Coverage of a large recession – Connective tissue and frenectomy

Dear colleagues,
Today we share a case of coverage of a large recession in a lower central incisor, referred to us by an orthodontist after the completion of orthodontic treatment.

The patient presented with a localized gingival recession on the mandibular right central incisor, as well as a high frenal attachment. She also had a thin gingival biotype, which caused transparency in the roots of adjacent teeth—a common concern in cases with delicate tissue.

First attempt at coverage of the large recession

We performed a tunnel access and placed a connective tissue graft harvested from the palate. However, the connective tissue we obtained had a high proportion of fatty tissue and limited collagen density, which can affect the quality and stability of the graft.

The graft partially covered the recession, but not completely. While the result was acceptable esthetically, it did not fully meet our objectives for root coverage and long-term stability.

Second surgery with frenectomy

After a 4-month healing period, we decided to perform a second graft using the same tunnel technique. This time, we combined it with a frenectomy to reduce tension in the area and improve tissue stability.

Fifteen days after the second surgery, healing progressed well, and at the 5-month follow-up, the gingival margin appeared thicker, more stable, and with better coverage of the previously exposed root surface.

Want to see more soft tissue cases?

📎 Visit our clinical case section for more examples of soft tissue grafting, biotype management, and coverage of gingival recessions.

We hope you find this case informative and helpful in similar clinical scenarios.