ROOT COVERAGE USING CONNECTIVE TISSUE GRAFT ASSOCIATED WITH THE LATERALLY POSITIONED FLAP FOR THE TREATMENT OF RT2 GINGIVAL RECESSIONS
DOI:
https://doi.org/10.24980/ucm.v15i17.6724Keywords:
gingival recession, laterally positioned flap, connective tissue graft, periodontics, root coverageAbstract
Gingival recessions represent a common clinical challenge, particularly in the anterior mandibular region, where anatomical limitations may compromise the predictability of conventional root coverage techniques. This case report describes the treatment of a Cairo Type 2 (RT2) gingival recession using a combination of a connective tissue graft (CTG) and a laterally positioned flap (LPF). The objective was to evaluate the clinical outcome of this approach in the management of an isolated deep gingival recession. A 46-year-old systemically healthy female patient presented with an RT2 gingival recession affecting tooth 31, associated with a deficiency of keratinized mucosa. Following initial periodontal therapy, the surgical procedure was performed, consisting of harvesting a palatal connective tissue graft, stabilizing the graft at the recipient site, and laterally positioning a partial-thickness flap to achieve root coverage. The patient was evaluated at 7, 14, and 30 days postoperatively and again after 1 year. An increase in gingival thickness and satisfactory root coverage were observed, with perceived esthetic improvement and soft tissue stability at the long-term follow-up, although complete root coverage was not achieved. This approach proved effective in an anatomically challenging region, reinforcing that the combination of LPF and CTG may represent a predictable treatment alternative when appropriately indicated. It is concluded that CTG associated with LPF is a viable surgical option for the treatment of RT2 gingival recessions, providing esthetic and functional benefits when performed with appropriate treatment planning and precise surgical technique.
References
AROCA, S. et al. Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: a 6-month study. Journal of Periodontology, v. 80, n. 2, p. 244-252, 2009. Disponível em: https://doi.org/10.1902/jop.2009.080253. DOI: https://doi.org/10.1902/jop.2009.080253
BOSCO, A. F. et al. Laterally Positioned Flap with Subepithelial Connective Tissue Graft Modified One-Stage Procedure for the Treatment of Deep Isolated Gingival Recessions in Mandibular Incisors. Case Reports in Dentistry, v. 2021, p. 2326152, 2021. Disponível em: https://doi.org/10.1155/2021/2326152. DOI: https://doi.org/10.1155/2021/2326152
BOSCO, F.; MILANEZI, L. A.; PASSANEZI, E. Contribution to the technique of covering the exposed roots. Revista Regional de Araçatuba da Associação Paulista de Cirurgiões Dentistas, 1990. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-858810.
BRENNAND ROPER, M.; FIELDS, Y. Achieving the optimal emergence profile: the role of soft tissue grafting and pontic site development. British Dental Journal, v. 237, n. 11, p. 843-849, 2024. Disponível em: https://www.nature.com/articles/s41415-024-8023-2. DOI: https://doi.org/10.1038/s41415-024-8023-2
CABRERA, P. O. Connective tissue grafting: an option in reconstructive periodontal surgery. The Journal of the American Dental Association, v. 125, n. 6, p. 729-737, 1994. Disponível em: https://doi.org/10.14219/jada.archive.1994.0110. DOI: https://doi.org/10.14219/jada.archive.1994.0110
CAIRO, F.; NIERI, M.; PAGLIARO, U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions: a systematic review. Journal of Clinical Periodontology, v. 41, supl. 15, p. S44-S62, 2014. Disponível em: https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12182. DOI: https://doi.org/10.1111/jcpe.12182
CÉSAR NETO, J. B. et al. Root coverage for single deep gingival recessions: outcomes based on a decision-making algorithm. International Journal of Dentistry, v. 2019, Article ID 1830765, 9 p., 2019. Disponível em: https://doi.org/10.1155/2019/1830765. DOI: https://doi.org/10.1155/2019/1830765
CHACÓN RAMÍREZ, G. J.; TAVELLI, L.; BAROOTCHI, S.; WANG, H. L. “V‐Reverse” suturing technique for tunnel soft tissue graft and flap stabilization: technique illustration. Clinical Advances in Periodontics, v. 11, n. 3, p. 129-133, 2021. Disponível em: https://doi.org/10.1002/cap.10134. DOI: https://doi.org/10.1002/cap.10134
CHAMBRONE, L.; CASTRO PINTO, R. C. N. de; CHAMBRONE, L. A. The concepts of evidence-based periodontal plastic surgery: application of the principles of evidence-based dentistry for the treatment of recession-type defects. Periodontology 2000, v. 79, n. 1, p. 81-106, 2019. Disponível em: https://doi.org/10.1111/prd.12248. DOI: https://doi.org/10.1111/prd.12248
CHAMBRONE, L.; TATAKIS, D. N. Long-term outcomes of untreated buccal gingival recessions: a systematic review and meta-analysis. Journal of Periodontology, v. 86, n. 3, p. 332-345, 2015. Disponível em: https://doi.org/10.1902/jop.2016.150625. DOI: https://doi.org/10.1902/jop.2016.150625
CHAMBRONE, L.; TATAKIS, D. N. Periodontal soft tissue root coverage procedures: a systematic review from the AAP regeneration workshop. Journal of Periodontology, v. 86, supl. 2, p. S8-S51, 2015. Disponível em: https://doi.org/10.1902/jop.2015.130674. DOI: https://doi.org/10.1902/jop.2015.130674
CORTELLINI, P.; BISSADA, N. F. Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations. Journal of Clinical Periodontology, v. 45, supl. 20, p. S190-S206, 2018. Dispoível em: https://doi.org/10.1002/JPER.16-0671. DOI: https://doi.org/10.1111/jcpe.12948
DA SILVA, R. C. et al. Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft. Journal of Periodontology, v. 75, n. 3, p. 413-419, 2004. Disponível em: https://doi.org/10.1902/jop.2004.75.3.413. DOI: https://doi.org/10.1902/jop.2004.75.3.413
DE SANCTIS, M.; CLEMENTINI, M. Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. Journal of Clinical Periodontology, v. 41, suppl. 15, p. S108-S122, 2014. Disponível em: https://doi.org/10.1111/jcpe.12189. DOI: https://doi.org/10.1111/jcpe.12189
FATANI, B. et al. Modifications in the free gingival graft technique: a systematic review. Cureus, v. 16, n. 4, p. e58932, 2024. Disponível em: https://doi.org/10.7759/cureus.58932. DOI: https://doi.org/10.7759/cureus.58932
FOUDA, M.; ALUCKAL, E.; ABRAHAM, A. The case for using free gingival grafts in the anterior mandible: clinical case reports. Journal of Orofacial Research, v. 11, n. 1, p. 23-27, 2022. Disponível em: https://mansapublishers.com/index.php/jofr/article/view/3195.
GOYAL, L. et al. Free gingival graft as a single step procedure for treatment of mandibular Miller Class I and II recession defects. World Journal of Plastic Surgery, v. 8, n. 1, p. 12-17, 2019. Disponível em: https://doi.org/10.29252/wjps.8.1.12. DOI: https://doi.org/10.29252/wjps.8.1.12
GRUPE, H. E.; WARREN, R. F. Repair of gingival defects by a sliding flap operation. Journal of Periodontology, v. 27, n. 2, p. 92-95, 1956. Disponível em: https://doi.org/10.1902/jop.1956.27.2.92. DOI: https://doi.org/10.1902/jop.1956.27.2.92
HÜRZELER, M. B.; WENG, D. A single-incision technique to harvest subepithelial connective tissue grafts from the palate: a retrospective study. Journal of Periodontology, v. 70, n. 7, p. 840-845, 1999. Disponível em: https://openurl.ebsco.com/EPDB%3Agcd%3A6%3A32285094/detailv2?sid=ebsco%3Aplink%3Acrawler-gcd&id=ebsco%3Agcd%3A37215221&crl=c&jrnl=01987569&link_origin=scholar.google.com.
HWANG, D.; WANG, H.-L. Flap Thickness as a Predictor of Root Coverage: A Systematic Review. Journal of Periodontology, v. 77, n. 10, p. 1625–1634, 2006. Disponível em: https://doi.org/10.1902/jop.2006.060107 DOI: https://doi.org/10.1902/jop.2006.060107
JATI, A. S.; FURQUIM, L. Z.; CONSOLARO, A. Gingival recession: its causes and types, and the importance of orthodontic treatment. Dental Press Journal of Orthodontics, v. 21, n. 3, p. 18-29, 2016. Disponível em: https://doi.org/10.1590/2177-6709.21.3.018-029.oin. DOI: https://doi.org/10.1590/2177-6709.21.3.018-029.oin
KASSAB, M. M.; COHEN, R. E. The etiology and prevalence of gingival recession. Journal of the American Dental Association, v. 134, n. 2, p. 220-225, 2003. Disponível em: https://doi.org/10.14219/jada.archive.2003.0137. DOI: https://doi.org/10.14219/jada.archive.2003.0137
LANGER, B.; LANGER, L. Subepithelial connective tissue graft technique for root coverage. Journal of Periodontology, v. 56, n. 12, p. 715-720, 1985. Disponível em: https://doi.org/10.1902/jop.1985.56.12.715. DOI: https://doi.org/10.1902/jop.1985.56.12.715
LEE, C. T. et al. Root coverage with a modified laterally positioned flap combined with a subepithelial connective tissue graft in advanced recession. Journal of periodontal & Implant Science, v. 44, n. 6, p. 300-306, 2014. Disponível em: https://doi.org/10.5051/jpis.2014.44.6.300. DOI: https://doi.org/10.5051/jpis.2014.44.6.300
MARTINS, T. M. et al. Root coverage of adjacent gingival recessions with a combination of two surgical techniques. RSBO – Revista Sul-Brasileira de Odontologia, v. 12, n. 2, p. 225-232, 2015. Disponível em: https://revodonto.bvsalud.org/scielo.php?pid=S1984-56852015000200014&script=sci_abstract.
PARMA-BENFENATI, L.; PARMA-BENFENATI, S. Laterally positioned flap with connective tissue graft to treat deep isolated gingival recessions in the mandibular anterior region: a retrospective case series with 10-year follow-up. Clinical Advances in Periodontics, v. 16, n. 2, p. 279-287, 2025. Epub 29 abr. 2025. Disponível em: https://doi.org/10.1002/cap.10358. DOI: https://doi.org/10.1002/cap.10358
PINI PRATO, G. P. et al. Coronally advanced flap: the post-surgical position of the gingival margin is an important factor for achieving complete root coverage. Journal of Periodontology, v. 76, p. 713-722, 2005. Disponível em: https://doi.org/10.1902/jop.2005.76.5.713. DOI: https://doi.org/10.1902/jop.2005.76.5.713
PINI PRATO, G. P. et al. Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession. Journal of Periodontology, v. 63, p. 919-928, 1992. Disponível em: https://doi.org/10.1902/jop.1992.63.11.919. DOI: https://doi.org/10.1902/jop.1992.63.11.919
SANTANA, R. B. et al. Single-stage advanced versus rotated flaps in the treatment of gingival recessions: a 5-year longitudinal randomized clinical trial. Journal of Periodontology, v. 90, n. 9, p. 941-947, 2019. Disponível em: https://doi.org/10.1002/JPER.18-0284 DOI: https://doi.org/10.1002/JPER.18-0284
STAFFILENO, H. Management of gingival recession and root exposure problems with periodontal disease. Dental Clinics of North America, v. 3, p. 111-120, 1964. Disponível em: https://doi.org/10.1016/S0011-8532(22)02003-1. DOI: https://doi.org/10.1016/S0011-8532(22)02003-1
THOMA, D. S. et al. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. Journal of Clinical Periodontology, v. 41, supl. 15, p. S77-S91, 2014. Disponível em: https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12220. DOI: https://doi.org/10.1111/jcpe.12220
TROMBELLI, L. et al. Healing response of human buccal gingival recessions treated with expanded polytetrafluoroethylene membranes: a retrospective report. Journal of Periodontology, v. 66, p. 14-22, 1995. Disponível em: https://doi.org/10.1902/jop.1995.66.1.14 DOI: https://doi.org/10.1902/jop.1995.66.1.14
ZUCCHELLI, G. et al. Bilaminar techniques for the treatment of recession type defects: a comparative clinical study. Journal of Clinical Periodontology, v. 30, p. 862-870, 2003. Disponível em: https://doi.org/10.1034/j.1600-051X.2003.00397.x DOI: https://doi.org/10.1034/j.1600-051X.2003.00397.x
ZUCCHELLI, G. et al. Coronally advanced flap + connective tissue graft techniques for the treatment of deep gingival recession in the lower incisors: a controlled randomized clinical trial. Journal of Clinical Periodontology, v. 41, n. 8, p. 806-813, 2014. Disponível em: https://doi.org/10.1111/jcpe.12269 DOI: https://doi.org/10.1111/jcpe.12269
ZUCCHELLI, G. et al. Laterally moved, coronally advanced flap: a modified surgical approach for isolated recession-type defects. Journal of Periodontology, v. 75, n. 12, p. 1734-1741, 2004. Disponível em: https://doi.org/10.1902/jop.2004.75.12.1734. DOI: https://doi.org/10.1902/jop.2004.75.12.1734
ZUCCHELLI, G.; DE SANCTIS, M. Modified two-stage procedures for the treatment of gingival recession. The European Journal of Esthetic Dentistry, v. 8, n. 1, p. 24-42, 2013. Disponível em: https://pubmed.ncbi.nlm.nih.gov/23390619/.
ZUCCHELLI, G.; DE SANCTIS, M. Treatment of multiple recession-type defects in patients with esthetic demands. Journal of Periodontology, v. 71, n. 9, p. 1506-1514, 2000. Disponível em: https://doi.org/10.1902/jop.2000.71.9.1506 DOI: https://doi.org/10.1902/jop.2000.71.9.1506
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ruan Henrique Delmonica BARRA, Luiz Guilherme FIORIN, Ester Oliveira SANTOS, Elisa Mara de Abreu FURQUIM, Gabriela Carrara SIMIONATO, Otávio Augusto Pacheco VITÓRIA, Juliano Milanezi de ALMEIDA (Autor)
This work is licensed under a Creative Commons Attribution 4.0 International License.
