Introduction
Gingival recession is defined as the exposure of the root surface by an apical shift in the position of the gingival. Recession of the gingival margin results in impaired esthetics and hypersensitivity. 1 Prevalence in Indian population: Mythri et al (2015): 40.98% subjects. The Bernotti v-y flap is a coronally advanced flap technique: Dr. Ana Luisa Bernotti. It is a microsurgical technique with or without connective tissue graft. It improves mucosal biotype and keratinized band in a isolated mucosal recession, dehiscence and translucent tissue, at teeth or implants sites. It is a conservative flap design, inspired in semilunar and modified semilunar tarnow’s technique.
Case I
28 year old male patient came with a chief complaint of sensitivity in upper left back tooth since 2 months. No relevant medical and dental history was present. On intraoral examination gingival recession was seen i.r.t 24 with probing depth of 2mm and CAL of 4mm
CASE II
26 year old male came with chief complaint of sensitivity in lower right back tooth since 2 months. .No relevant dental and medical history. On intra-oral examination, gingival recession presnet i.r.t 45 with probing depth of 1mm and CAL of 5 mm.
Post-Operative Instructions
The patient was advised amoxicillin 500mg thrice daily for 5 days and analgesic (Paracetamol 325 mg +Aceclofenac 100 mg) daily for three days. The patient was instructed to rinse with a 0.2% chlorhexidine solution for 2 weeks. The patient was instructed to be cautious while mastication and to avoid toothbrushing at the surgical site for 14 days.
Discussion
The surgeons are now interested in more user-friendly, less invasive, esthetically favourable patient-oriented surgeries. The concept of “Extension for prevention" has now changed to “Conserve to preserve." 2 The concept of "minimally invasive surgery (MIS)" is one such peculiar and innovative approach which aims to produce minimal wounds, minimal flap reflection, and gentle handling of the soft and hard tissues (Harrel et al. 2005).Various minimally invasive root coverage techniques used in the recent years have shown greater predictability and higher success rates. 3 Vestibular incision subperiosteal tunnel access (VISTA) (Zadeh et al 2011), Modified VISTA technique (Lee et al 2013), Gum drop technique ( Tutle D 2014), Pin Hole surgery (Chao et al 2015). Advantages of VY Bernotti technique includes protection to the interdental tissue, no invasive flaps or iatrogenic black triangles, provides a better blood supply, resulting in less crestal bone loss, allows for coronal movement of the marginal tissue with no tension from the suture on the vertical slope in creating the "Y" part of the flap, allows for excellent soft-tissue match and is an alternative to conventional grafting techniques.Limitations include it is technique sensitive, needs a thicker biotype of tissue, atleast 2mm of keratinized gingiva to show a better result
Conclusion
The V-Y Bernotti flap technique provides a good alternative to conventional root coverage procedures especially for treatment of single isolated gingival recession. Minimal incisions, excellent wound healing 4 and minimal patient discomfort are some of the main advantages of this technique. However the procedure is technique sensitive and a good case selection is an important criterion for the success of this procedure. Hence further long term studies are needed to evaluate the effectiveness and success of this technique.
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