Fixed contralateral anchored suturing for coronal flap advancement.

Abstract

Background: Fixed contralateral anchored suturing (FICAS) for coronal flap advancement is a novel suturing technique that utilizes ceramic attachments bonded to the buccal or lingual of the teeth as an anchorage point for suspensory sutures. This technique is designed to increase flap stability and improve graft adaptation in periodontal plastic surgery.

Methods: Two patients with localized gingival recession defects were treated with connective tissue grafting. One case used a tunneling technique, and the other used a coronally advanced flap. A ceramic button is bonded to the tooth surface contralateral to the flap. This is the lingual surface in both cases presented. Subepithelial connective tissue grafts and flaps were coronally advanced using periosteal stretching and then secured with nylon sutures. The sutures are looped over the ceramic button in a specific suspensory configuration.

Results: Follow-up at 2 weeks and 6 months revealed uneventful healing. No loss of sutures, ceramic buttons, or any postoperative infection occurred. The bonded buttons successfully protected the sutures and wound from disruption by tongue movements and food. There were visible increases in gingiva thickness, keratinized and attached tissue. Significant root coverage was achieved.

Conclusions: The FICAS technique may be a viable alternative for tension-free coronal flap advancement and stable soft tissue adaptation, specifically in complex soft tissue cases such as a dehiscence or Recession type (RT)2 and RT3 defects. Additional research, ideally randomized controlled trials, is necessary to substantiate these observations and determine the long-term success of this technique compared to others previously described.

Key points: Fixed contralateral anchored suturing used ceramic buttons as a remote anchorage point for suspensory sutures. Maximizing flap stability and minimizing tension on delicate tissues are critical factors for favorable healing in periodontal plastic surgery. Buttons bonded to the contralateral surface of the flap may improve esthetics compared to other suspensory suturing techniques.

Plain language summary: Fixed contralateral anchored suturing technique is a new suturing technique that involves bonding a button to the tooth surface, which will hold suspensory sutures. Sutures play a critical role in holding the tissues in a stable and favorable position during initial healing. The authors aim to introduce this technique to improve upon the esthetics of previously reported suspensory suturing techniques, and potentially improve outcomes and root coverage in both simple and complex recession cases.