PMC8238592_01
Preoperative front view of the patient showing a deep recession at #22.
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A 28-year-old nonsmoking female was referred to a private practice in Londrina, Parana, Brazil, in February 2017 for the treatment of an isolated deep-wide recession on the buccal aspect of tooth #22 (Figure 1).
Preoperative close view showing the root defect covered with composite and an absence of keratinized tissue.
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The first attempt to treat the area was using a composite on the root exposure to control her sensitivity (Figure 2).
Iodine solution staining revealed the presence of approximately 3 mm of keratinized tissue at the donor area distal to the defect. This area was not adequate for an LPF.
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The MARF technique was used to increase the donor area. Initially, a horizontal incision was made onto the attached portion of the gingiva.
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This consisted of a horizontal beveled incision made on the attached portion of keratinized tissue at an angle of 45 degrees, formed by the blade and the portion of the gingiva, making contact with periosteum at a point slightly apical to the alveolar crest (AC) (Figure 4).
Next, two vertical incisions extending through the mucogingival line were made to connect to the horizontal incision. A split thickness was moved 3 mm apically and sutured.
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The split-thickness flap was repositioned 5 mm apically and secured with three single absorbable sutures (Figure 5).
Eight weeks later, the donor area was increased to approximately 6 mm.
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Eight weeks later (Figure 6), the second procedure was performed using the LPF.
A beveled bleeding area was created mesially in the reception area.
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A split-thickness flap with approximately 4.5 mm of keratinized tissue and free of tension was passively transferred laterally over the recipient area and sutured with nonabsorbable material (Figures 7 and 8).
The 4.5 mm of keratinized tissue was moved laterally to the receptor area and sutured at CEJ. Note that the collar of 1.5 mm of keratinized tissue was maintained in its original position.
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A split-thickness flap with approximately 4.5 mm of keratinized tissue and free of tension was passively transferred laterally over the recipient area and sutured with nonabsorbable material (Figures 7 and 8).
Postoperative front view at the three-year follow-up showing an excellent color match of the tissues.
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At the recipient area, the recession decreased from 7 mm to 0.0 mm, and the keratinized tissue and the attached gingiva increased from 0.0 mm to 4 mm and from 0.0 mm to 2.5 mm, respectively, in the three-year observation (Figures 9 and 10).
Close view of the treated area. Complete root coverage was obtained with 4 mm of keratinized tissue. Note that the donor area also increased its dimension with no additional recession.
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At the recipient area, the recession decreased from 7 mm to 0.0 mm, and the keratinized tissue and the attached gingiva increased from 0.0 mm to 4 mm and from 0.0 mm to 2.5 mm, respectively, in the three-year observation (Figures 9 and 10).