{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:59:00Z","timestamp":1790258340441,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This case report presents a modified pedicle flap technique\u2014the novel overlapping rotated double (NORD) flap\u2014as an alternative to conventional approaches such as coronally advanced flap with subepithelial connective tissue graft (SCTG). While SCTG offers predictable outcomes, it involves a second surgical site, increasing patient morbidity. In contrast, the NORD flap uses adjacent pedicle flaps in an overlapping design, with one flap mimicking a connective tissue graft, thereby enhancing tissue thickness and vascularity without donor site complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Two systemically healthy patients\u2014a 35\u2010year\u2010old female with a thick gingival phenotype and a 40\u2010year\u2010old male with a thin phenotype\u2014presenting with isolated recession type 1 (RT1) gingival recessions were treated using the NORD flap. All procedures were performed under local anesthesia with standard postoperative protocols. Follow\u2010ups were conducted at 14 days, 1 month, 6 months, and 12 months. Clinical outcomes were assessed using the root coverage esthetic score and patient\u2010reported outcome measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over 90% root coverage was achieved in both cases, regardless of phenotype. The technique eliminated graft harvesting, minimized complications, and was associated with minimal postoperative pain, requiring only two analgesic doses in 48 h.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The NORD flap offers a conservative and effective alternative for managing isolated gingival recessions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>Value of innovation<\/jats:bold>\n                      : This novel pedicle\u2010based technique serves as a viable alternative to graft harvesting in cases where minimizing patient morbidity is a priority, thereby avoiding a secondary surgical site or when subepithelial connective tissue graft is contraindicated or undesirable:\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Achieves high root coverage (&gt;90%) across different gingival phenotypes, demonstrating versatility.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Enhances soft tissue thickness and vascularity through an overlapping pedicle design that mimics a connective tissue graft.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Minimizes postoperative discomfort, with low analgesic requirement.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain language summary<\/jats:title>\n                    <jats:p>This case report introduces the novel overlapping rotated double (NORD) flap, a modified pedicle\u2010based approach designed to overcome limitations associated with conventional root coverage procedures. Although the subepithelial connective tissue graft is considered the gold standard due to its predictability, the technique necessitates harvesting from a secondary donor site, thereby increasing patient morbidity and postoperative discomfort. The NORD flap provides a biologically driven alternative by utilizing two adjacent pedicle flaps in an overlapping configuration, one of which functions analogously to a connective tissue graft. This design enhances gingival thickness, vascularization, and stability of the flap while obviating the need for graft procurement. Two cases presenting with isolated RT1 recessions were managed using this approach. All surgeries were performed under local anesthesia, followed by routine postoperative care, and evaluated. Clinical parameters, including the root coverage esthetic score, and patient\u2010reported outcome measures demonstrated favorable results, with &gt;90% root coverage achieved in both cases. The technique was associated with minimal pain, rapid healing, and elimination of donor site morbidity, underscoring its potential as a conservative and effective alternative for isolated recession defects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cap.70018","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T13:19:35Z","timestamp":1760447975000},"page":"522-529","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Novel overlapping rotated double flap: A modified pedicle technique for root coverage in isolated RT1 gingival recession\u2014Case study of two patients"],"prefix":"10.1002","volume":"16","author":[{"given":"Ritika","family":"Arora","sequence":"first","affiliation":[{"name":"Department of Periodontics and Oral Implantology Post Graduate Institute of Dental Sciences  Rohtak India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakshi","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Periodontics and Oral Implantology Post Graduate Institute of Dental Sciences  Rohtak India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ridhima","family":"Singhal","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitika","family":"Monga","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajinder K.","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Periodontics and Oral Implantology Post Graduate Institute of Dental Sciences  Rohtak India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shikha","family":"Tewari","sequence":"additional","affiliation":[{"name":"Department of Periodontics and Oral Implantology Post Graduate Institute of Dental Sciences  Rohtak India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/odi.14289"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12114"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12226"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016357.2020.1758773"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/idj.12617"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051x.1994.tb00278.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2007.060277"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2004.75.12.1734"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2002.73.12.1405"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12547"},{"issue":"15","key":"e_1_2_9_12_1","first-page":"S92","article-title":"Working Group 3 of the European Workshop on Periodontology. Surgical techniques on periodontal plastic surgery and soft tissue regeneration: consensus report of Group 3 of the 10th European Workshop on Periodontology","volume":"41","author":"Sanz M","year":"2014","journal-title":"J Clin Periodontol"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.17\u20100733"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002060\u2010200110000\u201000001"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2009.080565"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.13254"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051X.2011.01732.x"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13106"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2008.05.007"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.4103\/jisp.jisp_222_17"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12588"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010023\u201004975\u20107"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1089\/pho.2013.3602"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2006.050450"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972\u2010124X.164762"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.21474\/IJAR01\/12456"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1978.49.7.351"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.4103\/1735\u20103327.113370"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.18231\/2457-0087.2018.0031"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1968.39.2.65"},{"issue":"6","key":"e_1_2_9_31_1","first-page":"82","article-title":"Root coverage using double papilla preservation flap: a case report","volume":"6","author":"Yalamanchili PS","year":"2014","journal-title":"J Int Oral Health"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.4103\/0975\u20108844.99888"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2005.76.10.1758"}],"container-title":["Clinical Advances in Periodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.70018","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cap.70018","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.70018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:01:13Z","timestamp":1790254873000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/cap.70018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":32,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/cap.70018"],"URL":"https:\/\/doi.org\/10.1002\/cap.70018","archive":["Portico"],"relation":{},"ISSN":["2573-8046","2163-0097"],"issn-type":[{"value":"2573-8046","type":"print"},{"value":"2163-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]},"assertion":[{"value":"2025-06-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}