Root Coverage in the Esthetic Area with Micro-surgical Coronally Advanced Flap

Gingival recessions in the ‘esthetic zone’ are often a consequence of the buccal positioning of the teeth in the arch and improper oral hygiene (excessive brushing and or wrong technique and toothbrush).

multiple gingival recessions

Fig.1
Initial situation shows multiple gingival recessions affecting the aesthetic area. In this specific case, being the recessions related to the upper central incisors and the canine, I elected to execute two separate procedures avoiding to involve the upper left lateral incisor.

open flap on central incisors

Fig.2
A full-split thickness flap was elevated under the microscope to expose the underlying roots.

nylon suture after root coverage surgery

Fig.3
After scaling and root planing of the exposed roots, and after conditioning with EDTA, the flap was advanced coronally to completely cover the previously exposed root. Sutures are 7-0 Nylon.

before and after root coverage surgery

Fig.4
The same procedure was executed to the upper left canine. The inter proximal papilla was de epithelialized to accomodate the flap and provide the new soft tissue anatomy.

teeth and gums one week after periodontal surgery

Fig.5
One week post-op shows an early maturation of the soft tissue.

teeth and gums after root coverage surgery

Fig.6
The two-year follow-up shows the maturation and stability of the soft tissue and the good adaptation.

gingival recessions before and after periodontal surgery

Fig.7
Initial (top) and a 5-years (bottom) follow-up shows maintenance and stability of the result.

Conclusions

Gingival recessions are a very common finding in the mouth of our patients. When this problem is manifested in the esthetic zone might represent a serIous problem. The CAF (coronally advanced flap) offers today the most reliable solution to this problem. The association of this procedure with the use of the microscope, makes it less morbid and more delicate and accurate. The literature supports this procedure as one of the most effective for the resolution of the problem.

Bibliography

Cairo F, Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol. 2008 Sep; 35(8 Suppl):136-62.
Bittencourt S, Del Peloso Ribeiro E, Sallum EA, Nociti FH Jr, Casati MZ. Surgical microscope may enhance root coverage with sub epithelial connective tissue graft: A randomized controlled clinical trial. J Periodontol. 2012 Jun;83(6):721-30.
Pini Prato GP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C, Rotundo R, Muzzi L. Coronally advanced flap: the post-surgical position of the gingival margin is an important factor for achieving complete root coverage. J Periodontol. 2005 May;76(5):713-22.

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