PMC3932284_01
Preoperative photograph showing recession in relation to 32.
CRIM.DENTISTRY2014-509319.001.jpg
PMC3932284_01_CRIM.DENTISTRY2014-509319.001.jpg
fig1
Clinical photographs were taken preoperatively (Figure 1) and postoperatively (Figure 10).
Radiograph in relation to lower anterior region showing absence of interdental bone loss.
CRIM.DENTISTRY2014-509319.002.jpg
PMC3932284_01_CRIM.DENTISTRY2014-509319.002.jpg
fig2
Intraoral periapical radiograph (IOPA) of the area showed no bone loss in relation to number 32 (Figure 2).
Proposed flap design for double papillary in relation to tooth number 32.
CRIM.DENTISTRY2014-509319.003.jpg
PMC3932284_01_CRIM.DENTISTRY2014-509319.003.jpg
fig3
Figure 3. Following local anesthesia, an intracrevicular incision through the bottom of the crevice followed by mesial and distal vertical releasing incisions were made including both papillae adjacent to 32 (Figure 4).
Intracrevicular incision followed by mesial and distal vertical releasing incisions for double papilla flap in relation to tooth number 32.
CRIM.DENTISTRY2014-509319.004.jpg
PMC3932284_01_CRIM.DENTISTRY2014-509319.004.jpg
fig4
Figure 3. Following local anesthesia, an intracrevicular incision through the bottom of the crevice followed by mesial and distal vertical releasing incisions were made including both papillae adjacent to 32 (Figure 4).
Partial thickness flap reflection in relation to tooth number 32.
CRIM.DENTISTRY2014-509319.005.jpg
PMC3932284_01_CRIM.DENTISTRY2014-509319.005.jpg
fig5
A partial thickness flap was reflected by sharp dissection as close to the periosteum as possible, beyond the mucogingival junction, and was extended until the partial thickness flap could be passively positioned over the defect without tension (Figure 5).
Donor site in the palate used for harvesting the subepithelial connective tissue graft.
CRIM.DENTISTRY2014-509319.006.jpg
PMC3932284_01_CRIM.DENTISTRY2014-509319.006.jpg
fig6
Subepithelial connective tissue graft was obtained (Figure 7) in the region of number 24 and number 25 from the palate with two incisions (L-shape) (Figure 6), to prevent severe postoperative pain and discomfort and for early wound healing.
Harvested free connective tissue graft.
CRIM.DENTISTRY2014-509319.007.jpg
PMC3932284_01_CRIM.DENTISTRY2014-509319.007.jpg
fig7
Subepithelial connective tissue graft was obtained (Figure 7) in the region of number 24 and number 25 from the palate with two incisions (L-shape) (Figure 6), to prevent severe postoperative pain and discomfort and for early wound healing.
Papillary grafts from adjacent papillae first sutured midbuccally in relation to recipient site.
CRIM.DENTISTRY2014-509319.008.jpg
PMC3932284_01_CRIM.DENTISTRY2014-509319.008.jpg
fig8
The harvested connective tissue graft was sutured over the defect using a 5-0 vicryl suture to cover the graft, both papillae were first sutured midbuccally in relation to number 32 (Figure 8) followed by suturing of vertical incisions using 5-0 mersilk suture without tension (Figure 9).
Suturing of vertical incisions using 5-0 mersilk suture without tension.
CRIM.DENTISTRY2014-509319.009.jpg
PMC3932284_01_CRIM.DENTISTRY2014-509319.009.jpg
fig9
The harvested connective tissue graft was sutured over the defect using a 5-0 vicryl suture to cover the graft, both papillae were first sutured midbuccally in relation to number 32 (Figure 8) followed by suturing of vertical incisions using 5-0 mersilk suture without tension (Figure 9).
Sixth month postoperative view showing complete recession coverage in relation to tooth number 32.
CRIM.DENTISTRY2014-509319.010.jpg
PMC3932284_01_CRIM.DENTISTRY2014-509319.010.jpg
fig10
Clinical photographs were taken preoperatively (Figure 1) and postoperatively (Figure 10).