08/05/2026
A young female patient was referred to me to treat gingival recession in one of her tooth.
On clinical examination, gingival recession was observed wrt 31 (Miller's Class III (1985) and RT 2 (Cairo 2011)), shallow vestibular depth, tooth was slightly buccally placed compared to the adjacent teeth and was also sensitive because of the root exposure. There was a fixed lingual retainer (wire and composite) as the patient underwent orthodontic treatment few years back. There was no TFO or occlusal discrepancy. There was thin keratinized tissue (thin periodontal phenotype (WWP 2017)) in the lower anterior region compared to upper arch and absence of width of KT wrt 31.
After considering all the clinical and radiological factors, I decided to go for a CTG (connective tissue graft) with MCAT (modified coronally advanced tunnel) approach. (Carvalho et al. 2006).
CTG was harvested using trap door technique (Edel 1974) by incison technique given by Liu and Weisgold (2002) (class III type A).
The harvested graft was placed supra-periosteally in the tunnel created as the recipient site and was stabilized using 2 anchor sutures on each ends (mesially and distally) and coronally sling sutures was placed. Suture material used were (5-0 vicryl plus and 5-0 PTFE with 18 mm 3/8 reverse cutting round body needle).
Root biomodification was done using EMD (enamel matrix derivative) (Emdogain gel by Straumann).
After 1 month of healing we can see complete root coverage with increased thickness and width of Keratinized tissue, improved esthetic, as well as decreased tooth sensitivity.
