{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T08:10:15Z","timestamp":1778141415306,"version":"3.51.4"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"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"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Fixed contralateral anchored suturing (FICAS) for coronal flap advancement is a novel suturing technique that utilizes ceramic attachments bonded to the buccal or lingual of the teeth as an anchorage point for suspensory sutures. This technique is designed to increase flap stability and improve graft adaptation in periodontal plastic surgery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Two patients with localized gingival recession defects were treated with connective tissue grafting. One case used a tunneling technique, and the other used a coronally advanced flap. A ceramic button is bonded to the tooth surface contralateral to the flap. This is the lingual surface in both cases presented. Subepithelial connective tissue grafts and flaps were coronally advanced using periosteal stretching and then secured with nylon sutures. The sutures are looped over the ceramic button in a specific suspensory configuration.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Follow\u2010up at 2 weeks and 6 months revealed uneventful healing. No loss of sutures, ceramic buttons, or any postoperative infection occurred. The bonded buttons successfully protected the sutures and wound from disruption by tongue movements and food. There were visible increases in gingiva thickness, keratinized and attached tissue. Significant root coverage was achieved.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The FICAS technique may be a viable alternative for tension\u2010free coronal flap advancement and stable soft tissue adaptation, specifically in complex soft tissue cases such as a dehiscence or Recession type (RT)2 and RT3 defects. Additional research, ideally randomized controlled trials, is necessary to substantiate these observations and determine the long\u2010term success of this technique compared to others previously described.<\/jats:p>\n <\/jats:sec>\n \n Key points<\/jats:title>\n \n \n \n Fixed contralateral anchored suturing used ceramic buttons as a remote anchorage point for suspensory sutures.<\/jats:p>\n <\/jats:list-item>\n \n Maximizing flap stability and minimizing tension on delicate tissues are critical factors for favorable healing in periodontal plastic surgery.<\/jats:p>\n <\/jats:list-item>\n \n Buttons bonded to the contralateral surface of the flap may improve esthetics compared to other suspensory suturing techniques.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Plain language summary<\/jats:title>\n Fixed contralateral anchored suturing technique is a new suturing technique that involves bonding a button to the tooth surface, which will hold suspensory sutures. Sutures play a critical role in holding the tissues in a stable and favorable position during initial healing. The authors aim to introduce this technique to improve upon the esthetics of previously reported suspensory suturing techniques, and potentially improve outcomes and root coverage in both simple and complex recession cases.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/cap.70064","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T07:11:56Z","timestamp":1778137916000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fixed contralateral anchored suturing for coronal flap advancement"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9859-9623","authenticated-orcid":false,"given":"Pooria Fallah","family":"Abed","sequence":"first","affiliation":[{"name":"Private Practice Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Bowers","sequence":"additional","affiliation":[{"name":"Private Practice Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wade","family":"Knight","sequence":"additional","affiliation":[{"name":"Private Practice Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0407-6075","authenticated-orcid":false,"given":"Rodrigo","family":"Neiva","sequence":"additional","affiliation":[{"name":"Department of Periodontology and Oral Implantology Temple University, Maurice H. Kornberg School of Dentistry Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"issue":"3","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1034\/j.1600-051X.29.s3.11.x","article-title":"Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review","volume":"29","author":"Roccuzzo M","year":"2002","journal-title":"J Clin Periodontol"},{"key":"e_1_2_9_3_1","first-page":"303","article-title":"Surgical therapies for the treatment of gingival recession: a systematic review","volume":"3","author":"Oates T","year":"2002","journal-title":"Ann Periodontol"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/j.1600-0757.1996.tb00188.x","article-title":"Suturing techniques for periodontal plastic surgery","volume":"11","author":"Moore RL","year":"1996","journal-title":"Periodontol 2000"},{"issue":"1","key":"e_1_2_9_5_1","first-page":"138","article-title":"Influence of suturing on wound healing","volume":"62","author":"Burkhardt R","year":"2013","journal-title":"Periodontol 2000"},{"issue":"1","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1902\/jop.1991.62.1.5","article-title":"Early healing events at the dentin\u2010connective tissue interface: light and transmission electron microscopy observations","volume":"62","author":"Wikesj\u00f6 UME","year":"1991","journal-title":"J Periodontol"},{"issue":"11","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1902\/jop.1990.61.12.719","article-title":"Periodontal repair in dogs: effect of wound stabilization on healing","volume":"61","author":"Wikesj\u00f6 UME","year":"1990","journal-title":"J Periodontol"},{"issue":"1","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/j.1600-051X.1991.tb01120.x","article-title":"Periodontal repair in dogs: effect of heparin treatment of the root surface","volume":"18","author":"Wikesj\u00f6 UME","year":"1991","journal-title":"J Clin Periodontol"},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1902\/jop.2000.71.2.188","article-title":"Coronally advanced flap procedure for root coverage: flap with tension versus flap without tension\u2014a randomized controlled clinical study","volume":"71","author":"Pini\u2010Prato G","year":"2000","journal-title":"J Periodontol"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/j.1600-0501.2009.01829.x","article-title":"Role of flap tension in primary wound closure of mucoperiosteal flaps: a prospective cohort study","volume":"21","author":"Burkhardt R","year":"2010","journal-title":"Clin Oral Implants Res"},{"key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1111\/j.1600-051X.2009.01492.x","article-title":"Treatment of class III multiple gingival recessions: a randomized clinical trial","volume":"37","author":"Aroca S","year":"2010","journal-title":"J Clin Periodontol"},{"key":"e_1_2_9_12_1","first-page":"338","article-title":"A modified suture technique for plastic periodontal and implant surgery\u2014the double\u2010crossed suture","volume":"4","author":"Zuhr O","year":"2009","journal-title":"Eur J Esthet Dent"},{"key":"e_1_2_9_13_1","first-page":"653","article-title":"Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet\u2010derived growth factor BB","volume":"31","author":"Zadeh HH","year":"2011","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1002\/ccr3.582","article-title":"A novel suturing approach for tissue displacement within minimally invasive periodontal plastic surgery","volume":"4","author":"Ronco V","year":"2016","journal-title":"Clin Case Rep"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/cap.10134","article-title":"V\u2010reverse\u201d suturing technique for tunnel soft tissue graft and flap stabilization: technique illustration","volume":"11","author":"Chac\u00f3n Ram\u00edrez GJ","year":"2021","journal-title":"Clin Adv Periodontics"},{"issue":"4","key":"e_1_2_9_16_1","first-page":"549","article-title":"The trapezoidal sling suture: a technical note of a novel suturing technique for tunneling flap procedures","volume":"41","author":"Ramirez JC","year":"2021","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_9_17_1","first-page":"479","article-title":"Subpapillary continuous sling suturing method for soft tissue grafting with the tunneling technique","volume":"30","author":"Allen EP","year":"2010","journal-title":"Int J Periodontics Restorative Dent"},{"issue":"2","key":"e_1_2_9_18_1","first-page":"189","article-title":"The tunneling technique for periodontal plastic surgery","volume":"37","author":"Allen EP","year":"1993","journal-title":"Dent Clin North Am"},{"issue":"12","key":"e_1_2_9_19_1","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1902\/jop.1985.56.12.715","article-title":"Subepithelial connective tissue graft technique for root coverage","volume":"56","author":"Langer B","year":"1985","journal-title":"J Periodontol"},{"issue":"2","key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1902\/jop.1987.58.2.95","article-title":"The subpedicle connective tissue graft: a bilaminar reconstructive procedure for the coverage of denuded root surfaces","volume":"58","author":"Nelson SW","year":"1987","journal-title":"J Periodontol"},{"issue":"2","key":"e_1_2_9_21_1","first-page":"126","article-title":"Connective tissue graft technique assuring wide root coverage","volume":"14","author":"Bruno JF","year":"1994","journal-title":"Int J Periodontics Restorative Dent"},{"issue":"1","key":"e_1_2_9_22_1","first-page":"11","article-title":"The novel periosteal flap stretch technique: a predictable method to achieve and maintain primary closure in augmentative procedures","volume":"22","author":"Fallah Abed P","year":"2020","journal-title":"J Int Acad Periodontol"},{"key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.jclinepi.2017.04.026","article-title":"CARE guidelines for case reports: explanation and elaboration document","volume":"89","author":"Riley DS","year":"2017","journal-title":"J Clin Epidemiol"},{"issue":"9","key":"e_1_2_9_24_1","first-page":"799","article-title":"Classification of gingival recession: a new proposal","volume":"38","author":"Cairo F","year":"2011","journal-title":"J Clin Periodontol"},{"key":"e_1_2_9_25_1","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/j.1600-051X.2005.00660.x","article-title":"Coverage of localized gingival recessions: comparison of micro\u2010 and macrosurgical techniques","volume":"32","author":"Burkhardt R","year":"2005","journal-title":"J Clin Periodontol"},{"issue":"2","key":"e_1_2_9_26_1","first-page":"S52","article-title":"Periodontal soft tissue root coverage procedures: a consensus report from the American Academy of Periodontology Regeneration Workshop","volume":"86","author":"Tatakis DN","year":"2015","journal-title":"J Periodontol"},{"issue":"9","key":"e_1_2_9_27_1","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1902\/jop.2000.71.9.1506","article-title":"Treatment of multiple recession\u2010type defects in patients with esthetic demands","volume":"71","author":"Zucchelli G","year":"2000","journal-title":"J Periodontol"},{"issue":"2","key":"e_1_2_9_28_1","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s00784-020-03419-w","article-title":"Vascular survey of the maxillary vestibule and gingiva: clinical impact on incision and flap design in periodontal and implant surgeries","volume":"25","author":"Shahbazi A","year":"2021","journal-title":"Clin Oral Investig"},{"issue":"5","key":"e_1_2_9_29_1","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1563\/aaid-joi-D-20-00026","article-title":"Influence of different incision designs on flap extension: a cadaveric animal model","volume":"47","author":"Traboulsi\u2010Garet B","year":"2021","journal-title":"J Oral Implantol"},{"issue":"1","key":"e_1_2_9_30_1","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1186\/s12903-025-07270-x","article-title":"Comparison of vertical releasing incisions and horizontal extending incisions for periodontal accelerated osteogenic orthodontics in the anterior region: a randomized controlled trial with clinical and radiographic outcomes","volume":"25","author":"Chen Y","year":"2025","journal-title":"BMC Oral Health"},{"issue":"3","key":"e_1_2_9_31_1","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1111\/j.1600-051X.2006.01039.x","article-title":"Coronally advanced flap: a modified surgical approach for isolated recession\u2010type defects. Three\u2010year results","volume":"34","author":"De Sanctis M","year":"2007","journal-title":"J Clin Periodontol"},{"issue":"7","key":"e_1_2_9_32_1","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1902\/jop.2009.090041","article-title":"Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative randomized clinical trial","volume":"80","author":"Zucchelli G","year":"2009","journal-title":"J Periodontol"},{"issue":"5","key":"e_1_2_9_33_1","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S1079-2104(96)80190-9","article-title":"Integrated processes responsible for soft tissue healing","volume":"82","author":"Wong ME","year":"1996","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"issue":"2","key":"e_1_2_9_34_1","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1563\/1548-1336-35.2.82","article-title":"Suturing for optimal soft\u2010tissue management","volume":"35","author":"Silverstein LH","year":"2009","journal-title":"J Oral Implantol"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972\u2010124X.175178"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\u2010journals\u201010015\u20101604"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\u2010journals\u201010021\u20101231"},{"key":"e_1_2_9_38_1","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/j.1600-0501.2007.01352.x","article-title":"Influence of suture tension on the tearing characteristics of the soft tissues: an in vitro experiment","volume":"19","author":"Burkhardt R","year":"2008","journal-title":"Clin Oral Implants Res"},{"key":"e_1_2_9_39_1","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1902\/jop.1995.66.3.205","article-title":"Vascular changes following mucoperiosteal flap surgery: a fluorescein angiography study in dogs","volume":"66","author":"McLean TN","year":"1995","journal-title":"J Periodontol"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010018\u20102597\u20105"}],"container-title":["Clinical Advances in Periodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.70064","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cap.70064","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.70064","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T07:12:01Z","timestamp":1778137921000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/cap.70064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":39,"alternative-id":["10.1002\/cap.70064"],"URL":"https:\/\/doi.org\/10.1002\/cap.70064","archive":["Portico"],"relation":{},"ISSN":["2573-8046","2163-0097"],"issn-type":[{"value":"2573-8046","type":"print"},{"value":"2163-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]},"assertion":[{"value":"2025-12-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"cap.70064"}}