JIDAM “An Official Journal of IDA - Madras Branch” ©2022. Available
online

ISSN No: 2582-0559

Volume No: 9, Issue No: 1

CASE REPORT

TARNOW’S TECHNIQUE WITH STABILIZING SUTURES -A

CASE REPORT

Dr Arunagiri, Dr. Anil Melath, Dr. Subair K, Dr. Arjun M.R,

Department of Periodontics, Mahe Institute of Dental Sciences and Hospital, Chalakkara, Pallor ,673310, Mahe, India

DOI: 10.37841/jidam_2022_V9_I1_05

Address for Correspondence

Dr Arunagiri

Post-Graduate Student

Mahe Institute of Dental Sciences and Hospital, Chalakkara,

Pallor ,673310, Mahe, India

Mail id: giriarun133@gmail.

com

Received : 15.10.202

1 Accepted : 22.1.2022

First Published: 28.1.2022 Published : 30.03.2022

ABSTRACT

Periodontal  plastic  surgery  mainly  establishing  an
ideal pink aesthetics through soft tissue reconstruction
of  gingival  recessions.  Transplantation  of  autogenous
soft  tissue  grafts  are  considered  a  gold  standard
treatment  modality  for coverage of gingival recession
defects  with  predictable  and  aesthetic  outcomes.
Hence  various  surgical  techniques  are  used  in
combination  with  such  grafts  for  gingival  recession
coverage.  This  case  report  presents  a  treated  case  of
Miller’s  Class  II  gingival  recession  defect  in  relation
to maxillary right second premolar with adequate root
coverage  as  well  as  increase  in  keratinized  gingiva
using Tarnow’s technique with Stabilizing sutures.

KEYWORDS:

Gingival

recession,

Tarnow’s

technique, Root coverage, Pink aesthetics

Volume No: 9, Issue No: 1

Arunagiri

et al: Tarnow’s Technique with Stabilizing Sutures -A Case Report

INTRODUCTION

Marginal    tissue    recession    is    a    common    condition    in
Periodontology  and  is  characterized  by  the  displacement  of
the  gingival    margin  towards  to the    mucogingival  junction
with  root  surface  exposure;  it  may  occur  at  isolated  or
multiple    areas    of    oral    cavity    with    different    extension
degrees.  Today,  “marginal  tissue  recession”  has  been  the
most    accepted    term,    because    the    tissue    showing    the
problem  can  be  the  alveolar  mucosa  instead  of  the  gingiva.
When  present;  marginal  tissue  recessions  may  implicate  in
compromising  the    patient’s    periodontal    health,    aesthetic
and    comfort.    Concerning    to    periodontal    health,    the
recessions  are  capable  of  acting  as  a  local  modifying  factor
for  the  installation  and  progression  of  periodontal  disease,
because    an    alteration    in    the    normal    gingival    contour
(regular    concave    arch)    occurs,    which    collaborates    for
greater  bacterial  plaque.

Gingival    recession    has    been  defined  as  the  apical
displacement  of  the  gingival  margin.    Localized  gingival
recession  is  an unesthetic condition that is usually observed
over  the  labial  aspect  of  prominent  teeth  and  may  be
associated

with

root

caries

and

hypersensitivity.

Histologically,  the  collapse  of  gingival  tissue  results  in
attachment loss by destruction of the  periodontal  connective
tissue  and  alveolar  bone.  The exposed  root  surface  has
been    a    therapeutic    challenge    to  clinicians    for    many
years.  The  most  frequent  etiologic factors  associated  with
recessions  are  inflammatory periodontal  disease,  traumatic
tooth    brushing    and  inadequate  attached  gingival
dimensions.

In the last three decades, a number of

techniques  have  been  proposed    to    obtain    root    coverage
and  to  improve  patients’ aesthetics,  quality  of  life  and
oral  health  including Semilunar coronally repositioned flap
(Tarnow’s  technique),    pedicle  flaps  (PF),  free  soft  tissue
autografts  (FSTA),  subepithelial  connective  tissue  graft
(SCTG),  coronally  advanced    flaps  (CAF),    SCTG    with
CAF  and  guided  tissue  regeneration (GTR).

CASE REPORT

34  years  old  male  patient  reported  to  our  Department
(Periodontics)  with  chief  complaint  of  receded  gums  and
mild  sensitivity  in  the  upper  right  back  tooth  region  for  the
past  3  months.  It  was  diagnosed  as  Millers  Class  II
Recession  (Fig  1).  Root  conditioning  was  done  with
doxycycline  for  3-5  minutes  (Fig  2).  A  split-thickness  flap
was  raised  under  local  anaesthesia.  A  semilunar  external
bevel  incision  was  given  directed  coronally  following  the
curvature  of  the  gingival  margins  8mm  from  the  crest  of
interdental  gingiva.  A  split  thickness  sulcular  incision
extending  to  the  semilunar  incision  was  given  carefully  to
elevate a partial thickness flap (Fig 3). After which a partial-
thickness flap was raised and advanced 6 mm coronal to CEJ
and  pressed  with  moist  gauze  for  5  minutes  to  stabilize  it.
Additional  stabilizing  suture  was  placed  in  the  area  and
periodontal pack (Coe pack) was placed for 1week.

Fig 1: Pre-Operative photograph

Fig 2: Root Conditioning

Fig 3: Split-thickness flap raised

Figure 2

Root Conditioning

Volume No: 9, Issue No: 1

Arunagiri et al: Tarnow’s Technique with Stabilizing Sutures -A Case Report

Fig 4: Sutures placed

Fig 5: Post-Operative photo after 3 months

DISCUSSION

A  denuded  root  surface  frequently  results  from  a
combination  of  predisposing  and  triggering/aggravating
factors.  Predisposing  factors  for  gingival  recession  include
bone  dehiscence,  insufficiency  of  width  and/or thickness  of
keratinised  gingiva,  tooth  malposition  and  high  frenal
attachment.

1,2

Triggering factors include traumatic abrasion,

abfraction,  erosion,  inflammation  (dental  plaque,  calculus,
gingivitis,  and  periodontitis)  and  iatrogenic  factors
(inappropriate  fixed  prostheses,  poorly  designed  partial
dentures,  operative  procedures,  orthodontic  treatment,  and
traumatic occlusion)

The primary goal of periodontal plastic and esthetic therapy
is  root  coverage.  Periodontal  plastic  surgery  is  defined  by
World  Workshop  in  Clinical  Periodontics  1996  as  surgical
procedures  performed  to  correct  or  eliminate  anatomic,
developmental,  or  traumatic  deformities  of  the  gingival.
Many periodontal plastic procedures have been described  in
the  past.  There  is  extensive  data  in  the  literature  which
provides an insight into the various surgical modalities used
for  the  treating  gingival  recession.  But  limitations  of  these
procedures  are  lack  of  predictability,  compromised  blood
supply,

postoperative

discomfort,

and

postoperative

morbidity. The traditional semilunar coronally repositioned
flap being presented has many advantages like no tension on
the flap, no shortening of the vestibule, no sutures are needed

because  of  the  lack  of  tension  of  the  tissue  being  coronally
positioned,  minimum  discomfort  to  the  patients  and  single
operative  site

. The main indication for carrying out this

technique  is  adequate  width  of  attached  gingiva,  Class  I
buccal/labial defects, where aesthetics is affected and cannot
be  controlled  by  non-surgical  therapy.  The  procedure  can
also be used where there has been recession around previous
full  coverage  restorations  in  the  anterior  section  of  the
mouth,  where  the  patient  has  a  high  enough  lip  line  when
smiling to show the denuded roots

The  root  coverage  was  97%  at  1  month  and  95%  at  3
months. Santana et al who showed a  mean root coverage of
41.78  %  root  coverage.  Bettencourt  in  2007

used

microsurgical techniques and fibrin glue adhesive and found
root coverage of 90.1%. The  microsurgical technique  might
have  improved the  handling of thin and delicate soft tissues
and  more  sensitive  detection  of  root  coverage  in  shallow
defects.  Also  in  SLF,  root  coverage  may  not  be  uniform
especially at the margins due to the greater dimension of the
donor  tissue  than  the  recipient  site  which  may  cause
instability  of  the  flap.  Santana  et  al  also  reported  a  lack  of
stability  in  root  coverage  might  be  due  to the  apical  pull  of
the contracted wound at the area of the semilunar horizontal
incision.  In  this  study,  there  was  a  deterioration  of  the
stability  of  the  flap  at  6  months.  This  may  be  due  to  the
increase in plaque and gingival index at 6 months, which was
not statistically but may be clinically significant. Proper oral
hygiene maintenance and brushing technique may be crucial
for  follow  up.  Gingival  recession  is  characterized  by
displacement  of  the  gingival  margin  apically  from  the
cemento-enamel  junction resulting  in root surface exposure.
It  is  a  common  condition  and  its  extent  and  prevalence
increase  with  age.  A  significant  proportion  of  the  adult
population  is  affected  by  this  alteration  which  may  lead  to
aesthetic concerns and complaints of hypersensitivity.

In  the  present  case,  maxillary  right  second  premolar
presented  with  unesthetic  Class  II  gingival  recession  with
inadequate  width  of  attached  gingiva.  Hence,  semilunar
coronally  positioned  flap  technique  with  sutures  was  the
procedure  of  choice.  In  this  case  report  significant
improvements in clinical parameters such as recession height
and  width  and  clinical  attachment  level  was  observed.  A
100%  root  coverage  was  seen  in  15  and  95%  in  3  months
(Fig  5).  Also  the  technique  offers  advantages  like  ease  of
performing.

Long-term

clinical

and

histological

investigations are needed to confirm these results with larger
sample size.

CONCLUSION

Semilunar  coronally  positioned  flap  (Tarnow’s  technique)
procedure  is  a  simple  technique  which  has  high  patient
acceptance and provides satisfactory results for treating class
I  &  II  recession  defects  especially  in  the  aesthetic  zone.
Further studies with larger sample size are needed in order to
evaluate  the  long-term  stability  of  the  obtained  positive
results.

Volume No: 9, Issue No: 1

Arunagiri

et al: Tarnow’s Technique with Stabilizing Sutures -A Case Report

FINANCIAL SUPPORT AND SPONSORSHIP:

Nil

CONFLICTS OF INTEREST:

There are no conflicts of interest.

REFERENCES

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2.Tarnow DP. Semilunar Coronally Repositioned Flap. J
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3.Tugnait A, Clerehugh V. Gingival recession: its
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4.Glossary of Periodontal terms. 4th edn. Chicago: American
Academy of Periodontology. American Academy of
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5.Edel A. The use of free connective tissue graft to increase
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Pathol. 1975; 39: 341–346.

6.Santana RB, Mattos CML, Dibart S. A clinical comparison
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inPe r iodontol 2010;37:651-58.

7.Bittencourt S, Ribeiro EP, Sallum EA, Sallum AW, Nociti
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coronally repositioned flap. J Periodontol. 2007; 9:1695-
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