PMC4365168_01
Class II Miller's recession in lower left central incisor
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F1
A 39-year-old male patient reported with the chief complaint of unesthetic appearance of his front lower tooth [Figure 1].
5 mm length of recession
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F2
On examination, it was found that 5 mm deep and 3 mm wide Class II gingival recession (Miller, 1985) was present on the lower right central incisor [Figures 2 and 3].
3 mm width of recession
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F3
On examination, it was found that 5 mm deep and 3 mm wide Class II gingival recession (Miller, 1985) was present on the lower right central incisor [Figures 2 and 3].
Vestibular incision placed extending from canine to canine exposing the periosteum
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F4
Later, a horizontal incision was made using a no. 15 surgical blade at the mucogingival junction retaining all of the attached gingiva [Figure 4].
Preparation of recipient site
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F5
First, intracrevicular incision and a second incision made parallel and apical to the first incision [Figure 5].
Tunnel created at the recipient site
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F6
The incisions were followed by split-thickness dissection of the facially located tissue up to the level of the vestibular incision so as to create a tunnel [Figure 6].
Periosteum scraped to create the fenestration, periosteum remains attached to bone at one end
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F7
The care was taken not to remove the periosteal strip completely and to leave it pedicled to the bone and the rest of the surrounding periosteum at the lateral end [Figure 7].
Pedicled periosteal graft placed over the area of recession through the prepared tunnel
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F8
The pedicled periosteal donor tissue was then moved vertically toward the recession area, passing through the tunnel [Figure 8].
Six months postoperative view showing complete root coverage
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F9
At 6 months postoperative, root coverage was nearly 100% of the recipient site, with minimal probing depths, no inflammation, and a favorable esthetic result [Figure 9].