Application of a Vertically Coronally Advanced Flap for Root Coverage and Vestibule Depth Increase in a Mandibular Incisor: A 7-Year Follow-Up

Introduction. Gingival recessions affecting mandibular incisors are difficult to treat because of the thin buccal bone plate, the narrow band of keratinized tissue, the high frenal insertions and, above all, the shallow vestibule, which limits passive coronal advancement of the flap. The vertically coronally advanced flap (V-CAF) combined with a connective tissue graft (CTG) was proposed to obtain root coverage and simultaneously increase vestibule depth, but long-term documentation is scarce. Aim. To present the long-term clinical outcome of a vestibule depth increase alongside with root coverage of a deep isolated gingival recession of a mandibular central incisor treated with V-CAF + CTG and followed for seven years on a 35-year-old female. Results. Vestibule depth, minimal at one month because of the extensive coronal advancement, increased progressively during soft tissue maturation and, at 3 and 7 years, reached the level of the adjacent anatomical regions.