Treatment of Miller class 3 gingival recession with free gingival graft and creeping attachment phenomenon: 2 case reports; 2-year follow-up

Periodontal plastic surgical procedures applied to regulate the gingival-mucosa relations that complicate periodontal diseases and affect the success of periodontal treatment are referred to as mucogingival surgery. It is known that complete root surface closure can be achieved in mucogingival surgical procedures to be applied in patients without interproximal bone loss. However, recent studies suggest that patients with bone loss can also be treated successfully. The movement of the marginal edge of the gingiva towards the coronal margin after mucogingival surgery is defined as 'creeping attachment'. This case report aims to emphasize the importance of creeping attachment after free gingival grafting in patients with Miller class III gingival recession. Intraoral and radiologic examinations of two systemically healthy, non-smoking female patients aged 27 and 28 years showed mild to moderate periodontal bone loss and were diagnosed as stage 1 periodontitis. Patients with frenulum recession and gingival recession in the mandibular incisor region had Miller class III recession. Free gingival graft was applied to the patients and the changes in the graft and gingival recession area and creeping attachment were observed for 2 years. After free gingival grafting, in addition to the initial postoperative root surface closure in patients with Miller class III gingival recession, it was observed that the size of the gingival recession decreased or the root surface closure rate increased with creeping attachment over time.