Introduction: Gingival recessions at anterior teeth can be an aesthetic problem for the patients who complain of crown lengthening and can be accompanied by lack of attached gingiva and tooth hypersensitivity. Different surgical techniques (pedicle and free soft-tissue grafting) are proposed for treatment of the exposed root surfaces in the aesthetic zone of dentition. The objective of mucogingival periodontal surgery in the treatment of recession type defects is a complete root coverage and fulfilment of the patient’s aesthetic demands. A bilaminar technique is a suitable technique that can be used for root coverage in the treatment of gingival recessions of a single tooth as well as for root coverage in multiple teeth. The literature survey reports that this technique shows good results in the treatment of Miller’s class I, class II and class III gingival recessions with adequate thickness and height of apical keratinized tissues to the exposed root surface and has high predictability for root coverage.
Aim: The aim of this case report is to present the satisfactory aesthetic outcome of bilaminar technique for multiple recession defects of Miller’s class III in the frontal segment of the mandibula.
Materials and Methods: Miller’s class III gingival recessions, affecting tooth 41 and tooth 31, were established. A bilaminar technique (connective tissue graft and coronally advanced flap) was used for root coverage of established recessions.
Results: The bilaminar technique resulted in complete root coverage and gain of clinical attachment level and keratinized width of gingival tissues.
Conclusion: The proposed bilaminar technique presents satisfactory aesthetic outcome in case of thin gingival tissues, interproximal attachment loss, and loss of interdental bone height in the zone between lower central incisors.
Kim DM, Neiva R. Periodontal soft tissue non‐root coverage procedures: a systematic review from the AAP regeneration workshop. J Periodontol. 2015; 86(S2):S56–S72. doi: 10.1902/jop.2015.130684.
Mythri S, Arunkumar SM, Hegde S, Rajesh SK, Munaz M, Ashwin D. Etiology and occurrence of gingival recession - an epidemiological study. J Indian Soc Periodontol. 2015; 19(6): 671-5. doi: 10.4103/0972-124X.156881.
Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003;134(2):220-5. doi: 10.14219/jada.archive.2003.0137.
Serino G, Wennström J, Lindhe J, Eneroth L. The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene. J Clin Periodontol. 1994; 21(1):57-63. doi: 10.1111/j.1600-051x.1994.tb00278.x.
Susin C, Haas AN, Oppermann RV, Haugejorden O, Albandar JM. Gingival recession: epidemiology and risk indicators in a representative urban Brazilian population. J Periodontol. 2004; 75(10):1377–86. doi: 10.1902/jop.2004.75.10.1377.
Marini MG, Greghi SL, Passanezi E, Sant’ana LC. Gingival recession: prevalence, extension and severity in adults. J Appl Oral Sci. 2004; 12(3):250-5. doi: 10.1590/s1678-77572004000300017.
Chrysanthakopoulos NA. Gingival recession: Prevalence and risk indicators among young greek adults. J Clin Exp Dent. 2014; 6(3):243–9. doi: 10.4317/jced.51354.
Grover HS, Aggarwal N. Observational study on the association between gingival recession and other clinical variables in an adult population in India. Ind J Dent Sci. 2012; 4:1–7.
Gillette WB, Van House RL. The effects of improper oral hygiene procedure. J Am Dent Assoc. 1980; 101(3):476–80. doi: 10.14219/jada.archive.1980.0295.
Zucchelli G, De Sanctis M. Treatment of multiple recession type defects in patients with aesthetic demands. J Periodontol. 2000; 71(9):1506-14. doi: 10.1902/jop.2000.71.9.1506.
Georgieva I. Etiology of gingival recessions – a literature review. Scr Sci Med Dent. 2019;5(2):13-8. doi:10.14748/ssmd.v5i2.5970.
Allen EP, Miller PD. Coronal positioning of existing gingiva: short-term results in the treatment of shallow marginal tissue recession. J Periodontol. 1989; 60(6):316-9. doi: 10.1902/jop.1989.60.6.316.
Wennstrom JL, Zucchelli G. Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study. J Clin Periodontol.1996; 23(8):770-7. doi: 10.1111/j.1600-051x.1996.tb00608.x.
Zucchelli G, Stefanini M, Ganz S, Mazzotti C, Mounssif I, Marzadori M. Coronally advanced flap with different designs in the treatment of gingival recession: A Comparative controlled randomized clinical trial. Int J Periodontics Restorative Dent. 2016;36(3):319-27. doi: 10.11607/prd.2698.
Borghetti A, Gardella JP. Thick gingival autograft for the root coverage of gingival recessions: a clinical evaluation. Int J Periodontics Restorative Dent. 1990;10(3):216-29.
Tolmie PN, Rubins RP, Buck GS, Vagianos V, Lanz JS. The predictability of root coverage by way of free gingival autografts and citric acid application: an evaluation by multiple clinicians. Int J Periodontics Restorative Dent. 1991;11(4):261-71.
Puri K, Kumar A, Khatri M, Bansal M, Rehan M, Siddeshappa ST. 44-year journey of palatal connective tissue graft harvest: A narrative review. J Indian Soc Periodontol. 2019;23(5):395-408. doi: 10.4103/jisp.jisp_288_18.
Wennstrom JL. Mucogingival surgery. In: Proceedings of the 1st European Workshop on Periodontology. Lang NP, Karring T, editors. London: Quintessence; 1994. pp.193-209.
Raetzke PB. Covering localized areas of root exposure employing the envelope technique. J Periodontol. 1985; 56(7):397-402. doi: 10.1902/jop.1985.56.7.397.
Harris R. The connective tissue and partial thickness double pedicle graft: a predictable method of obtaining root coverage. J Periodontol. 1992; 63(5):477-86. doi: 10.1902/jop.1992.63.5.477.
Zucchelli G, Amore C, Sforza NM, Montebugnoli L, De Sanctis M. Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study. J Clin Periodontol. 2003; 30(10): 862-70. doi: 10.1034/j.1600-051x.2003.00397.x.
Zucchelli G. Mucogingival esthetic surgery. Quintessence Publishing Co, Inc; 2013. p. 257-329.
Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Periodontol. 2018; 89(1):204-13. doi: 10.1002/JPER.16-0671.
Sullivan HC, Atkins JH. Free autogenous gingival grafts. Utilization of grafts in the treatment of gingival recession. Periodontics. 1968; 6(4):152-60.
Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol. 1985; 56(12):715–20. doi: 10.1902/jop.1985.56.12.715.
Mahajan A, Dixit J, Verma UP. A patient-centered clinical evaluation of acellular dermal matrix graft in the treatment of gingival recession defects. J Periodontol. 2007; 78(12):2348–55. doi: 10.1902/jop.2007.070074.
Guinard EA, Caffesse RG. Treatment of localized gingival recessions. Part III. Comparison of results obtained with lateral sliding and coronally repositioned flaps. J Periodontol. 1978; 49(9):457-61. doi: 10.1902/jop.1978.49.9.457.
Pini Prato G, Tinti C, Vincenzi G, Magnani C, Cortellini P, Clauser C. Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession. J Periodontol. 1992;63(11):919–28. doi: 10.1902/jop.1992.63.11.919.
Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985;5(2):8-13.
Remya V, Kishore Kumar K, Sudharsan S, Arun KV. Free gingival graft in the treatment of class III gingival recession. Indian J Dent Res. 2008; 19(3):247–52. doi: 10.4103/0970-9290.42959.
Yıldırım S, Kuru B. Gingival unit transfer using in the Miller III recession defect treatment. World J Clin Cases. 2015; 3(2):199–203. doi: 10.12998/wjcc.v3.i2.199.
Blanes RJ, Allen EP. The bilateral pedicle flap-tunnel technique: A new approach to cover connective tissue grafts. Int J Periodontics Restorative Dent. 1999; 19(5):471-9.
Esteibar J, Zorzano L, Cundín E, Blanco J, Medina J. Complete root coverage of Miller class III recessions. Int J Periodontics Restorative Dent. 2011;31(4):1-7.
Email this article (Login required) 
