Laterally stretched flap with connective tissue graft: a novel approach to treat deep/narrow gingival recessions in lower incisors

EuroPerio 9 Congress. European Federation of Periodontology. Amsterdam, Holland Poster Presentation PD171 Background: Different alternatives of treatment of deep/narrow gingival recessions with connective tissue grafts have been proposed: Tunneling procedures1 leave a considerable area of the graft exposed conditioning its nutrition.2,3 Coronally advancing the flap to cover the graft requires extensive repositioning of a -mostly mucosal- flap and the mucogingival junction; while lateral displacement4 is generally achieved by placing vertical incisions, potentially leaving visible scars. The aim of this case series is to present the technical description, and the results obtained with 21 gingival recessions treated with a recently published novel approach: the laterally stretched flap (LSF) with connective tissue graft (CTG).5 Technical variants, and keys to success will be reviewed. Clinical Procedure: 17 patients with 21 deep/narrow Miller class II and III gingival recessions were treated and followed-up between 6 months and 4 years. Recession depth (Rec) and keratinized tissue (KT) were registered at baseline and at final evaluation (Table 1). Mean % root coverage (MRC) and complete root coverage (CRC) were calculated. Briefly, the recipient site was prepared with intracrevicular incisions and a partial thickness envelope performed with tunneling instruments until ample tissue elasticity was obtained.5 A connective tissue graft was harvested from the palate with a modified single incision technique utilizing a parallel blade scalpel.6 The graft was inserted into the envelope and held with sutures at both lateral ends.7,8 The lateral edges of the recession were finally approximated with sutures to cover the graft. Outcomes: Clinical Outcomes: Class I and II recessions gained 99.2% of MRC and 88.5% of sites achieved CRC. Miller class III showed 79.2% of MRC and 23.1% of the sites reached CRC. KT was increased in all cases (Table 1). Conclusions: Laterally stretching the flap to cover the graft improved revascularization of the graft and wound stability rendering excellent esthetic outcomes with minimal patient discomfort.