Novel overlapping rotated double flap: A modified pedicle technique for root coverage in isolated RT1 gingival recession-Case study of two patients.

Abstract

Background: This case report presents a modified pedicle flap technique-the novel overlapping rotated double (NORD) flap-as an alternative to conventional approaches such as coronally advanced flap with subepithelial connective tissue graft (SCTG). While SCTG offers predictable outcomes, it involves a second surgical site, increasing patient morbidity. In contrast, the NORD flap uses adjacent pedicle flaps in an overlapping design, with one flap mimicking a connective tissue graft, thereby enhancing tissue thickness and vascularity without donor site complications.

Methods: Two systemically healthy patients-a 35-year-old female with a thick gingival phenotype and a 40-year-old male with a thin phenotype-presenting with isolated recession type 1 (RT1) gingival recessions were treated using the NORD flap. All procedures were performed under local anesthesia with standard postoperative protocols. Follow-ups were conducted at 14 days, 1 month, 6 months, and 12 months. Clinical outcomes were assessed using the root coverage esthetic score and patient-reported outcome measures.

Results: Over 90% root coverage was achieved in both cases, regardless of phenotype. The technique eliminated graft harvesting, minimized complications, and was associated with minimal postoperative pain, requiring only two analgesic doses in 48 h.

Conclusion: The NORD flap offers a conservative and effective alternative for managing isolated gingival recessions.

Plain language summary: This case report introduces the novel overlapping rotated double (NORD) flap, a modified pedicle-based approach designed to overcome limitations associated with conventional root coverage procedures. Although the subepithelial connective tissue graft is considered the gold standard due to its predictability, the technique necessitates harvesting from a secondary donor site, thereby increasing patient morbidity and postoperative discomfort. The NORD flap provides a biologically driven alternative by utilizing two adjacent pedicle flaps in an overlapping configuration, one of which functions analogously to a connective tissue graft. This design enhances gingival thickness, vascularization, and stability of the flap while obviating the need for graft procurement. Two cases presenting with isolated RT1 recessions were managed using this approach. All surgeries were performed under local anesthesia, followed by routine postoperative care, and evaluated. Clinical parameters, including the root coverage esthetic score, and patient-reported outcome measures demonstrated favorable results, with >90% root coverage achieved in both cases. The technique was associated with minimal pain, rapid healing, and elimination of donor site morbidity, underscoring its potential as a conservative and effective alternative for isolated recession defects.

Key points: Value of innovation: This novel pedicle-based technique serves as a viable alternative to graft harvesting in cases where minimizing patient morbidity is a priority, thereby avoiding a secondary surgical site or when subepithelial connective tissue graft is contraindicated or undesirable: Achieves high root coverage (>90%) across different gingival phenotypes, demonstrating versatility. Enhances soft tissue thickness and vascularity through an overlapping pedicle design that mimics a connective tissue graft. Minimizes postoperative discomfort, with low analgesic requirement.