Coronal repositioning of the flap Lateral positioning of the flap Flap with double papilla Other methods
Flap with double papilla
							25. The bipapillar flap has been sculpted: in yellow in the drawing we see the donor site without periosteum (the flaps are mucoperiosteal).
24. Bipapillar flap: In the drawing (in red) we see the sulcal epithelium (dashed line); in dark purple we see the two papillas to shift onto the recession.
Other methods
26. A gingival recession at 3.1 with a "pulling" frenulum is evident in the photograph.								27. Two mucoperiosteal flaps are sculpted with oblique incisions from the interproximal areas. A small frenulectomy is also performed.
28. Suturing of the double flap is performed.				29. Enlargement of the result following the operation: the recession is covered, the adhering gum has increased and there is contraction of the tissues on the root.
30. Rotated pedunculate flap (in practice it is a small flap for horizontal shifting): periosteal stimulation 21 days before the operation.				31. A "V" incision along the edge of the recession in correspondence to the vestibular surface of 3.6.
32. A vertical incision mesial to the papilla to be rotated: it ends apically at the flap centre of rotation.									35. In the photo the result of the operation is visible: the recession is covered and the adhering gum has increased sufficiently.
33-34. At the end of the operation the usual suturing of the flap with single stitches is performed.
References 1. J. BERGSTROM, "The topography of papillary gingiva in health and early gingi vitis", J. Cl. Periodont., 7, 423, 1984 2. H. BJJORN, "Coverage of denuded root surfaces with a lateral slid ing flap. Use of free gingival grafts", Odont. Revue, 22, 37-44, 1971 3. R.G. CAFESSE, E.A. GUINARD, "Treatment of localized gingival recession (II). Coronally repositioned flap with a gingival graft", J. Cl. Periodont., 49, 357-361, l978 4. D. COHEN, S. Ross, "The double papillae repositioned flap in periodontal therapy", J. Periodont., 39, 65, 1968 5. S. COTTI, G. PETTI, I. PES, "Gli innesti liberi di gengiva in terapia parodontale", Rassegna Medica Sarda, fasc. LXXX, 1-5, 1977 6. W.H. DAHLBERG, "Considerazioni sulle suture e sulle incisioni dei lembi parodontali", Cl. Od. Nord Amer. - Terapia parodontale, vol. 2, n. 3, 668-670, 1970 7. I. ERICSSON, J. LINDHE, "Recession in sites with inadequate width of the keratinized gingiva. An experimental study in the dog", J. Periodont., 2, 95-101, l984 8. J.R. GARTRELL, D.P. MATHEWS, "Recessione gengivale", Cl. Od. Nord Amer. - Terapia Parodontale, vol. 9, n. 2, 390-405, 1979 9. H. GRUPE, R. WARREN, "Repair of gingival defects by a sliding flap operation", J. Periodont., 27: 92, 1956 10. H.L. WARD, M. SIMRING, ManuaLe di clinica parodontale, 93-98, 1974 11. J. LINDHE, S. NYMAN, "Alterations of the position of the marginal soft tissue following periodontal surgery", J. Cl. Periodont., 7, 525-530, 1980 12. S. LINDSKOD, L. BLOMLOF, L. HAMMARSTROM, "Repair of periodontal tissues in vivo and in vitro", J. Cl. Periodont., 10-12, 188, 1983 13. E. MARGRAF, "A direct technique with a double lateral bridging flap for coverage of denuded root surface and gingiva extension. Clinical evaluation after 2 years", J. Cl. Periodont., 1, 69-74, 1985 14. H.C. SULLIVAN, J.H. ATKINS, "Gli innesti gengivali liberi in terapia parodontale", Cl. Odont. Nord Amer. - Terapia Parodontale, vol. 2, n. 3, 659-663, 1970. 15. J.WENNSTROM, J. LINDHE, "Role of attached gingiva for maintenance of periodontal health", J. Cl. Periodont., 2, 206-207, 1983 16. A. ZARA, "Il trattamento delle recessioni gengivali localizzate", Il Dentista Moderno, 10, 1891-1900, 1985.