Two-step procedure for root coverage using a free gingival graft and a subepthelial connective tissue graft

Gingival recession is a multifaceted problem, for which several treatment options are available. Both epithelized and subepithelial connective tissue grafts offer predictable solutions for the treatment of gingival recession.The case report involved a 30-year-old man with gingival recession of 8 mm on 41 (Miller's class II recession). Before surgery, full mouth scaling and polishing were performed. Recession height, width, probing depth, clinical attachment level (CAL), and width of the attached gingiva (WAG) were measured at the baseline, two months postoperatively, and six months postoperatively. Four weeks after scaling, the first step of increasing the width of the attached gingiva was carried out, using a free gingival graft. Two months after this step, the subepithelial connective tissue was harvested from the palate and placed in relation to 41, to cover the residual defect.Two months postoperatively, there was a 3 mm gain in WAG and 35% root coverage. Six months postoperatively there was a significant increase in WAG, CAL; and reduction in height and width of recession (root coverage achieved was 75%). These results suggested that this two-stage surgical procedure could be successful for root coverage in case of deep recession and lack of attached gingiva in the mandibular anterior region.