Two-step Surgical Procedure for Root Coverage (free Gingival Graft and Coronally Positioned Flap)

Background: Gingival recessions require treatment for many reasons – impaired aesthetic appearance, root sensitivity, cervical caries or abrasion. Two surgical techniques have been described that use free gingival graft for root coverage. The technique proposed by Bernimoullin et al. involves two surgical steps. The first step consists of creating attached gingiva by means of free gingival graft and second – coronally positioning of grafted tissue to cover the gingival recession. This indirect technique has advantages over other techniques because ensures development of an adequate band of attached gingiva. The minimal recommended healing period before second surgery is 8 weeks. Case report: This case presents a 50-years old man with gingival recessions up to 6 mm on #34 and #44 (class II according to Miller classification). Before surgery fullmouth scaling and polishing were performed and oral hygiene instructions were given. Recession height, width, probing depth, clinical attachment level, keratinized and attached gingiva were measured at baseline and six months post surgery. Results: Eight months after treatment there were significant increasing in keratinized and attached gingival tissues and reduction of height and width of recession (mean gain of root coverage was 91,67% and 90.91%) and great improvement in attachment level. Conclusion: These results suggest that two-stage surgical procedure is highly predictable for root coverage in case of deep recession and lack of attached gingiva.