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.

Abstract

Background: To evaluate the efficacy and long-term clinical outcomes of the one-stage procedure for covering isolated deep gingival recessions (GRs) in the mandibular anterior region employing a laterally positioned flap (LPF) with a connective tissue graft (CTG), with a retrospective case series.

Methods: Nine patients presenting 11 isolated mid-facial recessions, where no loss of attachment level or the interproximal loss is equal to or less than the buccal one, received a LPF with CTG. The study's primary outcome was the percentage of mean gingival recession coverage (mGRC) and its stability over time. Secondary endpoints included the frequency of complete gingival recession coverage (CGRC), changes in keratinized tissue width (KTW) over time, and final root coverage aesthetic score (RES).

Results: The mean of CGRC was 0.7, 0.4, and 0.5 mm for each time point with a mean up to 90% after the first year and up to 95% for 5- and 10-year follow-ups expressed in percentage, reporting an increase in KTW as well. At 1-, 5-, and 10-year follow-ups, the mean of the RESs was, respectively, 8, 7.04, and 7.09.

Conclusions: The present results suggest that the LPF + CTG is a valuable approach for treating deep isolated mandibular single recession type 1 (RT1) and RT2 GRs. It results in a favorable mean of CGRC, stable clinical outcomes over time, and an increase in KTW, with undisputed patient benefits and great clinician satisfaction.

Key points: This study highlights the effectiveness of a one-stage procedure using a laterally positioned flap (LPF) and connective tissue graft (CTG) for treating isolated deep gingival recessions (GR) in the mandibular anterior region. The primary outcome measured was the mean gingival recession coverage (mGRC) over time, while secondary metrics included complete gingival recession coverage (CGRC), keratinized tissue width (KTW), and root coverage aesthetic scores (RES). The mean CGRC was 90% after 1 year and 95% at 5 and 10 years; the mean RES scores were 8, 7.04, and 7.09 at the 1-, 5-, and 10-year follow-ups, respectively; KTW also increased significantly. These results confirm that the LPF + CTG technique is not only effective for treating recession type 1 (RT1) and RT2 GRs but also offers substantial benefits for patients and high satisfaction for clinicians, making it a recommended approach in practice.

Plain language summary: This case series aims to describe the effectiveness of the laterally positioned flap as a reliable and predictable technique for root coverage in cases of single isolated mandibular recession. The paper evaluates the mean rates of complete root coverage and increases in keratinized tissue following the surgical procedure, assessed at 1, 5, and 10 years postoperation. The results demonstrate good aesthetic outcomes and favorable clinical stability of the tissues over time.