The Double Subepithelial Connective Tissue Pedicle Graft Combined with an Interproximal- Buccal Tunneling Approach for Restoring Bilateral Missing Papillae: A Case Report.

Abstract

This case report presents a papillary reconstructive surgical procedure based on the use of a double subepithelial connective tissue pedicle graft (SCTPG) in conjunction with a coronally advanced tunnel flap (CATF) for root coverage of gingival recession defects (GRDs) with interproximal tissue loss and adjacent collapsed papillae. Two GRDs (teeth 12 and 13; FDI numbering system) with interproximal tissue loss and collapsed papillae were treated by means of a bilaminar approach, based on the use of a palatal double SCTPG rotated and inserted into a palatal-buccal tunnel flap at the level of the mesial and distal papillae of the maxillary right lateral incisor, associated with a CATF. Seven months after surgery, complete root coverage was achieved in both GRDs. Concerning the reconstruction of tooth 12's papillae, the distance from the contact point to the tip of the distal and mesial papillae decreased from 5 to 2 mm and from 4 to 2 mm, respectively. Overall, the patient was highly satisfied with the outcome. Within the limits of this case report, it could be demonstrated that the double SCTPG + CATF promoted prominent clinical and esthetic improvements to the baseline conditions of both the GRDs and collapsed papillae.