BackgroundA proper case selection and decision making is essential for management of multiple marginal tissue recessions (MTR) using a conventional or bilaminar approach. Coronally advanced flap (CAF) is one of the commonly used methods for management of MTR. CAF has been advocated in combination with soft tissue grafts as bilaminar technique, which had showed significant success in terms of root coverage.Methods and ResultsAim of this case series was to retrospectively evaluate Zucchelli's modification of envelope CAF (eCAF) and site‐specific bilaminar methods using Acellular Dermal Matrix (ADM) and Connective Tissue Graft (CTG) for management of MTR. A total of 15 subjects (five subjects/25 sites per technique, total number of sites = 75) who were managed by three different techniques with 12 months postoperative records were retrospectively evaluated. All patients showed significant clinical improvement in root coverage outcomes when compared to baseline. Mean root coverage achieved at 3 months (90%), 6 months (95%) and 12 months (95%) postoperatively did not reveal significant difference between three methods. Complete root coverage was observed in 86.6% of eCAF cases and in 86.6% and 95% of ADM/CTG with eCAF, respectively. There was an increase in width of keratinised tissue, both individually and collectively across all of the groups.ConclusionClinical outcomes suggested that bilaminar techniques should be used only in specific cases. Predictable results can be obtained without the use of a soft tissue graft or substitute if a careful treatment plan for technique selection is developed on an individual case‐by‐case basis.Key pointsWhy is this case new information? Comparison of site‐specific bilaminar modalities with modified coronally advanced flap alone What are the keys to successful management of such cases? Flap advancement and mobilisation Flap passivity What are the primary limitations to success in such cases? Case selection Flap tension Soft tissue phenotype Thickness of graft Operator skills

Eyes don’t see what mind does not know. It is important for a clinician to refresh his knowledge frequently to recognize some of the conditions that one may come across rarely no matter how insignificant the condition may seem. Especially in a dental outpatient department setting, individuals may complain of varied symptoms which the clinician, often tends to correlate to one of the oral diseases. We present a case of Eagle's syndrome with vague clinical presentation which could have easily gone undiagnosed if not for the application of simple diagnostic procedures and aids like Orthopantamogram (OPG).

Background: Connective tissue harvesting from the hard palate has been practiced since decades and remains the ‘gold standard’ for soft tissue grafts. Very little has been researched on healing patterns of the palatal donor site and the incidence of post-operative complications of donor site. Aim: The aim of the study was to evaluate the influence of two different suturing methods on the healing outcomes of donor site after Connective Tissue Graft (CTG) harvsting. Material and Methods: Thirty patients who had undergone CTG harvest for various procedures were analyzed for the assessment of clinical healing outcomes of palatal donor site. A similar technique for the harvest of CTG in both groups was used using Liu’s class Ia incision. The method of closure of the donor site in these patients was divided into two groups; Group A – combination of criss-cross and horizontal mattress sutures and Group B – simple interrupted sutures. The parameters assessed preoperatively were palatal tissue thickness, intraoperative superficial palatal flap thickness and postoperatively the incidence of post-operative complications and donor site healing was assessed using Wachtel’s index (2003) at 7 days, 14 days and 1 month postoperatively. Results: The incidence of complications was more in Group B in comparison to Group A. The healing outcomes differed significantly between Group A and B at 7 days, 14 days and 1 month postoperatively; however, there was no statistically and clinically significant difference at 03 months post operatively. Conclusion: The combination of criss-cross with horizontal mattress suture for closure of palatal donor site after harvesting with Liu’s Class Ia incision was found to yield superior patient comfort and lesser post-operative complications during the early healing period.

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