The wingspan suspension approach: A modified semilunar technique for multiple areas of recession

Abstract

Background: Gingival recession can be considered an undesirable condition that results in the exposure of the root surface. There are many techniques that can be employed to address gingival recession; however, they frequently involve a second surgical site. Other approaches have been introduced in the past to address this concern, and this case study discusses the use of a modified technique to achieve root coverage.

Methods: A patient presented to the periodontics clinic with concerns regarding gingival recession. A modification to the semilunar technique was employed to address the recession, whereas double sling sutures were utilized to maintain the coronal repositioning of the flap.

Results: Maxillary central incisors initially presented with 2-3 mm of facial recession and root coverage was achieved by use of a modified surgical semilunar approach. No rebound noted over a 6-month period, newly established gingival margin deemed clinically stable.

Conclusions: This case study provides an alternative to addressing gingival recession in the maxillary anterior region, when <3 mm of recession is noted. Avoidance of a second surgical procedure and/or donor site is of particular benefit, as well as maintenance of the blood supply.

Key points: Why is this case new information? There is insufficient evidence on the use of a modified wingspan incision design Phenotype modification with elimination of a second surgical site is most ideal for the patient. What are the keys to successful management of this case? Comprehensive diagnosis and proper case selection Meticulous flap management and adequate release to allow for repositioning without tension Appropriate use ofsuture and suturing technique. What are the primary limitations to success in this case? Thin periodontal phenotype Poor oral hygiene and plaque accumulation postoperatively Loss to follow-up.

Keywords: connective tissue; esthetics; gingival diseases; gingival recession; humans; periodontal diseases.

FIGURE 1

Initial presentation. The intraoral examination revealed a thick flat biotype with an adequate band of attached keratinized tissue, and Miller class I/ Cairo RT2 mucogingival defects observed at teeth #8,9.

FIGURE 2

Pre‐operatively, patient underwent maintenance therapy. On the day of surgery, the denuded root surfaces were thoroughly scaled and root planed.

FIGURE 3

Sulcular incisions and the wingspan incision were made from the distal line angle of #8 to the distal line angle of #9.

FIGURE 4

A continuous wingspan incision was made using a scalpel with a 15C blade in a partial thickness fashion.

FIGURE 5

Flap reflection, by means of partial thickness apically, and full thickness coronally within the sulcular access that was made.

FIGURE 6

Tunneling access was performed to adequately release a full thickness flap, ensuring passivity and potential for coronal advancement.

FIGURE 7

Coronal advancement of the flap repositioned 1 mm beyond the CEJ, to account for potential shrinkage during healing.

FIGURE 8

Double‐sling suspension sutures anchoring the facial and palatal papilla were utilized to suspend and maintain the coronal advancement of the flap.

FIGURE 9

Primary closure of MGJ, tension‐free approximation of the MGJ was made to achieve primary closure, without compromising the vestibular depth.

FIGURE 10

Two week follow‐up visit, the wound presented with minimal edema or erythema, and sutures were removed without complication.

FIGURE 11

Comparison of pre‐operative (A) with 12‐month follow‐up (B), the characteristics of the gingiva presented within normal limits, appearing almost identical to the adjacent tissues regarding color with a notable gain in root coverage, as well as minimal scarring.