16/04/2026
Some recession defects don’t need more coronal advancement. They need release.
This lower anterior RT2 recession was shallow and narrow, with very limited keratinized tissue and a powerful frenulum pull. Because these were RT2 defects, complete root coverage was never the main objective. The primary goal was to create a stable band of attached tissue and improve the quality and resistance of the marginal tissues.
For these situations, I still like the classic envelope approach described by John Bruno. It is a traditional repositioned flap technique with very specific indications: no vertical incisions, excellent vascularity, and a very natural integration of the graft.
A partial-thickness flap was elevated in the periosteal plane. In the midline, the dissection was extended into the submucosal plane to release the frenulum attachment. There was no need to remove the frenulum itself.
A 1.5 mm connective tissue graft was harvested using the double blade technique, then stabilized and anchored to the recipient bed with 7-0 resorbable sutures. The flap was finally repositioned in an attempt to achieve primary closure.
Once the submucosal release was completed, the tissues became much more elastic than expected and the graft ended up completely covered.
Not because the flap was pushed farther coronally.
But because the frenulum was no longer pulling it apically.
Traditional techniques are not obsolete.
They simply need to be understood, adapted, and used where they still work best.
DoubleBladeTechnique AttachedGingiva PeriodontalPlasticSurgery MucogingivalSurgery Periodontics SoftTissueGrafting LowerAnteriorRecession FrenulumPull Microsurgery DentalSurgery
