Treatment of an advanced gingival recession involving the apex of the tooth: periodontal plastic, endodontic surgical approach with a laterally stretched flap and a connective tissue graft

INTRODUCTION: This case report presents the successful multidisciplinary treatment of a maxillary lateral incisor with a deep and narrow recession involving the root apex associated with pulpal necrosis. The tooth initially considered with a hopeless prognosis, was treated with a combined periodontal plastic, regenerative, and endodontic surgical procedure. CASE PRESENTATION: A recently reported technique, the laterally stretched (LAST) flap with a connective tissue graft (CTG) technique for root coverage, was combined with enamel matrix derivative (EMD) for periodontal regeneration of the periapical lesion, that complemented an apicoectomy with retrograde sealing. The 6-year follow-up evidenced root coverage (RC) of 91.6% and increased keratinized tissue. Clinical and radiographic evaluation showed resolution of the periapical process. CONCLUSIONS: A severe gingival recession with endodontic involvement can be repaired if adequate control of the endodontic infection is obtained. The LAST flap, originally described for lower anterior teeth, was used successfully in a maxillary tooth, under extreme circumstances.