Novel Surgical Approach for Root Coverage of Single Deep Recessions on Mandibular Incisors: Gingival Pedicle With...

Gingival recession is a very common mucogingival defect in the adult population, with mandibular central and lateral incisors being the most frequently affected teeth. Limited information is available about the management of isolated deep recession lesions in the mandibular anterior area, where the predictability of the root coverage is reduced by unfavorable anatomical conditions. The purpose of this case report is to present a novel surgical technique for deep labial recessions on mandibular incisors, based on a gingival pedicle with split-thickness tunneling (GPST), in combination with connective tissue graft (CTG).

A 25-year-old female patient presented with a Class II Miller isolated buccal recession on #24, 5 × 3 mm. The recipient site design consisted of a laterally positioned flap with a width of 4 mm, in combination with a split-thickness tunnel preparation that reached the mesial line angle of #25 and extended beyond the mucogingival junction. A CTG (13 × 7 mm) was harvested from the palate and properly adapted over the root surface. Graft and flap were secured with internal mattress and single-interrupted sutures. Complete root coverage was obtained and maintained at 6 months with excellent esthetic outcomes.

This novel surgical approach, based on the combination of laterally displaced pedicle flap and tunneling in addition to CTG, seems to lead to promising results for the treatment of single deep mandibular anterior recessions.