1734 Volume 75 • Number 12 Laterally Moved, Coronally Advanced Flap: A Modified Surgical Approach for Isolated Recession-Type Defects G. Zucchelli,* C. Cesari,* C. Amore,* L. Montebugnoli,* and M. De Sanctis † Case Series Background: Various modifications of the laterally sliding flap have been proposed to reduce the risk of gin- gival recession at the donor tooth site, but the reported root coverage predictability was quite low. The goal of the present study was to evaluate the effectiveness with respect to root coverage of a modified surgical approach of the laterally moved flap procedure for the treatment of an isolated type of recession defect. Methods: One hundred and twenty (120) isolated gingival recessions (Miller Class I or II) with specific features of the keratinized tissue lateral to the defects were treated with a new approach to the laterally moved flap. The main surgical modifications consisted of the coronal advancement of the laterally moved flap and the different thickness during flap elevation. Clin- ical evaluation was made 1 year after the surgery. Results: At the 1-year examination, 97% of the root surface was covered with soft tissue and 96 defects (80%) showed complete root coverage. A statistical and clinically significant increase of keratinized tissue was observed. These favorable results were accomplished with no change in the position of gingival margin or in the height of gingival tissue at the donor tooth/site. Conclusions: The laterally moved, coronally ad- vanced surgical technique was very effective in treat- ing isolated gingival recessions. It combined the esthetic and root coverage advantages of the coronally advanced flap with the increase in gingival thickness and kera- tinized tissue associated with the laterally moved flap. The ideal gingival conditions must be present lateral to an isolated recession defect in order to render the pro- posed surgical technique an highly effective and pre- dictable root coverage surgical procedure. J Periodontol 2004;75:1734-1741. KEY WORDS Dental esthetics; gingival recession/surgery; keratin/physiology; surgical flaps; tooth root. T he international literature has documented that gingival recession can be successfully treated by means of several surgical approaches, irrespec- tively of the technique utilized, provided that the bio- logic conditions for accomplishing root coverage are satisfied; i.e., no loss of interdental soft and hard tissues height. 1 The selection of one instead of another surgical tech- nique depends on the local anatomic characteristics of the site to be treated and on the patient’s demands. The patient influences the selection of the surgical technique especially when concerned about an esthetic problem due to the exposure of root surfaces during smiling or function. In such patients, pedicle flap surgical techniques (coronally advanced or rotated flaps) are recommended if there is adequate keratinized tissue close to the reces- sion defect. In these surgical approaches, the soft tis- sue utilized to cover the root exposure is similar to that originally present at the buccal aspect of the tooth with the recession defect and thus the esthetic result is more satisfactory. Furthermore, the postoperative course is less troublesome since other surgical sites far from the tooth with recession defect, (palate, for example) are not involved. The coronally advanced flap is the first choice sur- gical technique when there is adequate keratinized tis- sue apical to the recession defect. 2,3 Optimum root coverage results, good color blending of the treated area with respect to adjacent soft tissues, and recuper- ation of the original morphology of the soft tissues mar- gin can be predictably accomplished using this surgical approach. 2,3 Furthermore, the coronally advanced flap is very effective in treating multiple recession defects affecting adjacent teeth with obvious advantages for the patient in terms of esthetics and morbidity. 3 Some unfavorable local anatomic conditions may ren- der the coronally advanced flap contraindicated: 1) the absence of keratinized tissue apical to the recession defect; 2) the presence of gingival (“Stillman”) cleft extending in alveolar mucosa; 3) the marginal insertion of frenuli; 4) the presence of deep root structure loss; or 5) presence of a very shallow vestibulum. In these sit- uations the clinician should take the soft tissues located laterally to the recession defect into consideration to * Department of Oral Science, Bologna University, Bologna, Italy. † Department of Periodontology, Siena University, Siena, Italy.