Management of Multiple Adjacent Gingival Recessions Using the Zucchelli Modification of the Coronally Advanced Flap Without Connective Tissue Grafting: A Case Report

Gingival recession is a common periodontal condition characterized by apical migration of the gingival margin, resulting in root surface exposure, dentinal hypersensitivity, esthetic concerns, and increased susceptibility to root caries. Multiple adjacent gingival recessions present a therapeutic challenge because treatment aims to achieve root coverage while preserving gingival harmony and esthetic outcomes. The Zucchelli modification of the coronally advanced flap (CAF) has been widely used for the management of multiple recession defects due to its ability to achieve coronal advancement without vertical releasing incisions while preserving the interdental papillae. This case report describes the treatment of multiple adjacent maxillary gingival recessions in a 45-year-old female with well-controlled HIV infection receiving antiretroviral therapy. The patient presented with root sensitivity and esthetic concerns associated with gingival recession affecting the maxillary anterior region. Following comprehensive clinical and periodontal evaluation, root coverage therapy was performed using the Zucchelli modification of the CAF without connective tissue grafting. After meticulous root surface preparation and tension-free coronal advancement, the flap was stabilized with resorbable sutures. Postoperative healing was uneventful, and follow-up examination demonstrated increased root coverage, improved gingival contour, reduction of root exposure, and enhanced esthetics. The patient reported significant improvement in both function and appearance. In this case, the Zucchelli modification of the CAF without connective tissue grafting was feasible in a carefully selected patient with medically controlled HIV infection and was associated with favorable clinical healing and esthetic improvement during follow-up.