Objectives To compare Double Flap Incision (DF), Coronally Advanced Lingual Flap (CALF), and Modified Periosteal Releasing Incision (MPRI) to Periosteal Releasing Incision (PRI) in flap advancement, postoperative complications in augmentation using titanium mesh. Material and methods Forty patients with partially edentulous posterior mandibles were randomly assigned to the four groups. We evaluated: (a) Flap advancement in mm (Primary outcome). (b) Pain using the Numerical Rating scale (NRS). (c) Swelling using the Visual Analogue Scale (VAS). (d) Exposure in mm and exposure percentage at 1 week to 6 months. Results The CALF showed the highest mean flap advancement of 19.9 (±5.0) mm while the PRI showed the lowest; 10.2 (±1.7) mm. The difference between groups was statistically significant (P value <.0001). MPRI showed the highest pain score of 5.3 (±1.3) while the DF showed the lowest; 2.39 (±1.7). Swelling did not show a significant difference between groups. MPRI showed the highest exposure mean; 18.6 mm (±26.3) while CALF showed the lowest; 2.5 mm (±4.0). PRI showed the highest exposure percentage; 7.4% (±9.3) while CALF showed the lowest; 0.4% (±0.7). The difference between groups was insignificant. Conclusions CALF reported highest advancement, least complications while PRI reported the highest complications.

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Introduction: This case report describes a technical modified method for harvesting a de-epithelialized connective tissue graft used for root coverage procedure. This simplified, time saving approach can be used as an alternative to the conventional subepithelial connective tissue graft or de-epithelialized grafts previously introduced. Case Presentation: A healthy 22-year-old male patient presented with a 2 mm recession on tooth #24 and a 1 mm recession on tooth #25 caused by periodontitis. Results: Root coverage procedure was performed using a de-epithelialized graft harvested by a modified method from the palate. The modification is to de-epithelialize the graft with the desired dimensions on the palate and then harvest it already de-epithelialized. Complete root coverage with stable 2 year follow-up was documented. Conclusions: Recession defects can be treated with a modified de-epithelized graft harvested from the palate without significant inflammation. This technique may serve as an alternative for the conventional SECTG or de-epithelialized grafts.

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