This composite of four clinical intraoral photographs documents a mucogingival surgery for root coverage of the mandibular left lateral incisor and canine. Image A illustrates the initial surgical phase with a full-thickness flap detachment extending beyond the mucogingival junction, exposing the underlying alveolar bone and root surfaces. Image B displays the placement of a subepithelial connective tissue graft, which is secured to the recipient site using fine resorbable sutures to ensure graft stability and close adaptation to the root surfaces. Image C shows the coronally advanced flap positioned over the graft and fixed with sling sutures at the interdental papillae, which provides tension-free closure and coronal positioning. Image D captures the post-operative outcome two months later, demonstrating successful healing, significantly increased zones of keratinized tissue, and successful root coverage with healthy gingival contours and integration of the grafted tissue.

This sequence of four intraoral clinical photographs documents a periodontal mucogingival surgery for root coverage using a subepithelial connective tissue graft (SCTG) and a double lateral sliding bridge flap (DLSBF) technique on the mandibular anterior teeth. (a) Baseline: Shows significant gingival recession on the mandibular incisors with exposed root surfaces and thin biotype. (b) Immediate Postoperative: Displays the surgical site with a coronally repositioned flap covering the SCTG, secured with multiple black silk interrupted sutures; the tissue is erythematous and edematous, characteristic of immediate surgical trauma. (c) Four-Month Follow-Up: Shows successful root coverage with healthy, pink, keratinized gingiva and a stable mucogingival junction. (d) Two-Year Follow-Up: Demonstrates long-term stability of the gingival margin with a visible apical scar in the vestibule corresponding to the previous surgical incision. The patient is also undergoing active orthodontic treatment, indicated by fixed metal brackets and an archwire. This progression illustrates the surgical management of Cairo class recessions and the aesthetic integration of grafted tissue over time.

This intraoral clinical photograph shows a postoperative view of the mandibular left quadrant, focusing on the successful surgical treatment of gingival recession on the lower left lateral incisor (tooth 32). The image demonstrates complete root coverage following a periodontal plastic surgery procedure, likely involving a subepithelial connective tissue graft and a double pedicle flap. The gingival margin at tooth 32 is positioned at the cemento-enamel junction (CEJ), matching the level of adjacent teeth. The interdental papillae are well-formed and fill the proximal spaces. The newly formed keratinized tissue appears pink, healthy, and firm, with a smooth texture and a clearly defined mucogingival junction. No clinical signs of inflammation, such as edema or erythema, are visible. The neighboring mandibular teeth appear clean with smooth enamel surfaces and an absence of plaque or calculus deposits. This visual serves as a clinical example of regenerative periodontal therapy achieving both functional attachment and esthetic harmony in the treatment of Miller's Class II recession.

This intraoral clinical photograph illustrates an intermediate stage of a periodontal plastic surgery procedure for root coverage. The image shows the mandibular anterior region, specifically tooth number 32 (lower left lateral incisor), which presents with Miller's class II gingival recession. A subepithelial connective tissue graft (SCTG) has been harvested and positioned over the denuded root surface. The surgical site displays a reflected partial-thickness flap with mesial and distal vertical releasing incisions. The adjacent papillary grafts from the interdental spaces are being manipulated and sutured midbuccally over the graft to provide a double pedicle covering. A metallic surgical periosteal elevator is visible at the inferior aspect of the site, reflecting the mucosal flap. The surrounding gingiva appears erythematous and edematous, consistent with acute surgical trauma and inflammation. Visible 5-0 sutures are used to stabilize the graft and approximate the tissue margins. This image demonstrates the clinical application of a combined SCTG and double pedicle flap technique for correcting localized gingival recession and increasing the zone of keratinized tissue.