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Combined use of root conditioning, fibrin-fibronectin system and a collagen membrane to treat a localized gingival recession: a 10-case report.

The purpose of this research was to evaluate the effectiveness of combined root surface conditioning with tetracycline HCI, fibrin sealing system, guided tissue regeneration procedure and coronal sliding flap application in the treatment of localized gingival recessions. The present study was conducted on 10 patients with localized facial recessions of at least 3mm. A trapezium-shaped flap was elevated apically to the margin of the bone dehiscence and the root surface was thoroughly scaled by hand instruments and burs. Tetracycline HCI (pH 1.9) solution was then topically applied for 5 minutes and the root surface thoroughly rinsed with sterile saline. A collagen membrane was trimmed and shaped to cover the entire root surface and later removed and a fibrin sealing system injected onto the root surface. Immediately membrane was placed again on the root surface without applying any pressure. The flap was sutured in the coronal position to completely cover the root surface and membrane. Control group patients were treated with only coronal sliding flap operation. Sutures were removed 10 days after surgery. Patients were clinically reevaluated 6 months postoperatively. The mean amount of root surface coverage obtained was similar in the test and control groups (test = 71.7%; control = 68.55%) but the clinical attachment gain (test = 4.21mm; control = 2.86mm) and pocket depth variations (test = 1.14mm reduction; control = 0.07mm reduction) differed significantly (P < 0.001). This study found promising healing of localized gingival recessions to result from a combined use of tetracycline HCI root demineralization, fibrin sealing system application, guided tissue regeneration procedure and coronal sliding flap operation.

Administration, Topical↗

Current trends in gingival recession coverage--Part II: Enamel matrix derivative and platelet-rich plasma.

The recession of the gingiva is increasingly becoming a prominent condition in the oral health of many patients and should be treated at its earliest detection. Part I of this discussion reviewed the multifactorial etiology and decision modality; a treatment option was demonstrated for gingival recession using the tunneling technique. This concluding part of the discussion highlights two clinical cases using alternative approaches. The correction of Class I and II gingival recessions are presented as a means of minimizing surgical trauma and achieving predictable aesthetic results.

Adult↗

Gingival recession. Reappraisal of an enigmatic condition and a new index for monitoring.

Gingival recession (GR) is an intriguing condition. This brief communication, after proposing a definition for GR, considers the possible relevance of anatomical, physiological, pathological and traumatic factors in its etiology. It is probable that no one factor in isolation leads to the development of GR. Because of the possible influence of several factors, not necessarily acting synchronously, the occurrence of GR at a given site may be difficult to explain fully, and any subsequent changes may be hard to predict. The importance of the CEJ (or other fixed point) in assessment of GR severity is discussed. A new two-figure Index of Recession (IR) (e.g., F2-4asterisk) is also described, in which the 1st digit relates to the proportional evaluation of the horizontal extent of GR at the level of CEJ, and the 2nd digit is the vertical extent of GR from CEJ in millimetres; the asterisk denotes involvement of the MGJ. The prefixed F (or L) denotes whether GR is facial (or lingual) to the involved root.

Gingiva↗

Treatment of gingival recession: comparison of two techniques of subepithelial connective tissue graft.

BACKGROUND: The increasing interest in esthetics and the subsequent need to solve related problems such as hypersensitivity and root caries have favored the development of many surgical procedures that permit the coverage of exposed roots. This clinical study was conducted to examine the coverage of gingival recession defects, where two different subepithelial connective tissue graft (SCTG) techniques (Langer and Langer and modified tunnel) were used. METHODS: Thirty one patients (21 females and 10 males), each contributing Miller Class I and II gingival recessions, were selected. Recession defects were randomly treated by using the Langer and Langer technique (17 patients) or the modified tunnel technique (14 patients). Vertical recession, probing depth (PD), and attachment level were assessed at baseline and 6 months postoperatively. RESULTS: Six months after the surgery, a significant reduction in recession depth was noticed in both groups. There was also a decrease of PD and attachment level for both groups, but not statistically significant. In comparison, at 6 months, statically significant differences were found between the tunnel and Langer and Langer techniques for root coverage and attachment gain. The percentage of root coverage was 96.4% and 75.5% in the tunnel and Langer and Langer groups, respectively. CONCLUSIONS: The present study suggests that the use of SCTG in combination with a tunnel procedure may result in an increased amount of root coverage and clinical attachment gain compared to the Langer and Langer technique. Further comparative studies are necessary to understand the periodontal healing generated by the tunnel procedure and Langer and Langer technique.

Adolescent↗

Treatment of localized gingival recessions using a bioresorbable membrane: a case report.

A patient with a localized gingival recession suffering from esthetic and hypersensitivity problems was selected for treatment with the guided tissue regeneration procedure. The use of a bioresorbable membrane (Guidor) made reentry surgery for membrane removal unnecessary. A complete root coverage was obtained, and 6 mm of clinical attachment gain was recorded after 6 months. The guided tissue regeneration procedure may represent an effective alternative to traditional mucogingival therapy for the treatment of recessions and permit the management of severe bone destruction with minimal soft tissue retraction. Furthermore, the guided tissue regeneration technique is likely to result in a greater amount of new connective attachment formation, although clinical relevance must still be confirmed by long-term trials.

Adult↗

[Oral findings in severely handicapped patients participating in the periodic dental check-up system for five years--dental caries, gingival recessions and hyperplasias, periodontal diseases].

In March 1987, we investigated the quality of oral hygiene, and the incidence of dental caries and periodontal diseases in 140 severely handicapped patients who had been hospitalized in two national sanatorium. All of the patients had participated under the Matsumoto Dental College Hospital Periodic Dental Check-up System for five years. The results were as follows: 1. The teeth of all the subjects had been brushed by the sanatorium nursing staff twice per day. The prevailing brushing technique was the horizontal method. 2. 37.5% of the subjects showed complete adaptability to the tooth brushing by the nursing staff. However, 2.1% showed no adaptability whatsoever. 3. The mean value of the OHI-S was 1.53. The labial surfaces of the maxillary anterior teeth showed the lowest OHI-S value, while the mandibular left posterior teeth showed the highest. 4. The DMF-T was estimated to be 12.51 (DMFT ratio = 48.2%). The average D-T was 2.07 +/- 4.03, and the average F-T was 8.43 +/- 7.22. 5. 19.3% of the patients were diagnosed with gingival hyperplasia, and 10.7% had local gingival recessions. 1) Of the patients who had taken Phenytoin daily, 35.5% were diagnosed with hyperplasia. 2) Most local gingival recessions were found on the labial gingiva of the mandibular anterior teeth. A relationship was determined to exist the local recession and the horizontal brushing method. 6. 89.2% of the patients suffered from periodontal diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

DMF Index↗

The free rotated papilla autograft: a new bilaminar grafting procedure for the coverage of multiple shallow gingival recessions.

The aim of this clinical pilot study is to evaluate the possibility and from a statistical point of view, the predictability of a new mucogingival technique. The purpose of this surgical procedure is to cover the exposed buccal root surface with less than 5 mm clinical probing attachment loss either in corono-apical or mesio-distal aspects. This surgical procedure is particularly indicated in either single or multiple gingival recessions with perfectly preserved mesial and distal interproximal osseous crests, and with a papillary dimension not inferior to the defect which needs to be treated. A sharp incision is performed at a 90 degrees angle to the vestibule, following the mucogingival line. A sharp dissection is accomplished to create a partial thickness envelope flap on the underlying alveolar mucosa. The epithelium from the facial aspect of the papilla is debrided with a full thickness approach, the facial papillary tissue is removed from the underlying tissue bed. The papilla is then reversed in such a way that the base of the papilla is at the cemento-enamel junction (CEJ) and the apex is at the base of the gingival recession area. The papilla is then sutured in place and completely covered by a coronally displaced partial thickness flap. The results obtained either as root coverage, or as an aesthetic result, may be considered positive. This procedure has the decided advantage of a single surgical site, avoiding any palatal patient discomfort, good color compatibility with adjacent tissue, and healing by primary intention.

Adult↗

Probing depth, attachment loss and gingival recession. Findings from a clinical examination in Ushiku, Japan.

The present investigation describes probing pocket depth, probing attachment level and recession data from 319 randomly selected subjects, aged 20-79 years, from Ushiku, Japan. The findings are reported as mean values, frequency distributions and percentile plots of the 3 parameters at buccal, interproximal and lingual surfaces of single rooted (incisors, canines, premolars) and molar teeth. Inter-as well as intra-examiner errors for probing pocket depth and probing attachment levels were assessed and found to be small. The data reported revealed that practically all subjects studied had one or more sites in the dentition affected by destructive periodontal disease and that the severity of disease increased with age. It was further observed that in each age group, molars had suffered more attachment loss than single rooted teeth and that the interproximal surfaces as a rule had lost more periodontal tissue support than corresponding buccal and lingual surfaces. The attachment loss difference observed between different surfaces of a given tooth or a group of teeth, however, was comparatively small. In the age groups between 20-59 years, advanced destructive periodontal disease was found in a small subgroup of the subject sample, while after the age of 60 years, widespread destructive periodontitis was common. An attempt was made to examine the progression of destructive disease with age by comparing the frequency distributions of sites with attachment loss of greater than or equal to 3 mm in subjects of different age groups. The data suggested that in younger subject groups, progression was confined to a subset of individuals, while in older age groups, more subjects and sites became involved. A major feature of destructive periodontal disease in older individuals was the accompaniment of attachment loss with recession at the gingival margin. Deep pockets were relatively infrequently detected, while advanced loss of attachment (with recession) occurred at many sites.

Adult↗

Comparative study of Emdogain and coronally advanced flap technique in the treatment of human gingival recessions. A prospective controlled clinical study.

OBJECTIVES: Various surgical techniques have been proposed for coverage of denuded root surfaces. The aim of this study was to evaluate a comparison of coronally repositioned flap procedure with or without the use of enamel matrix proteins in the treatment of recession defects. MATERIAL AND METHODS: This study was an intra-individual longitudinal test of 12 months duration conducted as a blinded, split-mouth, placebo-controlled and randomised design. It was performed in 2 dental schools. 36 patients, aged 22-62 years, with 2 paired buccal recession defects of at least 3 mm participated. Surgical recession coverage was performed as coronally-advanced flap technique at both sites in the same session. One site was additionally treated with commercially-available enamel matrix proteins (Emdogain) and the other site with placebo (propylene glycol alginate) in accordance with the randomisation list. A blinded examiner assessed pre- and post-surgical measurements. Clinical measurements and photographs were taken pre-surgically and after 1 week, 3 weeks, 3 months, 6 months and 12 months, postoperatively. Measurements comprised height and width of the gingival recession, height of keratinized tissue, probing attachment level, probing pocket depth and alveolar bone level by periodontal probe, Florida Probe or caliper to the nearest 0.5 mm. RESULTS: 12 months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. Gingival recession decreased from 3.7 mm to 0.8 mm for the Emdogain treated sites and from 3.9 mm to 1.0 mm for the control sites, corresponding to mean root coverages of 80% and 79%, respectively. This difference was not significant. With the exception of keratinized tissue gain, which was significantly higher (p=0.003) in the Emdogain group, all other clinical variables were not different in the between-group comparison. CONCLUSIONS: As the additional use of Emdogain together with coronally advanced flap technique for recession coverage showed no difference in the overall clinical outcome, there is no clear benefit to combine Emdogain with this surgical technique.

Adult↗

Oral piercing and gingival recession: review of the literature and a case report.

A young adult developed severe gingival recessions and radiographic signs of trauma to the periodontium after wearing a tongue barbell and a lip stud. Oral body art (piercing) can be hazardous to the periodontium; nevertheless, patients inclined to such practices do not see them as health hazards and are very reluctant to remove them.

Adolescent↗

A longitudinal study of isolated gingival recession in the mandibular central incisor region of children aged 6-8 years.

A 2-year longitudinal investigation of isolated gingival recession was undertaken in 42 children aged 6-8 years at the commencement of the study. Gingival inflammation was controlled by supervised tooth brushing or professional plaque control. Mandibular anterior crowding considered to have contributed to the degree of recession was untreated in 11 subjects, while in 13 subjects serial extractions had been undertaken. No attempt was made to correct frenal involvement in those subjects (9) where it might have been considered a contributing etiologic factor. After 2 years, improvement in gingival contour was most apparent in those subjects whose gingival inflammation had been controlled. This was achieved more readily with professional plaque control than with supervised tooth brushing. Improvement in arch alignment and gingival contour was greater in untreated subjects than in those receiving serial extractions. WHen gingival inflammation was controlled evidence of frenal involvement declined. Control of gingival inflammation appears to be the most important factor in the treatment of isolated gingival recession in the mandibular central incisor region.

Child↗

Depth of alveolar bone dehiscences in relation to gingival recessions.

Dehiscence depths were measured in vivo during surgical treatment of 113 teeth with gingival recession in 27 subjects. The average dehiscence depth determined was 5.43 mm with an average recession depth of 2.67 mm. Statistical evidence of a correlation between recession depth and dehiscence depth (average distance between lowest point of recession and dehiscence = 2.8 mm) leaves 16 affected teeth (n = 113) with a distance of 4 mm or more (up to a maximum of 7.5 mm) between the gingival margin and the alveolar crest (facial) unaccounted for. The significance of these deviations from mean values in the etiology and prognosis of recessions is discussed.

Adult↗

Subepithelial connective tissue graft in a localized, plaque-induced ulcerative gingival recession: a case report.

The transposition of connective tissue to increase the zone of keratinized tissue or cover exposed root surfaces has become an integral part of the surgical dental practice. An effort to expand the surgical protocol to gingival recession of ulcerative etiology is presented. Parameters such as pathogenesis, clinical characteristic, and histopathology are analytically discussed. Furthermore, different aspects of the mucogingival therapy phase of the grafting procedure are presented.

Adult↗

Clinical and histologic evaluation of human gingival recession treated with a subepithelial connective tissue graft and enamel matrix derivative (Emdogain): a case report.

A mandibular canine with significant gingival recession was selected for a pilot study to measure the attachment modalities resulting from mucogingival surgery. The tooth had 6 mm of recession as measured from the cementoenamel junction to the gingival margin, minimal pocketing, and no keratinized gingiva. The treatment regimen consisted of a subepithelial connective tissue graft (SCTG) plus Emdogain applied to the root surface. The tooth was extracted en bloc 6 months after surgery and processed histologically in a buccolingual plane. The tooth demonstrated a 2-mm gain of attachment and a 3-mm gain in keratinized tissue. The histologic study evidenced the migration of the junctional epithelium 1.2 mm apical to the sulcus. New cementum, evidence of newly formed woven bone, and connective tissue fibers anchored in the new cementum were evident.

Adult↗

Healing response of human buccal gingival recessions treated with expanded polytetrafluoroethylene membranes. A retrospective report.

Twenty-four (24) deep wide buccal gingival recessions were treated with ePTFE membrane according to guided tissue regeneration principles (GTR). Factors affecting the surgical outcome of the regenerative procedure were retrospectively analyzed. In 16 cases, the barrier membrane was used in conjunction with tetracycline root conditioning and fibrin-fibronectin system application, and 8 cases were treated with the membrane alone. Healing response was evaluated 12 months after surgery. Since no difference was observed between the two treatment protocols, all available data were grouped. Mean recession depth was reduced from 4.6 mm to 1.3 mm postoperatively, which represents an average root coverage of 71.7%. Fifty percent (50%) of the cases showed clinical attachment gain greater than or equal to 4 mm and a mean increase of keratinized tissue of 1.0 mm was observed. Baseline recession depth and extent of membrane exposure at the reentry procedure significantly influenced the amount of newly-formed tissue under the membrane. Recession reduction positively correlated with the preoperative recession depth and the regenerated tissue gain. Treatment was also affected by tooth location, recession reduction, and attachment gain, being significantly greater in upper than lower archs. Results suggest that GTR technique represents a predictable procedure to improve the soft tissue conditions of deep mucogingival defects. Randomized controlled trials of other forms of management of mucogingival defects as compared to the GTR technique will be necessary to fully evaluate the utility of the GTR technique.

Adult↗