A modified anchored suturing technique for enhanced flap stability in periodontal plastic surgery: A case series.

Background: Gingival recession is a common mucogingival condition that may cause esthetic concerns, root sensitivity, and functional problems. Tunneling techniques with connective tissue grafts (CTGs) are well established for root coverage and esthetic preservation. Various suspensory sutures have been proposed to stabilize coronally advanced flaps. The butterfly suture is a modified anchored approach intended to provide simultaneous stabilization of interproximal and midfacial areas. This case series describes the clinical application and short-term outcomes of this technique. Methods: Three systemically healthy patients (two males and one female, aged 20-45 years) with Cairo RT1 and RT2 recession defects were treated using a tunneling technique combined with CTG and stabilized with the butterfly suture. The patients were followed for 6 weeks, and outcomes were assessed descriptively. Results: Nine teeth were treated in the three patients. Seven defects achieved complete root coverage (CRC), and two achieved partial root coverage (PRC). Healing was uneventful in all cases, with no complications such as infection or necrosis. The patients reported satisfaction with the esthetic outcomes and resolution of dentin hypersensitivity. Conclusion: Within the limitations of this small case series, the butterfly suture provided stable coronal advancement and favorable root coverage outcomes. This technique may represent a simple and efficient alternative in tunneling procedures. Larger controlled studies with longer follow-up and patient-reported outcomes are necessary to validate its effectiveness.