The objective of this surgery done by Dr. Marc Hinze, Gräfelfing/Germany, is to cover multiple gingival recessions in the maxilla with a coronally advanced flap applying the ‘Zucchelli approach’. With the ‘Zucchelli approach’, the recession coverage is made possible due the rotational move of newly created papillae as part of the coronal advancement of the flap. In the present surgery, multiple recessions in the upper jaw are treated applying the ‘Zucchelli technique’.

Part of this approach is the creation of new surgical papillae: First, incisions are made diagonally in the area of the original papillae followed by sulcular incisions to lift the marginal tissue. Once the crestal bone is reached, the preparation of a full thickness flap in the vestibular area is conducted up to the mucogingival junction using the papilla elevator and raspatory. Beyond the mucogingival junction, the flap transitions into a split flap, so that it can be sufficiently mobilized and shifted coronally.

At the same time, the flap should be rotated, which allows to build a new papilla. The existing papillae have to be thoroughly de-epithelialized in order to generate a base for the apposition of the surgically created papillae. A meticulous de-epithelialization is important for the proper attachment and healing of the new papillae. Once thorough cleaning of the exposed root surfaces and their conditioning with PrefGel (an EDTA substance) is completed, Straumann Emdogain is applied. Now, the prepared flap is moved coronally so that the recession areas are covered up to the cementoenamel junction.

The surgeon attaches the new papillae to their papilla beds with microsurgical sling sutures. The needle enters the buccal flap papilla distally towards the palatal region. Here, the seam is carried around the neck of the tooth through the mesial interproximal area to again enter the papilla base from the buccal side. The suture is then looped back around the same tooth in the palatal area and through the distal interproximal space. Finally, it is tied with the free end, positioning the knot vestibularly. With the ‘Zucchelli approach’, the recession coverage is made possible due to the diagonal incisions and the rotational move of the newly created papillae as part of the coronal advancement of the flap.