PMC7481965_01
A 22-year-old man with gingival recession in the mandibular left central incisor. (a) Periapical radiograph. (b) Intraoral photograph of the labial side.
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The height of the interdental bone was normal, but loss of the interdental papilla was observed (Figures 1(a) and 1(b)).
(a) Tunnel preparation. (b) Deepithelialization using a high-speed handpiece at the hard palate. (c) Partially deepithelialized connective tissue graft. (d) Collagen dressing of the donor site.
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It was ensured that no trauma occurred to the marginal gingiva (Figure 2(a)). Thereafter, approximately 0.5-1 mm of epithelial layer was removed using a high-speed handpiece and a 2 mm-diameter round diamond bur, except for the designed epithelial portion (Figure 2(b)). The graft was carefully retrieved through a split-thickness flap using a 15C blade (Figure 2(c)). The donor site was dressed with collagen matrix (Collatape , Zimmer Dental, Mississauga, Canada) and secured with crossed horizontal sling suture technique using 5-0 monofilament suture (Dafilon , B Braun, Melsungen, Germany) (Figure 2(d)).
(a) The graft was introduced and secured using a vertical double-crossed suture. (b) Superficial epithelial sloughing and capillary ingrowth were observed at 1 week. (c) Optimal graft incorporation and complete reepithelization were noted at 4 weeks. (d) Complete root coverage and adequate attached gingiva were obtained at 1 year after surgery.
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Subsequently, the graft site on the left and right central incisors was secured using 5-0 monofilament suture (Dafilon , B Braun, Melsungen, Germany) with the vertical double-crossed suture technique proposed by Zuhr et al. (Figure 3(a)). Initially, it was observed that the epithelial layer was sloughing, and revascularization was observed underneath the tissue (Figure 3(b)). However, 1 month after surgery, the graft was completely reepithelized and assimilated into the surroundings with harmonious color and shape (Figure 3(c)). At 1 year postoperatively, no remarkable inflammation was observed, and the transplanted tissue was maintained (Figure 3(d)).