Novel Surgical Approach for Root Coverage of Single Deep Recessions on Mandibular Incisors: Gingival Pedicle With Split‐Thickness Tunnel Technique

Abstract

IntroductionGingival recession is a very common mucogingival defect in the adult population, with mandibular central and lateral incisors being the most frequently affected teeth. Limited information is available about the management of isolated deep recession lesions in the mandibular anterior area, where the predictability of the root coverage is reduced by unfavorable anatomical conditions. The purpose of this case report is to present a novel surgical technique for deep labial recessions on mandibular incisors, based on a gingival pedicle with split‐thickness tunneling (GPST), in combination with connective tissue graft (CTG).Case PresentationA 25‐year‐old female patient presented with a Class II Miller isolated buccal recession on #24, 5 × 3 mm. The recipient site design consisted of a laterally positioned flap with a width of 4 mm, in combination with a split‐thickness tunnel preparation that reached the mesial line angle of #25 and extended beyond the mucogingival junction. A CTG (13 × 7 mm) was harvested from the palate and properly adapted over the root surface. Graft and flap were secured with internal mattress and single‐interrupted sutures. Complete root coverage was obtained and maintained at 6 months with excellent esthetic outcomes.ConclusionThis novel surgical approach, based on the combination of laterally displaced pedicle flap and tunneling in addition to CTG, seems to lead to promising results for the treatment of single deep mandibular anterior recessions.

New Surgical Approach for Mandibular Anterior Root Coverage by Modified Tunnel Technique With Simultaneous Frenuloplasty: Technical Description and 5‐Year Recall Case Report

“…12 More recently, a combination of gingival pedicle with a tunnel technique has been described in this journal, but lateral displacement of the pedicled gingiva, in addition to being technically difficult, requires having an amount of gingiva lateral to the recession, which is rarely the case when the vestibule is shallow. 15 The surgical combined tunnel technique presented in this report for the first time allows complete coverage of the CTG and thus ensures optimal vascularization, even with thin periodontal phenotypes and severe shallow vestibule. Concomitant frenuloplasty allows a tension-free healing, but also acts as a deepening of the vestibule by isolating the graft site from the labial submucosal tissue.…”

“…Exposing a marginal portion of the CTG may be a solution, but it would adversely affect the vascular supply to that area, and studies show keratinized tissue gain but less recession coverage in such situations 12 . More recently, a combination of gingival pedicle with a tunnel technique has been described in this journal, but lateral displacement of the pedicled gingiva, in addition to being technically difficult, requires having an amount of gingiva lateral to the recession, which is rarely the case when the vestibule is shallow 15 …”

Gingival pedicle with split‐thickness tunnel technique: A retrospective case series for single mandibular anterior recessions

“…The surgical approach called “GPST” technique was described in detail previously 7 . Clinical examples of the surgical steps are presented in Figures 1–4.…”

“…In fact, the mandibular anterior area is characterized by several anatomical challenges, such as thin tissues, minimal vestibular depth, lack of keratinized mucosa, and high muscular attachments, 6 which hinders flap management and tissue mobilization during the surgical procedure. Recently, to reduce the risk of perforations and early flap dehiscence in this area, a specific approach, called gingival pedicle with split‐thickness tunnel (GPST) technique, was proposed for the treatment of deep isolated gingival recessions on mandibular incisors and canines 7 . Therefore, the aim of this paper is to present the results obtained in a series of 15 patients treated by means of GPST technique.…”

“…Recently, to reduce the risk of perforations and early flap dehiscence in this area, a specific approach, called gingival pedicle with split-thickness tunnel (GPST) technique, was proposed for the treatment of deep isolated gingival recessions on mandibular incisors and canines. 7 Therefore, the aim of this paper is to present the results obtained in a series of 15 patients treated by means of GPST technique. 1.…”