title: Modified coronally advanced flap associated with a subepithelial connective tissue graft for the treatment of adjacent multiple gingival recessions.
abstract: BACKGROUND
  The clinical choice of the appropriate surgical technique aiming at root coverage relies, among other factors, on the number of adjacent gingival recessions. This study aimed to clinically evaluate the effectiveness and the predictability of root coverage at adjacent multiple gingival recessions using a modified coronally positioned flap associated with the subepithelial connective tissue graft.
  
  
  METHODS
  Ten non-smoking, healthy subjects (five men and five women; mean age, 28.7 years) presenting 29 Class I or II adjacent multiple gingival recessions were enrolled. Each patient was treated using a modified coronally advanced flap associated with the subepithelial connective tissue graft. Probing depth (PD), clinical attachment level (CAL), recession depth (RD), and width of keratinized tissue (KT) were measured at baseline and 6 months later. The Student t test was used to compare treatment outcomes through time.
  
  
  RESULTS
  The results revealed significant CAL gain (mean gain +/- SD, 1.97 +/- 0.94 mm; P <0.0001), RD decrease (2.03 +/- 0.78 mm; P <0.0001), and KT increase (1.31 +/- 1.23 mm, P <0.0001). The average root coverage was 96.7%, and complete root coverage was found at 93.1% of the defects. Nine of the 10 patients (90% of the patients) experienced complete root coverage.
  
  
  CONCLUSIONS
  The modified coronally advanced flap associated with the subepithelial connective tissue graft was effective and predictable to produce root coverage at multiple adjacent gingival recessions associated with gain in the CAL and in the width of KT.
authors.affiliation: Department of Periodontics, São Leopoldo Mandic Dental Research Institute, Campinas, São Paulo (SP), Brazil.
authors.forename: Paulo F M
authors.initials: PF
authors.lastname: Carvalho
authors.forename: Robert C
authors.initials: RC
authors.lastname: da Silva
authors.forename: Patrícia R
authors.initials: PR
authors.lastname: Cury
authors.forename: Julio C
authors.initials: JC
authors.lastname: Joly
mesh_terms: D000328:Adult; D003238:Connective Tissue / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000637:transplantation*; D005889:Gingival Recession / Q000601:surgery*; D005893:Gingivoplasty / Q000379:methods*; D006801:Humans; D008297:Male; D013524:Surgical Flaps; D016896:Treatment Outcome