Double laterally-rotated bilayer flap operation for treatment of gingival recession

Many root coverage techniques, such as lateral pedicle flap, double papilla flap, free gingival graft, connective tissue graft, and guided tissue regeneration (GTR) procedure have been widely applied in clinical dental practice. Although they all provide various degrees of successful root coverage, some procedures are technique-sensitive and others require a 2-stage operation.

In this study, we describe a new technique with a double laterally-rotated bilayer flap for root coverage. Briefly, 2 partial-thickness flaps were prepared, one on each side of the gingival recession, and then laterally repositioned (with mutual overlapping) to cover the root exposure. After thorough planing of the exposed root surfaces, root conditioning with saturated citric acid solution (pH = 1.0) was performed. One partial-thickness flap was de-epithelialized and then rotated to cover the citric acid-conditioned root surface. Another partial-thickness flap was further rotated to cover the de-epithelialized flap. Both flaps were sutured to the recipient periosteal bed. This new root coverage technique was used to treat 2 teeth with gingival recession.

The results demonstrated that this new technique provides satisfactory root coverage of gingival recession and improves root dentin hypersensitivity of treated teeth. The main advantages of this technique are simple 1-stage surgery, esthetic color matching of the soft tissue, and a good blood supply of the reflected flap.

We conclude that the double laterally-rotated bilayer flap operation may provide a new alternative for the treatment of gingival recession.