Complete Root Coverage in Mandibular Anterior Recession Using Free Gingival Graft: A Case Report with Creeping Attachment

Abstract

Background: Achieving complete root coverage is challenging. Thus to resolve, we highlight the effective resolution of mandibular recession using free gingival graft; a case report showing creeping attachment and incremental adaptation to achieve complete root coverage. Materials and Methods: This case reveals about a 25 years old female patient who presented with gingival recession affecting the mandibular central incisor. Her predominant concerns were hypersensitivity and also the aesthetic enhancement. An extensive examination disclosed biofilm induced gingivitis within a reduced periodontium & mucogingival deformities. The gingival recession was classified as Cairo Recession Type 1. The treatment approach planned for an initial nonsurgical phase, succeeded by a surgical intervention utilizing a free gingival graft. This surgical procedure was to harvest the graft from the palatal mucosa and positioning it at the recipient site. Post-operative care & instructions were provided and given for a detailed follow-up schedule. Results: After two weeks, the graft showed successful integration. By two months, the patient exhibited increased thickness of keratinized gingiva, with a characteristic tire-patch appearance, with a mild recession of 1 mm. After 12-month follow-up, the patient exhibited good periodontal health, characterized by creeping attachment and complete root coverage. Conclusion: This success highlights the treatment plan's effectiveness in overcoming the hypersensitivity and also bringing back the aesthetics, while simultaneously promoting overall periodontal health. To conclude, factors which contributes to the successful achievement of creeping attachment include the recession's width, graft positioning, bone support, tooth alignment, patient hygiene practices, graft thickness, and root surface treatment.