case_images: PMC11232801_01
case_images: (a) Immediate preoperative view, tooth #31: Showing dimensions of recession defect; (b) Preoperative intraoral periapical radiographic view, Tooth #31
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case_images: There was no evidence of noncarious cervical lesions, root caries, or gross occlusal disharmony [Figure 1a]. There was no evidence of caries or any sign of periapical changes [Figure 1b].
case_images: Intraoperative views, tooth #31: (a) Recipient bed prepared (b) Laterally flipped periosteum being rotated from the adjacent edentulous site (c) Rotated periosteum sutured to the recipient bed using Ethicon Prolene Sutures (d) Free gingival graft stabilized on recipient bed using cyanoacrylate and suspensory suture
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case_images: Carefully, a partial thickness flap was elevated, exposing the underlying connective tissue bed, and 5 mm x 7 mm of connective tissue with periosteum was gently elevated as per the guidelines provided by the laterally displaced flap [Figures 2a and b]. The laterally flipped pedicle flap was stabilized over the exposed root surface using Ethicon Prolene Sutures [USP 6-0, 3/8 Circle Reverse Cutting NW879] [Figure 2c]. The graft was then adapted onto the periosteal connective tissue recipient bed using cyanoacrylate adhesive and stabilized in position by a suspensory suture using 3-0 black silk [Figure 2d].
case_images: Intraoperative views: (a) Palatal donor site with the free gingival graft outline; (b) Harvested free gingival graft
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case_images: A FGG, outlined based on the dimensions of the prepared recipient bed, was harvested from the left side of the palate, following the conventional guidelines [Figures 3a and b].
case_images: Diagrammatic representation of (a) Initial status -Cairo's RT2 recession and inadequate vestibular depth; (b) Recipient bed preparation- Deepithelialization and vestibular deepening; (c) Placing 3 mm long horizontal incision at the level of cementoenamel junction and then releasing incision; (d) Raising split-thickness flap from adjacent edentulous area to expose underlying periosteum; (e) Elevating periosteal pedicle from the adjacent edentulous area; (f) Sliding periosteal pedicle over denuded roots and sutured; (g) Adapting reflected split-thickness flap over periosteal donor site on adjacent edentulous area; (h) Stabilizing palatal free gingival graft using cyanoacrylate adhesive and suspensory suture
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case_images: The whole procedure is diagrammatically represented in Figure 4.
case_images: Postoperative view, 1 month: Showing healing of the recipient site in relation to tooth #31; (b) Postoperative view, 1 month: Showing complete root coverage in relation with tooth #31 with adequate width and thickness of keratinized gingiva
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case_images: Esthetic and functional outcomes were clinically appreciable, as well as very appealing to the patient, and the results were maintained until 1-year reevaluation period [Figure 5].