case_images: PMC4365168_01
case_images: Class II Miller's recession in lower left central incisor
case_images: JISP-19-99-g001.jpg
case_images: PMC4365168_01_JISP-19-99-g001.jpg
case_images: F1
case_images: A 39-year-old male patient reported with the chief complaint of unesthetic appearance of his front lower tooth [Figure 1].
case_images: 5 mm length of recession
case_images: JISP-19-99-g002.jpg
case_images: PMC4365168_01_JISP-19-99-g002.jpg
case_images: F2
case_images: On examination, it was found that 5 mm deep and 3 mm wide Class II gingival recession (Miller, 1985) was present on the lower right central incisor [Figures 2 and 3].
case_images: 3 mm width of recession
case_images: JISP-19-99-g003.jpg
case_images: PMC4365168_01_JISP-19-99-g003.jpg
case_images: F3
case_images: On examination, it was found that 5 mm deep and 3 mm wide Class II gingival recession (Miller, 1985) was present on the lower right central incisor [Figures 2 and 3].
case_images: Vestibular incision placed extending from canine to canine exposing the periosteum
case_images: JISP-19-99-g004.jpg
case_images: PMC4365168_01_JISP-19-99-g004.jpg
case_images: F4
case_images: Later, a horizontal incision was made using a no. 15 surgical blade at the mucogingival junction retaining all of the attached gingiva [Figure 4].
case_images: Preparation of recipient site
case_images: JISP-19-99-g005.jpg
case_images: PMC4365168_01_JISP-19-99-g005.jpg
case_images: F5
case_images: First, intracrevicular incision and a second incision made parallel and apical to the first incision [Figure 5].
case_images: Tunnel created at the recipient site
case_images: JISP-19-99-g006.jpg
case_images: PMC4365168_01_JISP-19-99-g006.jpg
case_images: F6
case_images: The incisions were followed by split-thickness dissection of the facially located tissue up to the level of the vestibular incision so as to create a tunnel [Figure 6].
case_images: Periosteum scraped to create the fenestration, periosteum remains attached to bone at one end
case_images: JISP-19-99-g007.jpg
case_images: PMC4365168_01_JISP-19-99-g007.jpg
case_images: F7
case_images: The care was taken not to remove the periosteal strip completely and to leave it pedicled to the bone and the rest of the surrounding periosteum at the lateral end [Figure 7].
case_images: Pedicled periosteal graft placed over the area of recession through the prepared tunnel
case_images: JISP-19-99-g008.jpg
case_images: PMC4365168_01_JISP-19-99-g008.jpg
case_images: F8
case_images: The pedicled periosteal donor tissue was then moved vertically toward the recession area, passing through the tunnel [Figure 8].
case_images: Six months postoperative view showing complete root coverage
case_images: JISP-19-99-g009.jpg
case_images: PMC4365168_01_JISP-19-99-g009.jpg
case_images: F9
case_images: At 6 months postoperative, root coverage was nearly 100% of the recipient site, with minimal probing depths, no inflammation, and a favorable esthetic result [Figure 9].