (CAL) of 6 mm on the buccal surface, radiographic interproximal bone loss mesial and distal sites, slight buccal prominence (dental linguoversion), slight dental extrusion, biofilm accumulation, protruding occlusal interference, and thin periodontal phenotype (Figure 2).
Case 1. (a) Vertical internal bevel incision extending into alveolar mucosa and external bevel incision along distal gingival margin of the recession defect and extending into alveolar mucosa. (b) Deepithelialized area after intrasulcular incision. (c) Flap of mix thickness. (d) Connective tissue graft positioned and stabilized. (e) Laterally positioned flap without tension and secured with sutures on recipient site.
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fig3
Two weeks after the occlusal adjustment, periodontal surgical treatment was performed using the LPF + SCTG technique (T.M.M.), as previously described (Figure 3). The CTG extended high enough into the mesiodistal direction, to cover teeth 41 and 42, high to cover the exposed root surface and remain within the tunnel created under the initial mesial incision of 41 tooth, in order to be covered by LPF later (Figure 3).
PMC8363451_02
Case 2. (a) Frontal aspect of smile. (b) Frontal view, gingival recession of 4 mm high by 3 mm wide.
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fig4
According to the clinical and radiographic examination, a RT1 RG was observed on the buccal surface of the right mandibular central incisor (4 mm high and 3 mm wide at the height of the CEJ), with a PD of 2 mm in the proximal and 1 mm on free surfaces, CAL of 5 mm on the buccal surface, absence of interproximal bone loss, slight (dental linguoversion) on the buccal surface, biofilm accumulation, protruding occlusal interference, and thin periodontal phenotype (Figure 4).
Case 2. (a) Vertical internal bevel incision extending into alveolar mucosa and external bevel incision along distal gingival margin of gingival recession (GR) defect. (b) Deepithelialized area after intrasulcular incision. (c) Flap of mix thickness. (d) Mesial papilla of tooth 41 deepithelialized and tunnel preparation. (e) Connective tissue graft (CTG) positioned and stabilized with sutures. (f) Laterally positioned flap without tension and secured with sutures on the recipient site.
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fig5
Two weeks after the occlusal adjustment, periodontal surgical treatment was performed using the LPF + SCTG technique (T.M.M.; Figure 5).
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Case 3. Frontal view, gingival recession of 5 mm high by 3.5 mm wide.
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According to the clinical and radiographic examination, an RT1 RG was observed in the buccal surface of the left mandibular central incisor (5 mm high and 3,5 mm wide at the height of the CEJ), with a PD of 2 mm in the proximal and 2 mm on free surfaces, CAL of 7 mm on the buccal surface, absence of interproximal bone loss, biofilm accumulation, and thin periodontal phenotype (Figure 6).
Case 3. (a) Vertical internal bevel incision extending in alveolar mucosa and an external bevel incision along distal gingival margin of gingival recession (GR) defect. (b) Flap of mix thickness. (c) CTG positioned and stabilized with sutures. (d) Laterally positioned flap without tension and secured with sutures on the recipient site.
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fig7
The CTG was extended mesiodistal enough to cover tooth #31 to #33 (decision made due to the width [3.5 mm] and height [5 mm] of the GR), to cover the exposed root surface and remain within the tunnel created under the initial mesial incision of tooth #31, to later be covered by LPF (Figure 7).
Case 1. Healing 18 months postoperatively. (a) Left side view showing complete root coverage. (b) Right side view showing maintenance of integrity of donor bed. (c) Front view showing keratinized tissue width gain and gingival tissue color very similar to that of the adjacent area.
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The follow-up time intervals were 18, 24, and 48 months, in cases 1, 2 and 3, respectively (Figures 8-10).
Case 2. (a) Frontal aspect of smile with visualization after healing 24 months postoperatively. (b) Front view showing complete root coverage and keratinized tissue width gain.
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The follow-up time intervals were 18, 24, and 48 months, in cases 1, 2 and 3, respectively (Figures 8-10).
Case 3. Frontal view, healing 48 months postoperatively demonstrating complete root coverage; maintenance of integrity of the donor flap area, keratinized tissue width gain, and gingival tissue color very similar to that of the adjacent area.
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The follow-up time intervals were 18, 24, and 48 months, in cases 1, 2 and 3, respectively (Figures 8-10).