26/01/2026
Because of limited instrument accessibility, managing gingival recession on the first molar ( #6) was particularly challenging. The oral vestibule was also shallow, and the attached gingiva was extremely thin; in retrospect, I believe it was the right decision not to perform a CAF in this case.
A T-CAF was also considered. Although the amount of recession on teeth #4 and #5 was minimal, I selected the VISTA technique to simultaneously convert the gingival biotype from thin to thick, which proved to be the correct choice. Complete root coverage of tooth #6 remains difficult to achieve; however, increasing soft tissue thickness should help protect the exposed root surface over the long term.
I initially aimed for a single-incision approach, but as the incision became discontinuous intraoperatively, I shifted to a trap-door design. In areas where the flap length was insufficient, accordionization was performed to gain additional extension.
One key point was positioning the suture budding on tooth #4 slightly toward the distal side, taking into account both gingival morphology and smile esthetics.
器具到達性わるいから、 6番の歯肉退縮は中々大変。口腔前庭も浅かったけど、付着歯肉薄すぎてCAFにしなくて本当に良かったと思ったケース。T-CAFかも迷いましたが、4,5歯肉の退縮量は少ないけれど同時にbio typeをThin→Thickに変える意味でもVISTA techniqueを選択して正解。6番の完全根面被覆は厳しそうだけど、厚みを増す事で根面を守れますように。Single Incisionを狙いましたが途中切れたのでTrap Doorにshiftし、短いところはaccordion化して延長しました。4番のSuture Boodingをやや遠心に上げているのが、歯肉形態的にもスマイル時の審美性も配慮したのがポイントです。
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