PMC7719491_01
Gingival recession associated to the left second upper molar showing a mucogingival defect.
CRID2020-8824246.001.jpg
PMC7719491_01_CRID2020-8824246.001.jpg
fig1
The clinical (Figure 1) and radiographic (Figure 2) evaluation revealed 5 mm Miller Class II recession on the second molar buccal aspect.
Patient's orthopantomography showing maxillary sinus pneumatization and absence of first left upper molar.
CRID2020-8824246.002.jpg
PMC7719491_01_CRID2020-8824246.002.jpg
fig2
The clinical (Figure 1) and radiographic (Figure 2) evaluation revealed 5 mm Miller Class II recession on the second molar buccal aspect.
Oroantral communication after flap dissection nearby the MV root of tooth no. 17.
CRID2020-8824246.003.jpg
PMC7719491_01_CRID2020-8824246.003.jpg
fig3
While preparing the flap, an oroantral communication was found apically to the first molar mesial buccal root with 3 mm diameter (Figure 3).
Suture of Schneider membrane with absorbable 6/0 polyglycolic acid suture.
CRID2020-8824246.004.jpg
PMC7719491_01_CRID2020-8824246.004.jpg
fig4
Oroantral communication closure started by suturing the Schneider membrane with a 6 0' absorbable suture (monofilament polyglecaprone suture, Surgiclryl-Monofast  SMI-Belgium) to close the perforation (Figure 4).
Connective tissue graft adaptation to the recipient bed.
CRID2020-8824246.005.jpg
PMC7719491_01_CRID2020-8824246.005.jpg
fig5
The connective tissue graft was sutured to the recipient bed with 6 0' absorbable suture (monofilament polyglecaprone suture Surgiclryl-Monofast  SMI-Belgium) (Figure 5), and the flap laterally and coronally moved and sutured with 5 0' nylon suture (monofilament SERALON, SERAG Wiessner) (Figure 6).
Flap laterally and coronally displaced sutured with 5 0' nylon suture.
CRID2020-8824246.006.jpg
PMC7719491_01_CRID2020-8824246.006.jpg
fig6
The connective tissue graft was sutured to the recipient bed with 6 0' absorbable suture (monofilament polyglecaprone suture Surgiclryl-Monofast  SMI-Belgium) (Figure 5), and the flap laterally and coronally moved and sutured with 5 0' nylon suture (monofilament SERALON, SERAG Wiessner) (Figure 6). A surgical stent was given to the patient to use during the following week (Figure 6).
Two weeks postop healing. Apically to the second premolar, there is an incomplete closure due to a noncompliant patient.
CRID2020-8824246.007.jpg
PMC7719491_01_CRID2020-8824246.007.jpg
fig7
Chlorhexidine 0.12%, antibiotic, and anti-inflammatory drugs were prescribed (Figures 7 and 8).
Four weeks postop healing with complete wound closure.
CRID2020-8824246.008.jpg
PMC7719491_01_CRID2020-8824246.008.jpg
fig8
Chlorhexidine 0.12%, antibiotic, and anti-inflammatory drugs were prescribed (Figures 7 and 8).
Two months of healing showing no signs of flap diescency.
CRID2020-8824246.009.jpg
PMC7719491_01_CRID2020-8824246.009.jpg
fig9
The surgery led to an almost complete root coverage, augmented width of keratinized mucosa, and probing depths < 2 mm with no bleeding on probing (Figures 9 and 10).
Eight months postop healing. Complete communication closure and complete root coverage with no signs of gingival inflammation:after.
CRID2020-8824246.010.jpg
PMC7719491_01_CRID2020-8824246.010.jpg
fig10
The surgery led to an almost complete root coverage, augmented width of keratinized mucosa, and probing depths < 2 mm with no bleeding on probing (Figures 9 and 10).