Gingival fenestration defects are a rare phenomenon. Gingival fenestration means the exposure of the tooth due to loss of the overlying bone and gingiva. Though treatment of mucosal fenestration occurring in association with chronic periapical inflammation has been reported previously, the occurrence and treatment of gingival fenestration have not been documented in great detail. This report describes the occurrence of a gingival fenestration that developed secondarily to a gutka chewing habit. Treatment of the fenestration along with coverage of an adjacent recession defect in a single-step procedure using a pouch and tunnel technique is described. 1. Introduction Gingival fenestrations are of uncertain etiology and have rarely been reported in the dental literature [1]. Gingival fenestration defects may create problems regarding plaque control, root hypersensitivity, and esthetics. Gingival recession may be caused by periodontal disease, improper oral hygiene, frenal pull, bone dehiscence, improper restorations, tooth malposition, viral infections of the gingiva, and oral habits [2]. Recession defects are treated to resolve a variety of patient-centered concerns including, but not limited to, root sensitivity, increased potential for root caries, difficulty in plaque control, and esthetics [3]. Furthermore, it must be remembered that exposed roots are prone to abrasion and erosion. Several innovations, modifications, and variations have been developed for surgical root coverage since Grupe and Warren [4] first described the laterally positioned flap. However, greater predictability of results became achievable only with the introduction of bilaminar connective tissue grafting techniques [5]. Raetzke in 1985 [6] described a bilaminar technique for isolated recession defects, creating an envelope or pouch around the recession area to receive connective tissue graft. Zabalegui and others [7] treated multiple gingival recessions by creating a tunnel under the areas of gingival recession to receive the connective tissue graft thus avoiding dissecting the intermediate papilla and improving blood supply to the flap. Highly successful root coverage was reported with these two techniques [6, 7]. Gutka is chiefly a mixture of powdered tobacco, areca nut (fruit of Areca catechu), and slaked lime (aqueous calcium hydroxide), usage of which is seen mainly in the Indian subcontinent and also enjoyed by immigrant communities settled in Europe and the United States [8]. Habitual gutka use has been associated with the occurrence of several oral mucosal disorders,
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