Periosteum for Root Coverage in an Isolated Gingival Recession as an Autogenous Graft: A Case Report

Abstract

In periodontal care, where patient results are crucial in guiding the development of surgical techniques, gingival recession management is a critical issue. The periosteum eversion technique (PET) emerges as a modern strategy that leverages the intrinsic regenerative capabilities of the periosteum to attain root coverage. A detailed case study showcases the effectiveness of PET in managing a Miller Class I gingival recession alongside an adjunctive platelet-rich fibrin (PRF) procedure. This approach entailed the deliberate elevation and eversion of the periosteal flap to encompass the recession area, securing it meticulously through suturing. Across a six-month observation period, this method exhibited successful root coverage, augmentation of keratinized tissue, and enhanced patient comfort, as reported, with no significant complications observed. These outcomes provide support for the incorporation of PET into standard periodontal protocols, underscoring its capacity to reshape the treatment landscape for gingival recession.

Keywords: autograft; isolated gingival recession; leukocyte platelet rich fibrin (l-prf); periosteum; root coverage.

Figure 1. Preoperative clinical picture

1A: showing gingival recession 2 mm from the cementoenamel margin junction to the coronal gingival margin; 1B: the width of the recession can be appreciated

Figure 2. Partial thickness flap reflected

Figure 3. Periosteum incision given at the apical end

Figure 4. Periosteum being everted and adapted over the recession area with 5-0 vicryl suture

Figure 5. Adaptation of the l-prf membrane over the periosteum

5A: l-prf coagulum taken; 5B: l-prf placed over the periosteum l-prf: leukocyte platelet-rich fibrin

Figure 6. Flap coronally advanced covering l-prf and periosteum secured with 5-0 vicryl suture

l-prf: leukocyte platelet-rich fibrin

Figure 7. Three-month postoperative picture

6A: sulcus depth lesser than 1 mm after coverage; 6B: complete root coverage achieved

Figure 8. Six-month postop picture