PMC7545419_01
Left maxillary canine presenting a RT2 gingival defect.
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A 53-year-old male, not smoker, presenting a recession type 2 (RT2) gingival defect in correspondence of the maxillary left canine, was referred for a periodontal evaluation (Figures 1 and 2).
Lateral view: noncarious cervical lesion with composite restoration is evident (note the radicular concavity).
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fig2
A 53-year-old male, not smoker, presenting a recession type 2 (RT2) gingival defect in correspondence of the maxillary left canine, was referred for a periodontal evaluation (Figures 1 and 2).
A minimum amount of keratinized tissue apical to the recession is still present.
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Adherent keratinized tissue apical to the recession was still present with small but still adequate thickness and high to perform a CAF (Figure 3).
The composite restoration is reshaped at the maximum root coverage level.
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A trapezoidal flap is designed with vertical releasing incisions arriving just at the mucogingival junction.
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From the angular point of such bevelled incision slightly divergent, two split thickness incisions were performed reaching the mucogingival junction (Figure 5).
Two horizontal releasing incision are done: one deep, parallel to the bone crest and one, more extended, more superficial parallel to the oral mucosa (note the elasticity of the mucosa).
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fig6
After a second, more extended superficial horizontal incision was performed with the blade parallel to the oral mucosa, in order to mobilize the flap thanks to mucosa's elasticity, without cutting deeper structure, reducing in such way the possible bleeding and swelling (Figure 6).
Root surface is treated with curettes and anatomical papillae deepithelialized.
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The anatomical papillae were deepithelialized (Figure 7).
An epithelial-connective tissue graft is harvested. The height is 4 mm, and the length corresponds to the root width plus 3 mm.
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The dimension of the graft was 4 mm in height and in length, and the mesiodistal dimension was 1.5 mm exceeding in both side the avascular root surface in the area corresponding the MRC (Figure 8).
The connective tissue graft is attached with the fibrin-fibronectin glue to the root at the MRC level.
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fig9
After washing the root surface with physiological solution, the fibrin fibronectin glue (Tisseel VH  , Baxter, U.S.A.) was applied with two drops on the side of the graft facing the dental surface and the graft was immediately positioned on the root at the established level and maintained in such position with a slight finger pressure for 5 minutes (Figures 9 and 10).
Note the thickness of the CTG bonded to the root.
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fig10
After washing the root surface with physiological solution, the fibrin fibronectin glue (Tisseel VH  , Baxter, U.S.A.) was applied with two drops on the side of the graft facing the dental surface and the graft was immediately positioned on the root at the established level and maintained in such position with a slight finger pressure for 5 minutes (Figures 9 and 10).
The flap has been coronally advanced and sutured.
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fig11
Finally, a sling suture, suspended around the cingulum was done, suturing the surgical papillae to the corresponding anatomical papillae (Figure 11).
Healing of the flap after 15 days, at sutures removal.
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After 15 days, sutures were removed and both surgical areas appeared in good status (Figures 12 and 13).
Palatal donor site healing after 15 days.
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After 15 days, sutures were removed and both surgical areas appeared in good status (Figures 12 and 13).
3-year lateral view (note the thickness of the soft tissue corresponding to the grafted area).
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In addition, gingival thickness graft improved during these years, creating a good connective tissue protection to the underlying periodontal structures as well as a natural emergency profile of the anatomical crown (Figures 14 and 15).
3-year buccal view (note the stability of the gingival margin, the partial root coverage achieved and the aesthetic blending of the area).
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fig15
In addition, gingival thickness graft improved during these years, creating a good connective tissue protection to the underlying periodontal structures as well as a natural emergency profile of the anatomical crown (Figures 14 and 15).