|Year : 2013 | Volume
| Issue : 2 | Page : 166-168
Semilunar coronally repositioned flap
Syed W Peeran1, Madhumala Thiruneervannan2, Marei H Mugrabi3
1 Department of Periodontology and Oral Implantology, Faculty of Dentistry, Sebha University, Sebha, Libya
2 Department of Periodontology and Oral Implantology, Vinayaka Missions Sankarachariyar's Dental College, Vinayaka Missions Research Foundation Deemed University, Salem, Libya
3 Department of Periodontics, Faculty of Dentistry, Al-Arab Medical University, Benghazi, Libya
|Date of Web Publication||13-Dec-2013|
Syed W Peeran
Department of Periodontology and Oral Implantology, Faculty of Dentistry, Sebha University, Sebha
Source of Support: None, Conflict of Interest: None
In this era where aesthetics is of prime concern complete root coverage of gingival recession defects with periodontal plastic surgery is a necessity. The present paper describes a case where semilunar coronally repositioned flap procedure was performed with a 2-year follow-up and no relapse. Semilunar coronally repositioned flap commonly referred to as 'Tarnow's technique' is a viable periodontal plastic surgical procedure.
Keywords: Gingival recession, periodontal plastic surgery, semilunar coronally positioned flap
|How to cite this article:|
Peeran SW, Thiruneervannan M, Mugrabi MH. Semilunar coronally repositioned flap. Arch Int Surg 2013;3:166-8
| Introduction|| |
Gingival recession is a common problem in dental patients. It is the apical migration of the marginal gingiva to the cementoenamel junction.  It results from excessive or improper flossing, excessive or improper tooth brushing, gingival abalation, gingival abrasion, gingival inflammation, gingival loss secondary to specific diseases such as necrotizing ulcerative periodontitis and herpetic gingivostomatitis, high frenal attachment and iatrogenic causes such as crown preparation. It may also be caused due to inadequately attached gingiva, oral habits resulting in gingival laceration including traumatic tooth picking and eating hard foods, pocket reduction periodontal surgery, secondary to prominent roots, smoking, tooth mal-position and trauma from occlusion. ,, Gingival recession is accompanied by unpleasant aesthetics due to root exposure, and may also lead to root caries and dentinal hypersensitivity. ,
Treating gingival recession presents a challenge for the general dental practitioner in his day-to-day practice. The purpose of this case report is to emphasize the feasibility and simplicity of carrying out semilunar coronally repositioned flap procedure and its long term benefits in case of maxillary class I gingival recession.
| Case Report|| |
An 18-year-old apparently healthy male patient reported to the department of periodontology and oral implantology, VMS dental college, Salem, India. He complained of unaesthetic appearance of his tooth due to root exposure and discomfort due to tooth sensitivity in left maxillary canine. Medical, surgical, and dental histories were non-contributory with family history being irrelevant. There was no history of trauma or tooth mal-position. Clinical intraoral examination revealed a thick gingival biotype with adequate amount of keratinized gingiva along with shallow gingival recession. Upon correlating the history and clinical examination the gingival defect was diagnosed as Miller's class I gingival recession [Figure 1].  Basic regular blood investigations were carried out and the results were normal. Under local anesthesia a sharp curette was used to plane the exposed root surface. A semilunar incision was placed using No.15 BP blade, and the tissue was repositioned in coronal direction and was stabilized with sterile wet gauze [Figure 2]. Healing was uneventful with complete resolution of the recession defect. Oral hygiene instructions were given and reinforced on the recall visits and the patient was advised to use a soft toothbrush. Recall visits until 24 months showed 100% gain in clinical attachment level [Figure 3]. The patient showed no signs of gingival recession recurrence and was completely satisfied with the outcome of treatment.
| Discussion|| |
Gingival recession is of major aesthetic concern in dentistry. A number of periodontal plastic surgeries have been used to treat gingival recession each demonstrating different level of success. Semilunar coronally repositioned flap is probably the simplest, minimally invasive, conservative, one-stage periodontal plastic surgical procedure. The technique was initially described by Tarnow as a semilunar incision made parallel to the free gingival margin of the facial tissue, and coronally positioning this tissue over the denuded root.  It generally requires no sutures, no tension on the flap, no shortening of the vestibule, the existing papillae are not interfered and the blood supply of the graft remains intact and can be successfully used to treat Miller's class I gingival recession. ,, The major drawback of this technique is its inability to yield a root coverage of more than 2 to 3 mm.  It can be used as a treatment procedure in isolated gingival recession in maxillary teeth and in patients who complain of having sensitive teeth from exposed dentine secondary to gingival recession.  It is effective in obtaining and maintaining the coronal displacement of the gingival margin and shows no significant differences when compared to sub-epithelial connective tissue graft and has a fairly predictable success rate. , A variety of modifications of semilunar coronally repositioned flap have also been described in the literature with the primary incision being semilunar in shape. ,,
To the best of our knowledge this present case is the only case reported recently where semilunar coronally repositioned flap was performed and a long time follow-up was carried out. Our case also correlates with literature by reinforcing the fact that semilunar coronally repositioned flap can be performed in simple dental surgical settings with the most basic instruments. Our case also shows that the patients generally have no post-operative complications and have an uneventful healing with this periodontal plastic surgical procedure.
Periodontal plastic surgical procedures are often cumbersome and require elaborate operator skill and experience. But that is not the case of semilunar coronally repositioned flap procedure.  The results of this simple procedure that was carried out in this present case improved the gingival aesthetics of the patient and resolved the Miller's class I recession.
| Conclusion|| |
This case shows that semilunar coronally repositioned graft remains a simple viable periodontal plastic surgical option in the treatment of Miller's class I recession defects, when case is properly selected and the procedure is carried out accurately.
| References|| |
|1.||American academy of Periodontology. Glossary of periodontal terms. 4 th ed. Chicago: The American academy of Periodontology; 2001, p. 44. |
|2.||Tarnow DP. Semilunar coronally repositioned flap. J Clin Periodontol 1986;13:182-5. |
|3.||Glover ME. Periodontal plastic and reconstructive surgery. In: Rose LF, Mealey BL, Genco RJ, Cohen DW, editors. Periodontics: Medicine, Surgery and Implants; 2004. p. 406-87. |
|4.||Wennstrom JL. Mucogingival therapy. Ann Periodontol 1996;1:671-701. |
|5.||Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13. |
|6.||Takei HT, Azzi RA, Han TJ. Periodontal plastic and esthetic surgery. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA, editors. Carranza's Clinical Periodontology. 10 th ed. St. Louis, Mo, USA: Saunders, Elsevier; 2006. p. 1005-29. |
|7.||Bittencourt S, Ribeiro Edel P, Sallum EA, Sallum AW, Nociti FH, Casati MZ. Semilunar coronally positioned flap or subepithelial connective graft for the treatment of gingival recession: A 30-month follow-up study. J Periodontol 2009;80:1076-82. |
|8.||Thompson BK, Meyer R, Singh GB, Mitchell W. Densensitization of exposed root surfaces using a semilunar coronally positioned flap. Gen Dent 2000;48:68-71. |
|9.||Santana RB, Mattos CM, Dibart S. A clinical comparison of two flap designs for coronal advancement of the gingival margin: Semilunar versus coronally advanced flap. J Clin Periodontol 2010;37:651-8. |
|10.||Haghighat K. Modified semilunar coronally advanced flap. J Periodontol 2006;77:1274-9. |
|11.||Sorrentino JM, Tarnow DP. The semilunar coronally repositioned flap combined with a frenectomy to obtain root coverage over the maxillary central incisors. J Periodontol 2009;80:1013-7. |
[Figure 1], [Figure 2], [Figure 3]