Muscle Evicted Tunneling Approach (META) with Crossed Belt & Suspenders Sutures (CBS) for Mandibular Incisor Root...

To present a proof-of-concept technique combining a novel Muscle Evicted Tunneling Approach (META) with the Crossed Belt & Suspenders (CBS) suture design to achieve simultaneous apical and lateral closure for root coverage in a challenging isolated mandibular recession.

A 32-year-old female with a RT2 recession at tooth 31 (thin phenotype; absent attached keratinized tissue; shallow vestibule) was treated with supra-muscular partial-thickness tunneling with myotomy and apicalization of muscle fibers (META), intraoral deepithelialized connective tissue graft, and Crossed Belt & Suspender (CBS) sutures to centralize the flap-graft complex without using vertical releases.

Complete root coverage was achieved with clinical restoration of vestibular depth, attached tissues increased, soft-tissue thickness improved, and hypersensitivity resolved. Outcomes remained stable at 1 year, with improved hygiene and deepened vestibule.

In this proof-of-concept case, the combination of META and CBS was associated with stable root coverage and concurrent gains in attached tissue and vestibular depth over the observation period.

This approach is indicated for RT1 and RT2 defects in mandibular incisors, where vestibule depth and muscle pull can compromise flap stability, enabling coronal positioning of the flap margin at the CEJ without vertical releases and supporting predictable esthetic and functional outcomes.