recession challenge

141 Rating(s).

Posted on By Edward Karl In Esthetic Therapy (General)

Patient presented with significant recession and an attempt to do a lateral sliding flap was a failure. An attempt to deepen the vestibule was made with a soft tissue graft. That was successful. Now my question is where do I make releasing incisions to move the tissue sideways and not lose the tissue already there and where do I remove tissue to adapt the moved tissue.

postage stamp graft

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I would likely make a subpapillary subperiosteal tunnel from #26-28 and place a large connective tissue graft with the area of the graft that covers the root left exposed. If there is adequate blood supply mesial, distal, and apically the graft will epithelialize and attach and provide root coverage and a gain of keratinzed gingiva. This case would be tough because of the two other surgical procedures that have likely resulted in increased scar tissue formation at the site that is less vascular. There are more ways to do this for sure, good luck! You may want to refer this one to a periodontist as it will be difficult to recover from at this point and achieve a satisfactory outcome.


Time to take the Hands-on Soft Tissue Course as part of Dentalxp Mastership week. These skills are of optimal importance. Dr. Salama


Henry Schein
Magnetic Mallet