## 3 Discussion  
In the last several years, several surgical approaches were developed to solve gingival recessions; however, few studies have proposed non-surgical approaches to treat gingival problems [31; 32; 33]. This case report describes a combination of professional and at-home procedures to solve GC in a non-surgical and natural way. The principle clinical procedures of the proposed protocol involved the debridement with mechanical and manual instrumentation, airflow/Perio-flow with erythritol powder, and the application of Croton Lechleri extract. Subgingival instrumentation to remove the biofilm and calculus is the cornerstone to perform a causative periodontal treatment, removing the biofilm and bacteria that contaminated the dental surface [34]. In addition, erythroid powder was included in the protocol before and after the debridement with mechanical and manual instrumentation. Erythritoid powder is an artificial sweetener and a food additive and is a chemically neutral, non-toxic, water-soluble polyol. Compared to glycine, it is more stable and more acceptable and tolerant to the patients [35]. Furthermore, erythritol powder showed a smooth surface on dentin compared with NaHCO3 and glycine powder [36]. Erythritol powder showed no significant damage to soft or hard tissue and, in a 12-month follow-up period, it resulted in significant reduction in probing pocket depth and bleeding on probing [36]. Few in vitro studies reported that subgingival air-polishing can influence cell viability, morphology, and proliferation, as well as wound closure [37; 38]. For this reason, after the debridement with mechanical and manual instrumentation, a second application of air-polishing was included in the proposed protocol. Indeed, the removal of calculus and plaque allows a direct stimulation of the gingival tissue, thus assuming a kind of healing stimulator by means of the air-polishing. After the clinical phase, the home intake of Croton Lechleri extract and tablet of Mycriaria Dubia aimed to promote the wound resolution. The medical application of Croton \begin{table}
\begin{tabular}{c c} \hline \hline  & **Clinical Procedures** \\ \hline
**1** & Biofilm staining \\
**2** & Airflow with erythroid powder \\
**3** & Debridement with mechanical and manual instrumentation \\
**4** & Airflow/Perio-flow with erythritol powder \\
**5** & Application of a cotton soaked with Croton Lechleri extract for 30 s \\ \hline \hline  & **At-Home Procedures** \\ \hline
**6** & Brush teeth with soft toothbrush \\
**7** & Application of a cotton soaked with Croton Lechleri extract, 3 times a day for 15 days \\  & Taking 2 tablets of Mycriaria Dubia 3 times a day for 3 months and then 1 time a day \\
**8** & for 1 year. \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Summary of the clinical and at-home procedures. Lechleri was first documented in 1979 [39]. As we described above, Croton Lechleri extract is constituted of alkaloid (taspine), proanthocyanidins, and diterpene lignans. Taspine hydrochloride appears to be the active healing component that increases the migration of fibroblasts [40]. The structural formula of taspine contains two lactone ring structures and belongs to the apophyllic alkaloids. Studies have shown that taspinine also has a variety of pharmacological effects, including antibacterial, wound repair, anti-inflammatory, antiviral, and cytotoxic effects [39]. Proanthocyanidins were found to have very strong antioxidative activities. The mechanism of antioxidative action was shown to involve a radical scavenging action, quenching action, and enzyme-inhibiting action. It was clarified that proanthocyanidins have overall antioxidative mechanisms [41]. Moreover, proanthocyanidin precipitation, caused by serum proteins, stimulates rapid formation of a dark crust [42]. The diterpene lignans contain a dimethylcedrusin-like substance that protects cells from degradation, inhibiting thymidine incorporation [43].