Lateral sliding bridge flap technique along with platelet rich fibrin and guided tissue regeneration for root coverage
A 38-year-old male patient reported to the Department of Periodontology with the chief complaint of hypersensitivity in lower front tooth region for 4 months. Clinical examination revealed Miller's Class III recession in mandibular anterior teeth measuring 2 mm each in mandibular central incisors, 1 mm in left lateral incisor, 3 mm in right lateral incisor and 4 mm each in mandibular canines []. The probing depth was recorded as 3 mm around the involved teeth. The medical history of the patient was non-significant.\nThe surgical procedure was explained to the patient and informed consent was obtained. Preparation of the patient was carried out, which included scaling and root planning of the entire dentition and oral hygiene instructions. The probing depth was recorded as 2 mm after initial preparation.\nBlood of the patient was drawn in 10 ml test tubes without an anticoagulant and centrifuged immediately. Blood was centrifuged using a table top centrifuge (REMY Laboratories) for 12 min at 2700 rpm.\nThe resultant product consisted of the following three layers:\nThe top most layer consisting of acellular platelet poor plasma PRF clot in the middle Red blood cells at the bottom [].\nPRF can be obtained in the form of a membrane by squeezing out the fluids in the fibrin clot [].\nThe PRF membrane was placed over GTR membrane (HEALIGUIDE®) [].\nIt included the bridge flap technique given by Marggraf[] and later modified by Romanos.[] Under local anesthesia, an arch shaped or semilunar incision was given in the vestibule at a distance, which was twice the amount of gingival recession plus 2 mm (2* gingival recession + 2 mm).[] This ensures a wide flap, which is necessary for a sufficient blood supply. A split thickness flap was then elevated in the apicocoronal direction [] and it was connected with the first incision so that the two flaps communicated with each other. The patency of the reflection was checked with the help of a periosteal elevator or a periodontal probe []. PRF in a collagen membrane carrier was placed over the sites with denuded root surfaces []. The entire flap was then coronally positioned to cover the membrane and sling sutures were placed []. A non-eugenol periodontal dressing (Coe-pack, GC) was given over the surgical site.\nThe patient was prescribed antibiotics (Amoxicillin, 500 mg thrice daily) and analgesics (Ibuprofen, 400 mg thrice daily) for 5 days and 0.12% chlorhexidine digluconate mouth rinse for 4 weeks. The patient was advised to follow routine post-operative periodontal mucogingival instructions, with minor modifications. He was told to avoid pulling on the lips to observe the surgical site. Both the dressing and sutures were removed 10 days after surgery. The patient was recalled after 8 weeks, and the complete root coverage was observed []. Six months follow-up showed stable results []. The patient was satisfied with the treatment.