Tunneled Coronally Advanced Flap and Connective Tissue Graft Wall for the Treatment of Isolated Infrabony Defect Associated with Gingival Recession: Technical Report with Cases

The integrity and phenotype of periodontal soft tissues significantly influence the outcome of surgical periodontal regenerative therapy. In cases with thin gingival phenotype, treating infrabony defects surgically can worsen gingival recession and loss of papillae. This report outlines a surgical approach for addressing infrabony defects at sites with gingival recession and thin phenotype. The treatment involves using a tunneled coronally advanced flap (TCAF) to obtain access for defect debridement, root instrumentation, graft placement, and tissue advancement for root coverage. A connective tissue graft (CTG) is secured to the two teeth flanking the infrabony defect with two subperiosteal sling (SPS) sutures to create a buccal soft tissue wall and to tent up the papilla overlying the defect to provide and maintain the necessary space for biomaterials and clot stability. The treatment significantly improved interproximal clinical attachment levels, tissue phenotype, and root coverage one-year post surgery. Treatment outcomes suggest that this approach may be used to effectively treat isolated infrabony defects associated with gingival recession.