Abstract

This paper demonstrates a novel suturing approach that achieves favorable and atraumatic soft tissue displacement in periodontal plastic surgery. Gingival recession, characterized by the apical displacement of the gingival margin, poses functional and aesthetic challenges, including root exposure, hypersensitivity, and diminished periodontal health. Successful treatment requires predictable root coverage, increased keratinized tissue width, and graft stabilization. Conventional techniques such as coronally advanced flaps and connective tissue grafts often face challenges related to graft stability and adaptation. To address these limitations, a novel bi- anchorage suture technique has been introduced, designed to enhance graft stabilization, minimize tension, and promote optimal healing outcomes. In periodontal plastic surgery, tunnelling flap techniques have developed as a scientific innovation with the focus on enhancing the vascular supply at the surgicalsite. A number ofsuturing techniques for flap stability have been reported in along with a variety of newer flap designs for recession coverage. The technique relies on a combination of tissue supported sling suture (TSS) and subpapillary sling suture (SSS)/ tooth supported sling suture. The present authors described the modification of subpapillary sling suture with crisscross pattern and they have found that the proposed suturing protocol achieves successful integration of graft, maximum root coverage, excellent esthetic results, and limited postoperative morbidity. This suturing technique is described in detail with schematic illustrations and clinical cases, and its advantages and potential limitations are discussed.

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