Microsurgical Coronally Advanced Flap with Platelet-Rich Fibrin and Hyaluronic Acid Gel for Localized Gingival Recession Coverage: A Case Report

Abstract

Background: Gingival recession, a prevalent condition in periodontics, often necessitates surgical management for associated attachment loss, dentin hypersensitivity, root caries, or esthetic deficiencies. It primarily results from plaque-induced inflammation, mechanical trauma, anatomic factors such as tooth malposition and mucogingival conditions. Numerous techniques, including free gingival autograft, subepithelial connective tissue graft (CTG), etc have been proposed. While the CTG remains the gold standard in terms of predictable outcomes, despite its clinical success, it is associated with inherent patient morbidity due to the need for a second surgical site for tissue harvesting, typically from the palatal mucosa. The coronally advanced flap (CAF) with platelet-rich fibrin (PRF) and hyaluronic acid offers advantages over the subepithelial connective tissue graft (CTG) by reducing patient morbidity, discomfort, and recovery time. It promotes faster healing, superior aesthetic outcomes, and improved tissue integration, while being less invasive than CTG. Presentation of Case: A 43-year-old male presented with concerns of unesthetic appearance and sensitivity in his maxillary right front tooth. Clinically, an isolated Miller’s Class I gingival recession was noted at tooth 13, with adequate attached gingiva. Following initial therapy with scaling and root planing, baseline clinical parameters were recorded on the day of surgery. The surgical treatment involved a coronally advanced flap, along with platelet-rich fibrin (PRF) and hyaluronic acid gel, using microsurgical principles. The procedure achieved 95% root coverage and a significant increase in keratinized gingiva. Excellent color matching and improved tissue texture led to a natural aesthetic result. The patient was highly satisfied and experienced minimal postoperative discomfort. Conclusions: The findings showed that by utilizing advanced microsurgical techniques in coronally advanced flaps with adjuncts such as platelet-rich fibrin and hyaluronic acid gel, excellent root coverage and significantly improved functional and aesthetic outcomes can be achieved.