Increasing Width of Attached Gingiva by Envelope Technique with Trap Door Technique for Subepithelial Connective Tissue Graft

Special Article – Surgery Case Reports

Austin J Surg. 2019; 6(23): 1223.

Increasing Width of Attached Gingiva by Envelope Technique with Trap Door Technique for Subepithelial Connective Tissue Graft

Trivedi A*

Nr Veeranjali Garden, India

*Corresponding author: Trivedi A, J 5 Staff Quarters, Civil Campus, Nr Veeranjali Garden, Asarwa, Ahmedabad – 380016, Gujarat, India

Received: September 13, 2019; Accepted: October 24, 2019; Published: October 31, 2019


Each periodontal plastic & esthetic procedure can be performed using a variety of surgical techniques that are selected based on their advantages and disadvantages relative to the specific clinical presentation of the defect. The present paper focuses on improvement of gingival status by increasing width of attached gingiva by “Envelope technique” with illustrated surgical steps by case presentation.

Keywords: Width of attached gingiva; Envelope technique; Subepithelial connective tissue graft


Miller (1993) proposed that the term periodontal plastic surgery is defined as “surgical procedures performed to prevent or correct anatomic, developmental, traumatic or disease induced defects of the gingiva, alveolar mucosa or bone” (Proceedings of the World Workshop in Periodontics 1996) [1].

Miller’s classification of periodontal recession (1985) [2]

Class-I: The recession does not extend to the muco-gingival junction and is not associated with an interdental bone resorption.

There is no pocket and the proximal septa are within normal limits. A root coverage of 100% can be obtained.

Class-II: The recession extends beyond the muco-gingival junction with no interdental bone resorption. There is a rupture of the attachment. A 100% root coverage may also be obtained.

Class-III: The recession is associated with an interdental proximal bone resorption and an extrusion with proximal root exposition.

Root coverage of 100% may not be obtained.

Class-IV: There is proximal bone resorption and the dental papilla is at the same level as the recession. 100% root coverage is impossible.

However, Azzi and Etienne (1998) have shown that root coverage of class III and class IV could be possible.

With the use of the envelope technique [3,4], an envelope is prepared apically and laterally to the recession, the placement of the connective tissue graft is done and to allow for the coronal advancement of the mucosal flap at time of suturing. The sub epithelial connective tissue graft is harvested from the palate or the retromolar pad by the use of a “trap door” approach. Compared to the epithelialized graft, the connective tissue graft is preferable due to less invasive palatal wound and improved esthetic result [5-7].

Case Report

A 48 -year- old male patient reported to Department of Periodontia, with chief complaint of lowering of gum & hypersensitivity in lower left canine since 3 years.

In intraoral soft tissue examination, according to Miller’s classification Grade – II recession was present in relation to lower left canine. Width of attached gingiva was inadequate in lower left canine region (Figure 1).