A Mucogingival Technique for the Treatment of Multiple Recession Defects in the Mandibular Anterior Region: A Case Series with a 2-Year Follow-Up

Abstract

In the mandibular anterior area, gingival recession can be associated with a minimal amount or lack of attached gingiva, a shallow vestibule, and high frenum insertion. These anatomical features may preclude the use of traditional root coverage procedures. This case series describes a a bilaminar technique with flap incision in the fornix for the treatment of adjacent gingival recession defects in patients with a shallow vestibule. It achieved high predictability in complete root coverage without decreasing the vestibular depth. At 24 months, the treatment resulted in 90.6% ± 16.8% root coverage, and 11 of the 15 treated teeth (73.3%) were completely covered.

Root Coverage Procedures for Multiple Recession Defects

“…Studies using subepithelial connective tissue graft (SCTG) on multiple Miller Class I and II gingival recession defects show mean percent root coverage ranging from 77 to 98%, with only 4 out of 17 studies reporting less than 90% [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Other than coronally positioned flaps, flap designs used include tunnel technique [12,13], modified coronally advanced tunnel (MCAT) technique [26], modified coronally advanced flap (MCAF) technique by Zucchelli and De Sanctis [17,29], and a modified coronally positioned flap with a horizontal incision in the alveolar mucosa [20].…”

“…Other than coronally positioned flaps, flap designs used include tunnel technique [12,13], modified coronally advanced tunnel (MCAT) technique [26], modified coronally advanced flap (MCAF) technique by Zucchelli and De Sanctis [17,29], and a modified coronally positioned flap with a horizontal incision in the alveolar mucosa [20]. While most studies evaluated their outcome between 6 and 12 months postoperatively, 5-year results were reported by Zucchelli et al with mean root coverage of 97% [22].…”

“…Multiple gingival recession defects in the mandibular anterior region are considered among the most challenging scenarios due to limiting factors such as shallow vestibule, inadequate keratinized tissue, and high frenum attachments. Bethaz et al evaluated a bilaminar technique for multiple gingival recession defects using a vestibular releasing incision when a shallow vestibule was present [20]. At 2-year follow-up, mean root coverage of 91% was achieved along with complete root coverage found on 73% of defects.…”

Technical Note on Root Coverage of Lower Anterior Teeth Using a Partially Deepithelialized Connective Tissue Graft (PE-CTG) Aided by a High-Speed Handpiece

“…During a coronally positioned flap (CPF) surgery, passive surgical positioning of the flap is difficult because of the shallow labial vestibule, high frenum attachment, and mentalis muscle activity. Therefore, it is difficult to achieve complete root coverage (CRC), and recurrence after surgery is high [ 5 ].…”

Efficiency of platelet-rich plasma on acellular dermal matrix application with coronally advanced flap in the treatment of multiple adjacent gingival recessions: A randomized controlled clinical trial

“…Pre- and postoperative standardized radiographs were taken to evaluate the interproximal alveolar bone level. The surgical procedure was not scheduled until the recession defects did not display either plaque deposits or bleeding on probing 20 …”