Novel Suture Technique to Stabilize Vestibule for a Double Laterally Positioned Flap

OBJECTIVES: The goal of treatment is to establish a band of attached keratinized tissue to facilitate pain free oral hygiene and to eliminate the muscle attachment in order to help mitigate future recession. METHODS: A 62yo white female presented with RT2 recession on teeth numbers 24,25. Due to extensive use of antiplatelet medication, the decision to limit surgical sites to one was made, ruling out free tissue grafts. The surgical plan consisted of preparing two partial thickness flaps and securing them over the deficient sites of 24,25. To maintain good adaptation of the flap to the periosteum, a 4.0 PTFE suture was used to secure the flaps by using the adjacent periosteum and teeth as anchors points. To obtain hemostasis, microfibrillar collagen was used directly on the site. The patient was followed up at one week and one month for post operative evaluation. RESULTS: The evaluation at one month revealed elimination of the aberrant frenum and the re-establishment of a 4mm healthy band of attached keratinized tissue. During the healing there was no evidence of any flap necrosis as the flap was adequately secured against the periosteum. CONCLUSIONS: Using the Periosteal-Tooth Anchor suture technique, the laterally positioned flaps were able to be secured in a manner that ensured survivability of the flaps and established a band of attached keratinized gingiva. IMPLICATIONS: By informing clinicians of this suture technique, it will improve the predictability of these demanding and technique sensitive cases.