The subepithelial connective tissue pedicle graft combined with the coronally advanced flap for restoring missing papilla: A report of two cases

This case report describes the clinical application of the coronally advanced flap procedure associated with the subepithelial connective tissue pedicle graft in the reconstruction of interdental papilla. This procedure was used in two distinct situations: to reconstruct missing papilla and cover two Miller Class IV gingival recessions between the maxillary right lateral incisor and canine (case 1) and to improve esthetics and restore missing papilla between the maxillary left central and lateral incisors (case 2). In case 1, there was a clinical attachment level gain, complete root coverage (canine), and an increase in papillary height. Case 2 showed similar improvements for the interdental papilla, ie, significant reduction of the black triangle. Subepithelial connective tissue pedicle graft associated with a coronally advanced flap yielded satisfactory esthetics and may be considered a viable approach for the treatment of missing papilla associated or not with recession-type defects. However, further investigation is required. Keywords: connective tissue, dental esthetics, gingival recession, gingival surgery, methods, surgical flaps