This technique was designed specifically for the wide multiple recessions frequently found in the maxilla where root coverage seems to be most difficult to obtain.
Indications - Inadequate donor site for a horizontal sliding flap, isolated wide gingival recession, multiple root exposure, multiple root exposure in combination with minimal attached gingiva, Recession adjacent to an edentulous area that also requires ridge augmentation.
A partial thickness flap is created with two vertical incisions placed at least 1/2 to one tooth wider M-d than the area of gingival recession. A horizontal incision is made approximately 5 to 6 mm from the maxillary molars. A second incision is made parallel 1 1/2 to 2 mm coronal to the first. Vertical incision are made on either side, the connective tissue is removed. the epithelium edge is kept. Graft is placed to the denuded root surface and sutured into place. The partial thickness flap is positioned and sutured. through the papilla. If more root coverage is desired then the flap can be split 6 weeks later and coronally repositioned.
If at least 1/2 to 2/3 of the graft is covered by the flap, the remaining portion which is not covered will survive over the denuded root. Plaque control is mandatory and seems to control gingival inflammation. Post-op probing depth ranged from 1 to 3 mm even in cases of 5 mm of root coverage, with no recurrence of recession. Gingivoplasty may be necessary.
In 4 years, 56 cases that are stable. Root coverage of 2 to 6 mm.
Need % root coverage, how many second procedures, how about citric acid.
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