Bridge flap technique as a single-step solution to mucogingival problems: A case series

Abstract

Shallow vestibule, gingival recession, inadequate width of attached gingiva (AG) and aberrant frenum pull are an array of mucogingival problems for which several independent and effective surgical solutions are reported in the literature. This case series reports the effectiveness of the bridge flap technique as a single-step surgical entity for increasing the depth of the vestibule, root coverage, increasing the width of the AG and solving the problem of abnormal frenum pull. Eight patients with 18 teeth altogether having Millers class I, II or III recession along with problems of shallow vestibule, inadequate width of AG and with or without frenum pull underwent this surgical procedure and were followed-up till 9 months post-operatively. The mean root coverage obtained was 55% and the mean average gain in width of the AG was 3.5 mm. The mean percentage gain in clinical attachment level was 41%. The bridge flap technique can be an effective single-step solution for the aforementioned mucogingival problems if present simultaneously in any case, and offers considerable advantages over other mucogingival surgical techniques in terms of simplicity, limited chair-time for the patient and the operator, single surgical intervention for manifold mucogingival problems and low morbidity because of the absence of palatal donor tissue.

Vestibular Extension along with Frenectomy in Management of Localized Gingival Recession in Pediatric Patient: A New Innovative Surgical Approach

“…Periodontal dressing was given to prevent epithelial re-attachment and to avoid the post-operative pain. Similar observations were also noted by Gupta et al 7 This new innovative surgical approach will definitely help in gaining not only sufficient sulcus depth, but also esthetically pleasant appearance. It also demonstrated that this procedure in children offers predictable success, when conditions are suitable and are correctly selected.…”

Complete root coverage in the treatment of Miller class III or RT2 gingival recessions: a systematic review and meta-analysis

“…Of the 16 articles focusing only on Miller class III GRs, nine of them [ 7 , 31 , 35 , 38 , 39 , 57 , 61 , 62 , 64 ] treated single GRs, six studies [ 6 , 53 , 56 , 58 – 60 ] included multiple GRs, and one study [ 67 ] included single or multiple Miller class III GRs. In the rest of articles, different kind of GRs were treated: single Miller class I, II and III GRs were treated in nine studies [ 40 , 41 , 44 , 48 , 50 , 51 , 63 , 65 , 66 ], whereas multiple Miller class I, II, III and IV GRs were treated in five articles [ 45 , 46 , 52 , 54 , 68 ], and single and multiple Miller class I, II and III GRs were treated in other seven articles [ 14 , 42 , 43 , 46 , 47 , 49 , 55 ] (Table 2 ).…”

“…In the treatment of Miller class III [ 4 ] or RT2 [ 5 ] recessions, the tunnel preparation and the CAFs were the most widely used surgical techniques. Regarding surgical procedures developed along twentieth century, they were used in 16 clinical studies [ 7 , 14 , 43 , 44 , 47 – 49 , 51 , 53 , 57 , 59 , 61 , 62 , 65 – 67 ] (Table 2 ).…”

“…In the majority of the studies, a subepithelial connective tissue graft or free gingival graft was used, followed by other alternatives such as connective tissue substitutes (acellular dermal matrix, porcine acellular dermal matrix) [ 36 , 45 , 52 , 60 , 68 ], bioabsorbable membranes (collagen membranes, PRF membranes) [ 36 , 43 , 46 , 48 ], platelet-derived growth factors (GEM21S®) [ 68 ] and enamel matrix proteins (Emdogain®) [ 6 , 14 , 42 ]. In 3 studies [ 47 , 51 , 63 ] no grafts were used (Table 2 ).…”

Root coverage with bridge flap

“…Clinical parameters included Probing Pocket Depth (distance from gingival margin to base of pocket), Gingival Recession (distance from cemento-enamel junction to gingival margin), width of attached gingiva (distance from base of pocket to mucogingival junction), and Clinical Attachment Level (distance from cemento-enamel junction to base of pocket). [6] The procedure was well explained to the patient and informed consent was obtained for surgery. The patient was medically sound and fit, so a surgical procedure was planned.…”