case_images: PMC10849809_01
case_images: The two lower central incisors show false gingival recession with thin and narrow interdental papilla (a), the occlusal view shows the mesial rotation of both central incisors and obvious frenal attachment (b), the flap was raised with pouching laterally and apically (c), FGG was deepithelialized on lateral ends (d), the graft was placed over the recession and deepithelialized ends placed under the pouch (e), the graft was sutured to the recipient tissue margins (f), and the area is covered with healthy, thick, and keratinized tissue (g, h).
case_images: CRID2024-5510846.001.jpg
case_images: PMC10849809_01_CRID2024-5510846.001.jpg
case_images: fig1
case_images: The CEJs were covered with gingiva, and there was no sign of steps at the cervical area (Figures 1(a) and 1(b)). The pouch was prepared with a tunneling instrument, and then, it was extended and raised laterally (Figure 1(c)). The graft was deepithelialized on both sides, while the epithelium remained intact in the middle part of the graft (Figure 1(d)). The coronal part of the graft pulled the gingival margin tags coronally (Figure 1(e)). The graft then was secured and immobilized with interrupted sutures (Figure 1(f)). The interdental papilla had also improved in consistency from a thin delicate gingival to a thick triangle that filled the interdental space (Figure 1(g)). Twenty-four-month postoperative follow-up shows the increase in the thickness of the keratinized gingiva (Figure 1(h)).
case_images: PMC10849809_02
case_images: Two lower central incisors show RT2 recession with missing adjacent lateral incisors (a), tissue tunneling was performed up to the midline of both canines (b-d), deepethialized CT was examined over the recession and edentulous area (e), the CTG was fixed with sutures over the teeth (f), and partial root coverage with thick tissue was achieved after 3 months (g, h).
case_images: CRID2024-5510846.002.jpg
case_images: PMC10849809_02_CRID2024-5510846.002.jpg
case_images: fig2
case_images: There was a narrow band of keratinized tissue apical to the free gingival margin, and no mobility was detected at either of the central incisors (Figure 2(a)). Coronally, the tunneling extended to the level of the alveolar ridges of the lateral incisor edentulous areas (Figures 2(b)-2(d)). A long free gingival graft of 1 mm thickness was harvested from the palate and completely deepithelialized with a 15c blade (Figure 2(e)). The graft was placed under the tunneling pouch and stretched laterally by the sutures, as previously described and fixed to the facial aspects of the left and right canines with composite, and then, the graft was advanced coronally on the labial surface of the crowns (Figure 2(f)). The gingival margins on the central incisors were now very close to the coronal level of the edentulous area's height (Figures 2(g) and 2(h)).
case_images: PMC10849809_03
case_images: Clinical image shows RT2 with no keratinized tissue around the recession (a), the recession length and width are 3 mm and 2 mm, respectively (b, c), coronally advanced flap with CTG (d), day 3 shows inflammation around the surgical area (e), day 14 shows shrinkage on the surgical area (f), postoperative labial and occlusal views show proper root coverage with proper thickness (g, h).
case_images: CRID2024-5510846.003.jpg
case_images: PMC10849809_03_CRID2024-5510846.003.jpg
case_images: fig3
case_images: The tooth had drifted laterally, and there was a deep vestibule, high frenal attachment, and a thin gingival biotype, with no keratinized gingival tissue on the tooth that was revealing a recession (Figure 3(a)). The recession dimensions were 3 mm high and 2 mm wide, and the root was exposed interproximally, displaying CEJ obviously at both interproximal and labial surfaces of the tooth with a flat interdental papilla (Figures 3(b) and 3(c)). The flap was placed over the graft and fixed with two sling sutures, and the vertical incisions were sutured by interrupted suture stitches (Figure 3(d)). After 6 months, full coverage of the recessed root surface was achieved with a thick gingival tissue, as the occlusal view shows (Figures 3(e)-3(h)).
case_images: PMC10849809_04
case_images: Both canines show RT1 with steps (a, b), and clinically about 4 mm and 5 mm recession on #33 and #43, respectively (c, d); day 14 shows inflammation around the surgical areas (e, f); after three months, healthy and keratinized tissue can be seen with partial exposure of the steps (g, h), and after 6 months, there is still a healthy and stable gingiva present around the composite filling (i, j).
case_images: CRID2024-5510846.004.jpg
case_images: PMC10849809_04_CRID2024-5510846.004.jpg
case_images: fig4
case_images: A 42-year-old female patient was referred with a chief complaint of hypersensitivity and tooth elongation of both #33 and #43 (Figures 4(a) and 4(b)). On clinical examination, RT1 of 4 mm and 5 mm recession was detected on #33 and #43, respectively (Figures 4(c) and 4(d)). After 2 weeks, the flaps were covering the recession completely (Figures 4(e) and 4(f)), and 3 months later, the gingiva looked healthy and stabilized (Figures 4(g) and 4(h)). The tissue was very similar in appearance to the original (Figures 4(i) and 4(j)).