case_images: PMC10834094_01
case_images: The timeline depicts the baseline assessment, the apically repositioned flap (in red), suture removal, soft tissue healing, and TCAF (in red), reporting pain killer's intake, gel administration, and pain levels for each postoperative week.
case_images: CRID2024-5571545.001.jpg
case_images: PMC10834094_01_CRID2024-5571545.001.jpg
case_images: fig1
case_images: As mentioned on the timeline (Figure 1) there was a first apically repositioned flap that allowed to remove tension on the site (Figures 2(A)-2(F)). As shown in Figure 1, the pain killer intake during the healing period was 3 tablets for the first surgery and 2 tablets after TCAF, while the pain perception showed a mean of 4.33 and 4.25, respectively.
case_images: Apically repositioned flap and gel application directly after surgical intervention.
case_images: CRID2024-5571545.002.jpg
case_images: PMC10834094_01_CRID2024-5571545.002.jpg
case_images: fig2
case_images: As mentioned on the timeline (Figure 1) there was a first apically repositioned flap that allowed to remove tension on the site (Figures 2(A)-2(F)). After performing both surgeries, a gel (Biorepair Parodontgel, Coswell Spa, Bologna, Italy) with hyaluronic acid and other active molecules (Biorepair Plus Parodontgel  Protezione Gengive: aqua, zinc hydroxyapatite (microRepair ) 20%, glycerin, sorbitol, hydrated silica, silica, cocamidopropyl betaine, cellulose gum, aroma, lactoferrin, sodium myristoyl sarcosinate, sodium methyl cocoyl taurate, Hamamelis virginiana leaf extract, Spirulina platensis extract, Calendula officinalis flower extract, zinc PCA, sodium hyaluronate, tocopheryl acetate, retinyl palmitate, sodium saccharin, phenoxyethanol, benzyl alcohol, sodium benzoate, potassium sorbate, limonene, and CI 77891) was applied directly on the wound 3 times per day for 7 days (Figures 2(D) and 2(E)).
case_images: Tunneled coronally advanced flap step by step: (A) baseline after 8 weeks from the apically repositioned flap; (B) incision; (C) soft tissue grafting; (D) suturing phase; (E) after 7 days; (F) at 4 weeks.
case_images: CRID2024-5571545.003.jpg
case_images: PMC10834094_01_CRID2024-5571545.003.jpg
case_images: fig3
case_images: After 8 weeks, a tunneled coronally advanced flap (TCAF) as described by Barootchi and Tavelli was applied combined with a CTG harvested from the palate (Figures 3(A)-3(F)). Figures 3(A)-3(F)) illustrate the execution of the TCAF.
case_images: Volumetric analysis showing the treated site where an increase in thickness was observed (blue area).
case_images: CRID2024-5571545.004.jpg
case_images: PMC10834094_01_CRID2024-5571545.004.jpg
case_images: fig4
case_images:  Figure 4 shows the superimposed model and the analysis performed with a squared region of interest starting for the cement-enamel junction (CEJ) considering the mesial and distal papilla through the apical portion of the exposed root.
case_images: Linear changes from baseline to 8 weeks at the buccal aspect show a root coverage of 93% and a soft tissue thickness ranging from 0.25 to 1.81 mm.
case_images: CRID2024-5571545.005.jpg
case_images: PMC10834094_01_CRID2024-5571545.005.jpg
case_images: fig5
case_images: At 8 weeks after the TCAF procedure the mean gain obtained was of 1.23 mm with a maximum of 3.75 mm and a minimum of 0.25 mm, moreover, using a cross-section of the scans and highlighting 8 points at 1 mm from each other it was possible to observe how the CTG underneath was crucial for the increase root coverage (Figure 5).
case_images: (A) Baseline lateral perspective; (B) baseline frontal perspective; (C) lateral view at the 8-week follow-up; (D) frontal view at the 8-week follow-up.
case_images: CRID2024-5571545.006.jpg
case_images: PMC10834094_01_CRID2024-5571545.006.jpg
case_images: fig6
case_images: During the entire healing period, the application of the healing gel did not show any adverse effect conversely showing reduced edema swelling and patient discomfort.  Figure 6 shows the baseline and 8-week follow-up results.