The Laterally Stretched/Coronally Advanced Flap (LAST/CAF) with Connective Tissue Graf Variation to Treat Deep-Wide and Multiple Deep-Narrow Defects. Case Report and Technical Description

In the surgical treatment of gingival recessions, ensuring adequate vascularization of the graft represents a significant challenge, particularly when covering large areas of avascular root surfaces. This report describes a new variant of the Laterally Stretched (LAST) flap technique, referred to as the LAST/CAF (Laterally Stretched/Coronally Advanced Flap), combined with a connective tissue graft (CTG). Two different scenarios where the LAST/CAF technique can be successfully applied are also illustrated by two clinical cases of severe gingival recessions. The first case involves a single, deep, and wide gingival recession defect, while the second case addresses multiple contiguous, deep, and narrow recession defects. Both cases demonstrate the successful management of extensive exposed root surfaces that challenge graft vascularization and survival. By laterally stretching the flap, graft exposure in the apical region of the recessions was minimized, while concomitant coronal advancement ensured complete graft coverage without excessive coronal displacement of the mucogingival junction (MGJ). This case report highlights the technical aspects of the LAST/CAF technique, demonstrating its ability to achieve successful root coverage in both isolated deep-wide and multiple deep-narrow gingival recession defects, while delivering esthetically pleasing results.