Coronal repositioning of the flap

5. Flap with coronal repositioning and free gingival graft: an incision is made along the line of the mucogingival junction;

6. After freeing the tissue between the incision and the free edge, the flap is sutured with a suspended stitch in a more coronal position;

7. A free gingival graft (red in the drawing) is sutured.

8. Gingival recession at 2.3 with a band of adhering gum.

9. Upper left: the tissue between the free edge and the incision along the mucogingival line is freed.

10. Upper right: the flap is sutured coronally: thus a lozenge of tissue that will receive the free graft is uncovered.

11. Centre left: taking of the free graft.

12. Above: graft sutured apically to the coronall y repositio ned flap.

13. To the side: the recession has been covered and the adhering band of gum around it has increased.

Lateral repositioning of the flap

14. Upper left: the laterally positioned flap. After eliminating any periodontal pockets that may be present or the epithelial sulcus, a mucous flap is sculpted at the distal region and a mucoperiosteal flap is sculpted at the mesial region.

15. Above: the flap is shifted mesially: the dashed line indicates the separation between the mucous flap (distal) and the mucoperiosteal flap (mesial).

16. The flap is positioned to cover the recession: distally (in red) we see the bed of the donor site covered by the periosteum (in red in the figure to the side).

17. Recession on the mesial root of 4.6.

18. "V"-shaped incision to eliminate the pocket corresponding to the recession.

19. A mucous flap is detached at the distal region and a mucoperiosteal flap is is detached at the mesial region.

20. The flap is sutured with single stitches.

21. With the part of the tissue remaining from the "design" of the flap a free gingival graft is taken.21. With the part of the tissue remaining from the "design" of the flap a free gingival graft is taken.

22. The graft is sutured onto the flap donor bed.

23. In the picture on the left we see an enlargement of the result of the operation: the recession is covered and the adhering gum has increased.

Flap with double papilla

24. Bipapillar flap: In the drawing (in red) we see the sulcal epithelium (dashed line); in dark purple we see the two papillas to shift onto the recession.

25. The bipapillar flap has been sculpted: in yellow in the drawing we see the donor site without periosteum (the flaps are mucoperiosteal).

Other methods

26. A gingival recession at 3.1 with a "pulling" frenulum is evident in the photograph.

27. Two mucoperiosteal flaps are sculpted with oblique incisions from the interproximal areas. A small frenulectomy is also performed.

28. Suturing of the double flap is performed.

29. Enlargement of the result following the operation: the recession is covered, the adhering gum has increased and there is contraction of the tissues on the root.

30. Rotated pedunculate flap (in practice it is a small flap for horizontal shifting): periosteal stimulation 21 days before the operation.

31. A "V" incision along the edge of the recession in correspondence to the vestibular surface of 3.6.

32. A vertical incision mesial to the papilla to be rotated: it ends apically at the flap centre of rotation.

35. In the photo the result of the operation is visible: the recession is covered and the adhering gum has increased sufficiently.

33-34. At the end of the operation the usual suturing of the flap with single stitches is performed.