Guided biofilm therapy before recession type 2 coverage: Case report
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Abstract
Recession Type 2 defects are challenging because interproximal attachment loss reduces the predictability of complete root coverage. This case report describes the integration of a structured Guided Biofilm Therapy protocol into presurgical and supportive care for a 26-year-old male smoker with a Recession Type 2 defect at tooth 41 after unsuccessful orthodontic treatment. At baseline, the plaque index was 93% and bleeding on probing was 36%. Tobacco-cessation counselling, individualised oral-hygiene instruction, biofilm disclosure, air polishing, and site-specific instrumentation were provided over three preparatory visits. Before surgery, the plaque index and bleeding on probing had decreased to 7% and 4%, respectively. The defect was then treated with a laterally closed tunnel and a palatal subepithelial connective tissue graft. At 6 months, the plaque index was 11% and bleeding on probing was 5%; at 12 months, the corresponding values were 7% and 5%. Complete clinical root coverage was maintained at both follow-ups, and serial radiographs showed changes suggestive of increased interproximal bone fill. The favourable outcome followed a combined program of risk-factor control, professional biofilm management, surgery, and maintenance; the independent effect of Guided Biofilm Therapy cannot be determined from a single case. Standardised controlled studies are required to clarify its adjunctive value in periodontal plastic surgery.
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How to Cite
Tanumiharja, L. J. S., Suwindere, W., Tampubolon, E. B., Adristi, T. . V., & Wijaya, M. W. (2026). Guided biofilm therapy before recession type 2 coverage: Case report. International Journal on Health and Medical Sciences, 4(3), 190–197. https://doi.org/10.35335/healmed.v4i3.764
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Mensi, M., Scotti, E., Sordillo, A., Dalè, M., & Calza, S. (2024). Air-polishing followed by ultrasonic calculus removal for the treatment of gingivitis: A 12-month, split-mouth randomized controlled clinical trial. International Journal of Dental Hygiene, 22(4). https://doi.org/10.1111/idh.12812
Sculean, A., & Allen, E. (2018). The Laterally Closed Tunnel for the Treatment of Deep Isolated Mandibular Recessions: Surgical Technique and a Report of 24 Cases. The International Journal of Periodontics & Restorative Dentistry, 38(4). https://doi.org/10.11607/prd.3680
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Tavelli, L., Barootchi, S., Nguyen, T. V. N., Tattan, M., Ravidà, A., & Wang, H. L. (2018). Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta-analysis. In Journal of Periodontology (Vol. 89, Number 9). https://doi.org/10.1002/JPER.18-0066
Tavelli, L., Barootchi, S., Stefanini, M., Zucchelli, G., Giannobile, W. V., & Wang, H. L. (2023). Wound healing dynamics, morbidity, and complications of palatal soft-tissue harvesting. In Periodontology 2000 (Vol. 92, Number 1). https://doi.org/10.1111/prd.12466
Tonetti, M. S., & Jepsen, S. (2014). Clinical efficacy of periodontal plastic surgery procedures: Consensus Report of Group 2 of the 10th European Workshop on Periodontology. Journal of Clinical Periodontology, 41. https://doi.org/10.1111/jcpe.12219
Vouros, I., Antonoglou, G. N., Anoixiadou, S., & Kalfas, S. (2022). A novel biofilm removal approach (Guided Biofilm Therapy) utilizing erythritol air-polishing and ultrasonic piezo instrumentation: A randomized controlled trial. International Journal of Dental Hygiene, 20(2), 381–390. https://doi.org/10.1111/idh.12533
Yein, N., Martande, S., Shetty, S. K., Kulloli, A., Swathi, P. V., Ramamurthy, P., & Sharma, D. (2026). Clinical efficacy of Guided Biofilm Therapy in the management of periodontal disease: A systematic review. BMC Oral Health, 26, 1078. https://doi.org/10.1186/s12903-026-08418-z
Zucchelli, G., & Mounssif, I. (2015). Periodontal plastic surgery. Periodontology 2000, 68(1), 333–368. https://doi.org/10.1111/prd.12059
Braun, A., Jepsen, S., & Krause, F. (2007). Subjective intensity of pain during ultrasonic supragingival calculus removal. Journal of Clinical Periodontology, 34(8). https://doi.org/10.1111/j.1600-051X.2007.01100.x
Cairo, F. (2017). Periodontal plastic surgery of gingival recessions at single and multiple teeth. In Periodontology 2000 (Vol. 75, Number 1). https://doi.org/10.1111/prd.12186
Cairo, F., Nieri, M., Cincinelli, S., Mervelt, J., & Pagliaro, U. (2011). The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: An explorative and reliability study. Journal of Clinical Periodontology, 38(7). https://doi.org/10.1111/j.1600-051X.2011.01732.x
Cairo, F., Nieri, M., & Pagliaro, U. (2014). Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. In Journal of Clinical Periodontology (Vol. 41). https://doi.org/10.1111/jcpe.12182
Cairo, F., Rotundo, R., Miller, P. D., & Pini Prato, G. P. (2009). Root Coverage Esthetic Score: A System to Evaluate the Esthetic Outcome of the Treatment of Gingival Recession Through Evaluation of Clinical Cases. Journal of Periodontology, 80(4). https://doi.org/10.1902/jop.2009.080565
Chambrone, L., Chambrone, D., Pustiglioni, F. E., Chambrone, L. A., & Lima, L. A. (2009). The influence of tobacco smoking on the outcomes achieved by root-coverage procedures: A systematic review. Journal of the American Dental Association, 140(3). https://doi.org/10.14219/jada.archive.2009.0158
Chambrone, L., & Tatakis, D. N. (2015). Periodontal Soft Tissue Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop. Journal of Periodontology, 86(2S). https://doi.org/10.1902/jop.2015.130674
Cortellini, P., & Bissada, N. F. (2018). Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. Journal of Clinical Periodontology, 45. https://doi.org/10.1111/jcpe.12948
Cyris, M., Festerling, J., Kahl, M., Springer, C., Dörfer, C. E., & Graetz, C. (2024). Guided biofilm therapy versus conventional protocol—clinical outcomes in non-surgical periodontal therapy. BMC Oral Health, 24(1). https://doi.org/10.1186/s12903-024-04898-z
Edel, A. (1974). Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. Journal of Clinical Periodontology, 1(4). https://doi.org/10.1111/j.1600-051X.1974.tb01257.x
Fernández-Jiménez, A., García-De-La-Fuente, A. M., Estefanía-Fresco, R., Marichalar-Mendia, X., Aguirre-Urizar, J. M., & Aguirre-Zorzano, L. A. (2021). Complete root coverage in the treatment of Miller class III or RT2 gingival recessions: a systematic review and meta-analysis. BMC Oral Health, 21(1). https://doi.org/10.1186/s12903-021-01494-3
Gagnier, J. J., Kienle, G., Altman, D. G., Moher, D., Sox, H., Riley, D., Allaire, A., Aronson, J., Carpenter, J., Hanaway, P., Hayes, C., Jones, D., Kaszkin-Bettag, M., Kidd, M., Kiene, H., Kienle, G., Kligler, B., Knutson, L., Koch, C., … Tugwell, P. (2013). The CARE guidelines: Consensus-based clinical case reporting guideline development. BMJ Case Reports. https://doi.org/10.1136/bcr-2013-201554
Jentsch, H. F. R., Flechsig, C., Kette, B., & Eick, S. (2020). Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy: a randomized clinical trial. BMC Oral Health, 20(1). https://doi.org/10.1186/s12903-020-01363-5
Liu, C. C., Dixit, N., Hatz, C. R., Janson, T. M., Bastendorf, K. D., Belibasakis, G. N., Cosgarea, R., Karoussis, I. K., Mensi, M., O’Neill, J., Spahr, A., Stavropoulos, A., & Schmidlin, P. R. (2024). Air powder waterjet technology using erythritol or glycine powders in periodontal or peri-implant prophylaxis and therapy: A consensus report of an expert meeting. Clinical and Experimental Dental Research, 10(1). https://doi.org/10.1002/cre2.855
Mensi, M., Scotti, E., Sordillo, A., Agosti, R., & Calza, S. (2020). Plaque disclosing agent as a guide for professional biofilm removal: A randomized controlled clinical trial. International Journal of Dental Hygiene, 18(3). https://doi.org/10.1111/idh.12442
Mensi, M., Scotti, E., Sordillo, A., Dalè, M., & Calza, S. (2024). Air-polishing followed by ultrasonic calculus removal for the treatment of gingivitis: A 12-month, split-mouth randomized controlled clinical trial. International Journal of Dental Hygiene, 22(4). https://doi.org/10.1111/idh.12812
Sculean, A., & Allen, E. (2018). The Laterally Closed Tunnel for the Treatment of Deep Isolated Mandibular Recessions: Surgical Technique and a Report of 24 Cases. The International Journal of Periodontics & Restorative Dentistry, 38(4). https://doi.org/10.11607/prd.3680
Shrivastava, D., Natoli, V., Srivastava, K. C., Alzoubi, I. A., Nagy, A. I., Hamza, M. O., Al-Johani, K., Alam, M. K., & Khurshid, Z. (2021). Novel approach to dental biofilm management through guided biofilm therapy (Gbt): A review. In Microorganisms (Vol. 9, Number 9). https://doi.org/10.3390/microorganisms9091966
Tavelli, L., Barootchi, S., Nguyen, T. V. N., Tattan, M., Ravidà, A., & Wang, H. L. (2018). Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta-analysis. In Journal of Periodontology (Vol. 89, Number 9). https://doi.org/10.1002/JPER.18-0066
Tavelli, L., Barootchi, S., Stefanini, M., Zucchelli, G., Giannobile, W. V., & Wang, H. L. (2023). Wound healing dynamics, morbidity, and complications of palatal soft-tissue harvesting. In Periodontology 2000 (Vol. 92, Number 1). https://doi.org/10.1111/prd.12466
Tonetti, M. S., & Jepsen, S. (2014). Clinical efficacy of periodontal plastic surgery procedures: Consensus Report of Group 2 of the 10th European Workshop on Periodontology. Journal of Clinical Periodontology, 41. https://doi.org/10.1111/jcpe.12219
Vouros, I., Antonoglou, G. N., Anoixiadou, S., & Kalfas, S. (2022). A novel biofilm removal approach (Guided Biofilm Therapy) utilizing erythritol air-polishing and ultrasonic piezo instrumentation: A randomized controlled trial. International Journal of Dental Hygiene, 20(2), 381–390. https://doi.org/10.1111/idh.12533
Yein, N., Martande, S., Shetty, S. K., Kulloli, A., Swathi, P. V., Ramamurthy, P., & Sharma, D. (2026). Clinical efficacy of Guided Biofilm Therapy in the management of periodontal disease: A systematic review. BMC Oral Health, 26, 1078. https://doi.org/10.1186/s12903-026-08418-z
Zucchelli, G., & Mounssif, I. (2015). Periodontal plastic surgery. Periodontology 2000, 68(1), 333–368. https://doi.org/10.1111/prd.12059
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