PMC5352164_01
(A) Initial clinical examination of the maxillary right canine with gingival recession and cervical abrasion. (B) Initial clinical examination of the maxillary left canine with gingival recession and cervical abrasion.
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The bilateral maxillary canines showed gingival recession, with 3 mm, thick gingival biotype and 4 mm high-keratinized gum (Figure 1 A and B).
(A) Shade selection. (B) Background white resin application on the maxillary left canine.
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Following shade selection (Figure 2A), initially, the Admira Bond (VOCO) adhesive system was used according to the manufacturer's recommendations. This resin was applied to mask the dark background of the stained substrate (Figure 2B).
The completed and polished restoration on the maxillary left canine.
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Finally, the finishing and polishing was performed with sandpaper disks and drills for resin (Figure 3).
Intrasulcular incision with two vertical relaxing incisions in the maxillary vestibule.
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Then, we placed mesial and distal vertical relaxing incisions and raised a mucoperiosteal flap (Figure 4).
(A) Total displacement of the flap in the apical direction and coronal traction of the flap. (B) Stabilization of the coronally positioned flap using one suspension suture each in the mesial and distal papillae and simple sutures to close the relaxing incisions.
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Using a periosteal Molt 7A spatula, we completely shifted the flap apically to provide the tissue with complete mobility, which subsequently facilitated coronal advancement of the soft tissue (Figure 5A). To stabilize the flap, each suspension suture was placed in the mesial and distal papillae, while simple sutures were used to close the relaxing incisions (Figure 5B).
(A) Internal bevel incision with a half-moon shape above the mucogingival line and coronal traction of the flap. (B) Stabilization of the coronally positioned tissue using suspension sutures, with the most apical portion of the connective tissue exposed for healing by secondary intention.
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The incision was placed above the mucogingival line in a half-moon shape, preserving the interdental papilla (Figure 6A). The coronally positioned tissue was stabilized with mesial and distal suspension sutures, leaving the most apical portion of the connective tissue exposed for healing by secondary intention (Figure 6B).
Clinical appearance of the right canine at 21 days after surgery.
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Partial root coverage on both sides was observed at 21 days (Figures 7 and 8), with no dentin hypersensitivity and satisfactory esthetics.
Clinical appearance of the left canine at 21 days after surgery.
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Partial root coverage on both sides was observed at 21 days (Figures 7 and 8), with no dentin hypersensitivity and satisfactory esthetics.
Clinical appearance of the right canine at 12 months after surgery.
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After 12 months, almost complete root coverage was observed on both sides (Figures 9 and 10), although esthetics were better for the right canine because of a less visible scar.
Clinical appearance of the left canine at 12 months after surgery.
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After 12 months, almost complete root coverage was observed on both sides (Figures 9 and 10), although esthetics were better for the right canine because of a less visible scar.