27 Pe opl e’s J our nal of Sci e nti f i c Re s earch V ol.3(2), July 2010 Periodontal Plastic Surgery for Cosmetic Root Coverage: A Case Report Neeraj Agr awal, Rosaiah K, SSV Prasad Department of Periodontics, People’s Dental Academy, People’s Campus Bhanpur, Bhopal-462037. Abstract: Based o n clini cal observation th at gingival recession may occur during orthodonti c therapy involving sites that have an “insufficient” zone of gingiva, it is suggested that grafting procedure to be adapted to increase the gingival dimensions preceding th e initiation of the orthodontic therapy. B ut once it is created, should be solved in appropriate way . We report a case treated for post-orthodontic gingival recession. The procedure involved the utilization of subepithelial connective tissue graft (SCTG) combined with coronally advan ced flap procedure. At the post-operative follow-up visits the success of the surgical appr oach was confirmed by the absence of bleeding to probing and p eriodontal pockets as well as presence of gingival tissue with normal color, texture and contouring. After 12 months of follow -up, the clin ical conditions were better than immediate post-operative result with satisfactory root coverage and periodontal health by the process known as creeping attachment. An excellent esthetical outcome was achieved and the patient was satisfied with case resolution. Key Words: Peridontal plastic surgery, cosm etic root coverage, sub epithelial conne ctive tissue graft , gingival recession. Introduction: Gingival recession is defined as the location ofthe marginal tissue, apical to the cementoenamel junct ion (CE J) with exposure of the root sur face (Wennstrom, 1996). Localized gingival recession is an unesthetic condition that is usually observed over the labial as pect of pr omin ent teeth and may be associatedwith root caries and hypersensitivi ty (V ekalahti ,1989). Many etiological and predisposing factors have been reported in the lite rature. I t can be caused by traumatic injuries (excessive or inadequate brushing) and by destructive periodontal disease (Joshipura et al, 19 94). Other predisposing factors may also play a role in recession development, i.e., tooth malpositioning, alveolar bone dehiscence, thin and delicate marginal tissue covering a nonvascularized root surface, high muscle attachmen t and frenal pull, occlusal tr auma, lip pier cing and iat rogeni c fact ors rela ted to recon s- tructive, conservative periodontologic, orthodontic orprostheti cs tre atmen t (W enn strom & Pi niPrato, 2006). Experimental evide nce suggests that orthodontic tooth movement does not actually cause gingival recession but m igh t create an env ironm ent that pred ispose s so me peop le to the condi ti on, par tic ula rl y if teet h ar e repositioned in a facial direction and alveolar bone dehiscences are created (Wennström et al, 1987). Similarly, orthodontic tooth movement lingually or----------- ----------------- ------------------------------------------------- Corresponding Author: Dr. Neeraj Agrawal, Senior Lecturer, Department of Periodontics. Peoples Dental Academy Campus, People’s Campus Bhanpur, Bhopal-462037. Phone No .: +919424619777 E mail : [email protected]Case Report pal atal ly wi ll pro babl y re sul t in res ol uti on of any alv e olarbone dehisc ences and an increa sed bucc o-ling ual dimension of gingiva on the facial aspect of the tooth. Wi despread use of prophylactic ging ival grafts to prevent recession in orthodontic patients has been reported (V anarsdall, 1995) to augme nt bucco- lingual width of the gingiva, while some periodontist suggestedwait and watch approach (Andlin-Sobocki & Bodin, 1993). Once recession has occured, it needs to be covered for various reasons discussed above. Several techniques have been used including formation of a free gingi val graft (FGG), la terally positione d flap (LPF) or coronally advanced flap (CAF) as well as guidedtissue regeneration (GTR) and sub-epithelial connective tissue grafts (SCTG) alone or in combination with othertechniques (Wennstrom & PiniPrato, 2006). This case report presents a case of post orthodontic gingival recession treated by subepithelial connective tissue graft surgery. Case report: A 16 year old girl reported to the Department of Periodontics with the c hief comp laint of unaesthetic appearance of her front lower teeth. On examination, it was found that 7mm class II gingival recession (Miller,1985) was there on the lower left central incisor(Fig.I). She had undergone orthodontic correction andwas on retention appliance. Such t ype of recession was not present prior to the commencement of the orthodontic treatment. For the root coverage, periodontal plastic sur gery was planned with sub- epitheli al conne ctive tissue free graft. Systemic
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27People’s Journal of Scientific Research Vol.3(2), July 2010
Periodontal Plastic Surgery for Cosmetic Root Coverage: A Case ReportNeeraj Agrawal, Rosaiah K, SSV Prasad
Department of Periodontics, People’s Dental Academy, People’s Campus Bhanpur, Bhopal-462037.
Abstract:
Based on clinical observation that gingival recession may occur during orthodontic therapy involving sites that
have an “insufficient” zone of gingiva, it is suggested that grafting procedure to be adapted to increase the gingivaldimensions preceding the initiation of the orthodontic therapy. But once it is created, should be solved in appropriate way.
We report a case treated for post-orthodontic gingival recession. The procedure involved the utilization of subepithelial
connective tissue graft (SCTG) combined with coronally advanced flap procedure. At the post-operative follow-up visits
the success of the surgical approach was confirmed by the absence of bleeding to probing and periodontal pockets as well
as presence of gingival tissue with normal color, texture and contouring. After 12 months of follow-up, the clinical conditions
were better than immediate post-operative result with satisfactory root coverage and periodontal health by the process
known as creeping attachment. An excellent esthetical outcome was achieved and the patient was satisfied with case