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Surgical coverage of mandibular lingual recession is not a routinely implemented treatment procedure because of its lack of esthetic significance, which is one of the most common indications for recession coverage. A gold standard for recession coverage, the sub epithelial connective graft is used in conjunction with a novel modification of the tunneling technique to treat the lingual recession on mandibular anterior teeth. Case presentation: A 33-year-old male patient with a previous history of smokeless tobacco, presented with pain, irritation and recession in the mandibular lingual area. #23 showed 4mm Millers Class 2 lingual recession. Surgical procedure consisted of making a sub periosteal tunnel from #23-26 and placing a sub epithelial connective graft harvested from the palate within the tunnel and securing it in place with sling sutures. The lateral margins of the recession were approximated with polypropylene sutures and tunnel was closely secured to cover the graft completely. Three months post-treatment showed complete recession coverage, gain in keratinized tissue, increased gingival thickness and complete symptomatic resolution. Conclusion: Lingual recession in the area of mandibular anterior teeth is a commonly encountered and often ignored clinical scenario. Inflammation caused by calculus, prominent lingual freni and deleterious habits are the most common etiological factors. Gingival augmentation with a minimally invasive technique consisting of an autograft and modified sub periosteal tunnel is presented to address the issues of sensitivity, progressive recession and facilitation of good plaque control.

Treatment of a Mandibular Anterior Lingual Recession Defect with Minimally Invasive Laterally Closed Tunneling Technique and Sub-Epithelial Connective Tissue Graft