Double laterally moved coronally advanced flap combined with a connective tissue graft plus enamel matrix derivatives for the management of adjacent deep gingival recessions in lower incisors: A case report

Background

Several surgical approaches have been described for the management of deep adjacent gingival recessions (GRs) in the lower anterior sextant with contrasting clinical outcomes. A modified surgical technique is presented, which consists of a double laterally moved and coronally advanced flaps in combination with a connective tissue graft (CTG) and enamel matrix derivatives (EMDs).

Methods and Results

A 42-year-old systemically healthy female presented with dentin hypersensitivity and discomfort while brushing on two adjacent Cairo recession Type 2 of 7-mm depth with a narrow band of keratinized tissue in the lower incisors. The root coverage procedure was performed using a double laterally rotated and coronally advanced flap combined with a CTG harvested from the lateral palate and EMD. At 1-year follow-up, 85% of both of the roots were covered and 6 mm of keratinized tissue width was gained.

Conclusion

The presented technique is a predictable procedure for treating adjacent and deep GRs in the anterior sextant whenever keratinized tissue lateral to the gingival defects is available.

Key points

Why is this case new information?

• To the best of our knowledge, this is the first case report in the literature using a double laterally moved and coronally advanced flap combined with EMD and CTG for adjacent deep recessions.

What are the keys to successful management of this case?

• Flap design, handling of the bilateral pedicles, and suture technique are the most important factors to obtain a predictable root coverage.

What are the primary limitations to success in this case?

• Lack of keratinized tissue lateral to the recession defects, flap tension, and interproximal attachment loss are the main limitations to succeed with this technique.