PMC5896420_01
Clinical conditions at baseline. It was noticeable the scar tissue in the region of the intervention and the persistence of a gingival recession of 2.1.
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In the region of 2.1, a small band of keratinized tissue (1 mm) was found apical to the gingival margin, and scars extending from the region of 1.1 to 2.2 were found (Figure 1).
Trapezoidal flap was prepared. The vertical incisions extended significantly beyond the mucogingival junction and were beveled.
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The vertical incisions were connected by one sulcular, which was performed in the gingival sulcus of the affected tooth (Figure 2).
After the dissection of the scar tissues that limited the mobility of the flap, it can be repositioned coronally without tensions.
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The exposed root surface was accurately debrided through sharp curette (Figure 3).
A connective tissue graft was placed in the site of the recession and stabilized by the use of resorbable sutures.
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The graft was then placed to cover the recession defect, at the level of the CEJ, and stabilized using resorbable sutures (Monocryl  5-0, Ethicon, Inc., Johnson & Johnson, Piscataway, NJ, USA) anchored to the periosteum (Figure 4).
Detail of the sutures placed for vertical incisions.
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Then, the flap was sutured with interrupted sutures on the vertical release incisions (Deknalon  6-0 Deknatel, Genzyme GmbH, Lubeck, Germany) and one sling suture (Deknalon 6-0 Deknatel, Genzyme GmbH, Lubeck, Germany) (Figures 5 and 6).
The flap was sutured in a more coronal position, and the connective tissue graft was partially covered.
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Then, the flap was sutured with interrupted sutures on the vertical release incisions (Deknalon  6-0 Deknatel, Genzyme GmbH, Lubeck, Germany) and one sling suture (Deknalon 6-0 Deknatel, Genzyme GmbH, Lubeck, Germany) (Figures 5 and 6).
Clinical conditions one year after surgical intervention. If compared to baseline, a significant reduction of gingival recession could be observed.
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After one year, a significant reduction of the gingival recession was observed with an almost complete root coverage (Figure 7).
Clinical conditions 15 years after the surgical intervention.
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This clinical condition remained stable also after 15 years (Figure 8).