Patients today have become excessively concerned about esthetics. These esthetic concerns of patients have become an integral part of periodontal practice. Gingival recession is an esthetic problem that can be successfully treated by means of several mucogingival surgical approaches, any of which can be used, provided that the biologic conditions for accomplishing root coverage are satisfied with no loss of soft and hard tissue height interdentally. There are currently different techniques for root coverage which include pedicle grafts, free gingival grafts, connective tissue grafts, and guided tissue regeneration (GTR). This paper reports a case in which a new double papillary connective tissue graft technique has been used in the treatment of gingival recession. 1. Introduction The principal aim in surgically treating gingival recession is to cover the exposed root surfaces and consequently improve esthetic appearance, although there are other objectives such as inhibiting the progression of active recession, increasing the width of attached gingiva, and reducing dental hypersensitivity. Several techniques such as free gingival graft [1–3], laterally positioned flap [4–6], coronally positioned flap [7, 8], and double papilla graft [9] have been proposed for the same. The objective of free gingival graft procedure is to prevent future recession by increasing the width of keratinized gingiva rather than covering the root surface. A double-step procedure consisting of a free gingival graft to obtain a sufficient amount of keratinized tissue, if not already present, and a coronally positioned flap performed after healing to cover the exposed root surface has been proposed. Many variations of the grafting technique have been proposed for predictable root coverage [10–12]. In 1985, B. Langer and L. Langer [13] presented a surgical combination of a pedicle flap and a free graft, proposing that subepithelial connective tissue graft covering the lesion is overlapped by a partial thickness flap to ensure vascularization of the free graft. Different flap procedures further modified this technique resulting in a high success rate and predictability as shown in various longitudinal observations and case reports [14–17]. Recently, double papillary connective tissue graft has been used for the treatment of root coverage procedures for better esthetics and predictability. Of the various graft and nongraft procedures used, this case report describes double papillary subepithelial connective tissue graft, a technique in which bilateral pedicle flaps with connective
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