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 sur-gical periodontal regenerative therapy. In cases with a 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 a thin phenotype. The treatment involves using a tunneled coronally advanced flap to obtain access for defect de-bridement, root instrumentation, graft placement, and tissue advancement for root coverage. A connective tissue graft is secured to the two teeth flanking the infrabony defect using two subperi-osteal sling sutures to create a buccal soft tissue wall and tent up the papilla overlying the defect, providing and maintaining the necessary space for biomaterial and clot stability. The treatment significantly improved interproximal clinical attachment levels, tissue phenotype, and root coverage at 1 year postsurgery. Treatment outcomes suggest that this approach may be used to effectively treat isolated infrabony defects associated with gingival recession.