Bottom-up suturing approach with biologic and grafting support for RT2 gingival recessions with papilla deficiency: Two case reports.

BACKGROUND

The management of multiple recession type 2 (RT2) gingival recessions remains a major clinical challenge because of interproximal attachment loss and limited predictability. This study aimed to present a graft-driven bottom‒up suturing concept for simultaneous root coverage and interdental papilla reconstruction.

METHODS

Two systemically healthy patients with RT2 multiple gingival recessions in the mandibular anterior region were treated using a bilaminar approach with basal positioning of a connective tissue graft. Interproximal bone grafting and biologic adjuncts were used to provide structural support and enhance the healing environment. A modified vertical double-crossed suturing technique was applied to achieve graft-driven coronal advancement and tension control. Clinical outcomes were evaluated at 6‒12 months.

RESULTS

At 12 months, root coverage reached 94.4% in one case and 100% in the other. Both cases demonstrated stable interdental papilla height and a keratinized tissue width gain of 2.00‒2.33 mm. Comparable favorable outcomes were observed with both recombinant human fibroblast growth factor-2 and enamel matrix derivative.

CONCLUSIONS

The graft-driven bottom‒up suturing approach may represent a promising technique for the management of complex RT2 gingival recession defects. Surgical design and tension control appear to be key factors for achieving predictable root coverage and papilla reconstruction in challenging clinical scenarios.

KEY POINTS: A graft-driven bottom‒up suturing approach can achieve favorable root coverage in recession type 2 multiple gingival recessions. This technique enables simultaneous reconstruction of interdental papillae in challenging anterior cases. Careful surgical design and tension control are critical factors for improving clinical outcomes in complex recession defects.

PLAIN LANGUAGE SUMMARY: Gum recession, a condition in which the gums recede from the teeth, can be difficult to treat when the supporting tissue between teeth is also lost. In these cases, it is often hard to fully cover exposed roots or restore the natural shape of the gums. In these reports, we describe a new surgical approach used in two patients with multiple gum recessions in the lower front teeth. The technique uses a small piece of the patient's own tissue placed under the gum to support healing, along with a specific suturing method that gently moves the gum upward. After 12 months, both patients showed substantial root coverage and improvement in the shape of the gum between teeth, with stable results over time. These findings suggest that careful surgical design and control of tissue tension may help improve outcomes in challenging cases of gum recession.