Post-surgical care
trauma, pain
PLAQUE
With the use of a micro-surgical blade (Mini-Crescent® 1.25-mm micro-surgical blade, Sharpoint), a single-plane split-thickness dissection was done, extending at least 5 mm in all directions from the gingival margins. In the interdental spaces, the undersurface of the buccal interdental papillae was dissected extending coronally up to 2 mm from the CEJ. After instrumenting the exposed tooth surfaces with curettes, the CTG was positioned inside the tunnel and secured in place with two internal vertical mattress sutures at both mesial and distal ends, locating its coronal end 1 mm above the CEJ. No attempts were made to advance the marginal tissues: consequently, the most coronal portion of the CTG was intentionally left exposed. However, when large amounts of the CTG resulted exposed, the mesial and distal gingival marginal ends of the involved recessions were approximated through interrupted sutures. A split-full-split flap was elevated to allow its passive coronal advancement. Whenever possible, vertical releasing incisions were avoided. Once the exposed root surfaces were instrumented with curettes, the anatomical interdental papillae were de-epithelialized, and the CTG was sutured to these papillae aiming to secure the coronal end of the graft at the level of the CEJ, using single interrupted resorbable sutures (6/0 to 8/0). Finally, the flap was advanced and sutured 1 mm coronally to the CEJ through sling sutures, closely adapting every surgical papilla to the correspondent de-epithelized anatomic papilla and entirely covering the CTG.Patients were given anti-inflammatory and pain medication (Ibuprofen 600 mg) and were advised to take them as required, up to a maximum of 3 tablets/day. When contraindicated, paracetamol (500 mg) was used instead. Patients were also instructed to avoid any self-performed mechanical oral hygiene procedure or trauma on the surgical area for 14 days, and during 4 weeks, they were instructed to rinse with 0.12% chlorhexidine digluconate + 0.05% cetylpyridinium chloride for 1 min twice a day. Sutures were removed at 7–10 days after surgery. Thereafter, during the first month, the patients were recalled weekly for oral hygiene reinforcement and professional supra-gingival plaque removal and then at the 3- and 6-month follow-up visits.