Microsurgical treatment of gingival cleft accompanied by gingival recession

This case reported the treatment of the maxillary premolars with gingival cleft and gingival recession. Coronally advanced flap combined with connective tissue graft technique using the microsurgical approach showed satisfactory root coverage and aesthetic outcome in the 2-year follow-up. The chief complaint of the 23-year-old female patient was gingival recession and tooth sensitivity of the left maxillary premolars. Besides the gingival recession presented in the premolars, there was also a gingival cleft classified into “incomplete white gingival cleft” detected in the left maxillary first premolar. The recession was also accompanied by the non-carious cervical lesion. After initial therapy to eliminate the risk factors, the defects were treated with coronally advanced flap combined with connective tissue graft with a magnification of 6×. Two-year follow-up showed complete elimination and closure of the gingival cleft, as well as complete root coverage. The patient was satisfied with the aesthetic outcome. Gingival cleft could result in root sensitivity, root caries and gingival recession. The management of gingival cleft should be based on its types. “Red gingival cleft” is reversible, and non-surgical therapies such as patient education and behavioral modification could help with the healing. “White gingival cleft” requires surgical techniques including soft tissue grafting and microsurgical approach. The microsurgical technique of coronally advanced flap combined with connective tissue graft is indicated to provide satisfactory and stable outcome in the treatment of gingival cleft accompanied by gingival recession.