I think , Pedicle graft is the most suitable for the treatment of Class II gingival recession if the condition is suitable. since pedicle graft has connected to blood vessel and gives predictable result, compared to free gingival graft and others ( It has plasmatic circulation, and it needs more technique sensitive, need graft stabilisation)

Sir, there could be various paths that leads to ones destination and all may be correct. Which technique could be used for class 2 recession will depend on may other factors. To give some examples:

1. If recession is narrow and deep + thick gingival biotype or adjacent incisor in placed palatally, then lateral pedicle would be sufficient.

2. Same scenario but thin gingival biotype - then sub-epithelial connective tissue graft would be required.

3. If the vestibule is very shallow and width seems to be inadequate, then first FGG to increase the width, then coronally reposition (with or without PRF)

4. If associated with a non-carious cervical defect, then connective tissue graft along with coronally reposition flap would be better.

Also, in some case although CTG could be a better choice, but due to shallow palate or inability to procure CTG from palate, other less desired treatment may have to be undertaken with acceptable results.

Chambrone and Chambrone et al.... SUB EPITHELIAL CONNECTIVE TISSUE GRAFT ... a gold standard in treatment of such cases... Its predictability is unmatched to any of the other procedures.

Dear DR Kumar

If you excuse me to answer your question with some general details regarding covering a gingival recession

To cover a recession, we need first good quality of tissue (Keratinized Gingiva) this could be obtained locally either laterally if it is available by rotational or lateral repositioned flap. Or apical to the recession by advanced coronal flap, Both are pedicle flaps and this based on amount of keratinized gingiva present adjacent or apical to the recession. it also depends on gingival biotype whether the gingiva is thin or thick. with pedicle grafts we don't have problems of blood supply for the grafts as they are pedicle types both lateral repositioned flap or advanced coronal flap having attached base provides the flap with blood supply. Another treatment option when there is no enough tissue around locally to cover the recession, so we need to obtain tissue from remote areas in the mouth, which is usually harvested from the palate (masticatory gingiva) this could be obtained as free gingival graft with epithelium or free connective tissue graft without surface epithelium, which can be used with advanced coronal flap for covering a recession (Connective tissue graft usually used in cases of thin gingival biotype) in this case. we do not have problem of blood supply because a split technique used with advanced coronal flap that provides the graft with dual blood supply sources, from the periosteum and from the flap (connective tissue), the problem with free gingival graft when it is used to cover a recession directly because the part that used to cover the recession is placed on a denuded root surface with no blood supply and possibility of necrosis of the area on the root surface. in this case as sufficient blood is required for a graft to survive, which is the second important issue beside a good quality of tissue to be considered when we plan to cover a recession. there fore we should extend the graft toward either sides of the recession and apical to it after sloughing the epithelial tissue to provide blood supply for the free epithelial graft to survive. the third issue is the draft or the flap should be relaxed on its new bed, no tension, no pulling or pressure is exerted on it during the healing phase. this should be considered in cases of high renal attachment that have a puling action on the gingiva and subsequently causing tension to the flap or the free graft, in this cases frenectomy is considered to be performed three months prior to recession treatment..

these three important points should be considered properly when we are planing to cover any recession, in order to a chive best post surgical results.

Best Regards.