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Clinical cases

Clinical case no. 4 - Covering multiple gingival recessions at lower incisal teeth

20th of December 2022

Coverage of multiple gingival recessions at the lower incisal teeth using a verticulated flap technique displaced intracoronally with a subepithelial connective tissue graft. Recessions at the lower incisal teeth often co-occur with a thin gingival phenotype, a very narrow zone of sceratinised tissue and a shallow vestibule. Consequently, the surgical approach should take into account the correction of all the abnormalities mentioned. The surgical technique dedicated to this area is a verticalised lower lip mucosa flap displaced intracoronally. In this technique, the flap is prepared as a split-full-split flap (split flap in the gingival papilla area, full thickness up to the vestibular edge of the bony lamina and then split flap) in the case of a sceratinised zone present or only as a split at teeth where a zone of sceratinised tissue is absent. From the periosteal surface located apically to the dehiscence of the bone, the submucosal tissue is removed together with the muscle attachments, thus creating a bed for the subepithelial connective tissue graft. The exposed tooth root surfaces are prepared mechanically and chemically with 24% EDTA and enamel matrix-derived proteins. The SCTG is positioned at all incisal teeth at the level of the enamel-cementum junctions. Flap verticalisation is achieved with periosteal sutures positioned within the apical portions of the vertical cuts. The flap displaced intracoronally should completely cover the connective tissue graft. The sutures are removed after 14 days. The technique of the verticalised intracoronal displaced flap not only achieves optimum aesthetic results, but also restores the correct vestibular depth thus facilitating home plaque control.

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