International Journal of Clinical Case Reports 2017, Vol.7, No.2, 4-8
7
Figure 7 Post-operative clinical photograph on 1-month
follow-up
Figure 8 Donor site preparation
Figure 9 CTG placed at the recipient site
Figure 10 Post-operative clinical photograph on 1-month
follow-up
3 Discussion
In the modified Whale’s tail technique proposed originally by Biyanchi AE and Bassetti A, two incisions were
made on the buccal surface from mucogingival junction to the distal line angle of the tooth adjacent to the defect
in such a way that the mucoperiosteal flap could be elevated. These vertical incisions were joined by a horizontal
incision and were continued as crevicular incisions from the buccal to the palatal aspects of the defect- associated
tooth (Bianchi and Bassetti, 2009). In the present case, two semilunar incisions were made below the
mucogingival line on the buccal surface instead of the distinct horizontal and vertical incisions. The use of
incision closer to the osseous defect might have resulted in flap dehiscence and thereby, placement of sutures
closer to the defect might had increased the chance of bacterial colonization of the healing osseous defect. To
overcome the negative results, root coverage procedure was performed. Various methods have been proposed to
achieve surgical root coverage including pedicle gingival grafts, lateral pedicle flaps, free gingival grafts and
connective tissue grafts. All these methods are used based on their advantages and disadvantages as well as the
surgeon’s preference. Previously, free gingival grafts were used only to achieve increase in the width of
keratinized gingiva and not to cover the exposed root surface. The explanation to this might be due to less
coverage gained limited to around 3 mm width and 3 mm depth. Also, the blood supply to graft was insufficient
for its survival. Hence this method was not recommended for root coverage of wide and deep gingival recessions.
However, a series of different procedural methods were proposed by Miller, Holbrook and Ochsenbein to achieve
successful root coverage using free gingival grafts (Holbrook and Ochsenbein, 1983). The use of sub-epithelial
connective tissue grafts for root coverage was introduced by Langer and Langer (Langer and Langer, 1985).
Satisfactory results were achieved with this technique to cover wide and deep gingival recession and also,
multiple teeth with recession. On an average, 80% of root coverage was achieved by the connective tissue grafting
