Root coverage in a class IV recession defect achieved by creeping attachment: a case report

The amount of root coverage obtained after a graft procedure may be improved after the early phase of healing by a coronal displacement of the gingival attachment. The aim of this report is to present a clinical case of complete root coverage of a Miller's class IV recession achieved by creeping attachment subsequent to a laterally repositioned flap.

In 1995, a 44-year-old male patient was referred for a root coverage graft on the upper right central incisor. Clinical examination revealed that the upper right central incisor had a recession of 7 mm. The defect was classified as class IV according to Miller's classification of marginal tissue recession. It was decided that root coverage would be attempted using a laterally repositioned flap from the upper right lateral incisor and upper right canine. Sutures were removed ten days after surgery.

Four months after grafting, the amount of root coverage obtained was 4 mm. After an 8-year period, the previously denuded root surfaces were entirely covered by soft tissue. The marginal position of the gingiva appeared stable, the gingival tissue became firmly attached to the root surface and probing showed a shallow sulcular depth.

Several interesting observations were made after 8 years. In conclusion, the most significant and interesting finding of this report is that the amount of interdental papilla and marginal gingival tissue covering donor and recipient areas improved with time, providing an excellent aesthetic appearance.