Authors : Dr. Mitisha Anant Sawant; Dr. Rupali Saroshe; Dr. Madhu S. Ratre; Dr. Shaleen Khetarpal

Volume/Issue : Volume 11 - 2026, Issue 6 - June

Google Scholar : https://tinyurl.com/mtcdx9be

Scribd : https://tinyurl.com/ms66fxut

DOI : https://doi.org/10.38124/ijisrt/26jun1954

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Background: Gingival recession is a frequent mucogingival condition associated with root hypersensitivity, esthetic concerns, and compromised periodontal stability, particularly in patients with thin phenotype or a history of orthodontic treatment. Adequate keratinized tissue is a key determinant for predictable root coverage outcomes.  Aim: This case report describes the interdisciplinary management of localized gingival recession with inadequate keratinized tissue using a two-stage surgical approach involving free gingival graft (FGG) followed by coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG).  Case Description: A 20-year-old female undergoing orthodontic therapy presented with Miller Class II gingival recession in the mandibular anterior region. Clinical findings included 7 mm recession depth, 1 mm keratinized tissue width, and thin gingival phenotype. Initial treatment included phase I therapy followed by Stage I FGG to augment keratinized tissue. After a 3-month healing period, Stage II CAF with SCTG was performed for root coverage. Clinical parameters were recorded at baseline, post-Stage I, and at 6 months following Stage II surgery.  Results: At 6 months, recession depth reduced from 7 mm to 2 mm, with keratinized tissue width increasing from 1 mm to 4 mm. Improved tissue thickness and stable gingival architecture were observed with uneventful healing at both surgical sites.  Conclusion: The two-stage approach combining FGG preconditioning and CAF + SCTG may enhance predictability of root coverage in sites with inadequate keratinized tissue and thin phenotype. This protocol represents a viable option in anatomically challenging cases requiring staged periodontal plastic surgery.

Keywords : Gingival Recession, Free Gingival Graft, Coronally Advanced Flap, Connective Tissue Graft, Mucogingival Surgery, Orthodontics.

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