Surgical treatment options for grafting areas of gingival recession association with cervical lesions: a review

Combined Surgical and Restorative Procedures to Treat Maxillary Canine with Gingival Recession and Cervical Wear

Introduction

Gingival recession (GR) with cervical tooth wear is a major concern for patients on the prominent maxillary canines, from both esthetic and dentine hypersensitivity points of view. Hypersensitivity could be treated nonsurgically; however, esthetics remain the major patients' concern that mostly requires surgical intervention for covering the denuded root surface. Several surgical procedures are applied successfully for covering single and multiple gingival recession; however, these procedures are sensitive procedures and not always predictable. Semilunar coronally repositioned flap (SCRF) is a very simple procedure that found to be very predictable for covering a single recession in presence of sufficient keratinized gingiva apical to the recession. The procedure provides better clinical outcome by involving less adjacent papillary tissue that maintains greater blood supply and achieves maximum flap stability with mattress sutures with minimal postoperative complications. Therefore, this case report is aimed at explaining the simplicity of this surgical procedure in the presence of wide keratinized tissue around the recession and starting the restorative procedure after a sufficient soft tissue healing period. Case Presentation. 42-year-old systemically healthy female patient referred with a single wide gingival type 1 (RT1) and cervical wear around tooth #43. A semilunar coronally repositioned flap was released and advanced coronally to cover the denuded root totally; then, the flap stabilized by three mattress sutures, and complete root coverage was achieved. Six months later, the cervical lesion was restored with composite filling material. Sixteen-month and 32-month postoperative follow-up revealed full coverage of the denuded root surface with firm stable gingiva; later, the gingiva in the area looked stable and healthy.

Conclusion

Using SCRF in treating RT1 recession in the presence of wide keratinized gingiva is very promising surgical intervention for receded root coverage that requires less technical skill.

Treatment of multiple gingival recessions with concentrated growth factor membrane and coronally advanced tunnel technique via digital measurements: A randomized controlled clinical trial

Background/purpose

Research into biomaterial alternatives to connective tissue grafts (CTG) is a research hotspot. The purpose of this clinical trial was to compare the effectiveness of root coverage through tunnel technique with concentrated growth factor (CGF) vs CTG in treating multiple gingival recessions using digital measurements.

Materials and methods

Seventy Cairo Class I multiple gingival recessions (in 28 patients) were treated with either CGF or CTG combined with coronally advanced tunnel technique. Digital models were obtained at baseline, 2 weeks, 6 weeks, and 6 months post-op to compare the gain in gingival height, area, volume, and thickness. Tooth sensitivity, post-operative pain, and healing index were also recorded.

Results

Complete root coverage at 6 months post-op were 47.06% in the CGF group and 77.78% in the CTG groups. Mean root coverages were 80.55% and 96.18%, respectively. No statistical difference was demonstrated between the two groups in terms of gingival area gain at 2 weeks post-op, but the CTG group had greater increases in gingival height, area, volume, and thickness in the period after 2 weeks post-op. Pain scores were statistically significantly lower in the CGF group. At 6 months post-op, sensitivity scores decreased more significantly in the CTG group.

Conclusion

Digital measurements revealed post-operative gingival shrinkage was more pronounced in the CGF group than in the CTG group when combined with coronally advanced tunnel technique. Despite the ease-of-use and minimal post-operative discomfort, it is difficult to achieve similar root coverage outcomes to CTG when using CGF alone in treating multiple gingival recessions.

Multidisciplinary Treatment of Deep Non-Carious Cervical Lesion With a CAD/CAM Chairside Restoration in Combination With Periodontal Surgery: A 60-Month Follow-Up Technique Report

INTRODUCTION

Restoring function and esthetics are essential aspects of periodontology and restorative dentistry. Depending on their extension and the tissues involved, the treatment of non-carious cervical lesions (NCCLs) associated with gingival recessions may require a multidisciplinary approach, and different periodontal and restorative techniques have been described.

CASE PRESENTATION

This case report presents an innovative approach to treat a deep NCCL combined with a gingival recession in a canine region of a female patient. A Computer Aided Design - Computer Aided Manufacturing (CAD/CAM) chairside ceramic restoration in combination with mucogingival surgery procedures is described. A comprehensive analysis of the selected approach and its clinical implications is presented based on a 60-month follow-up. Conclusions After 60-month follow-up, clinical condition maintained stable, and a successful esthetic outcome was accomplished. Complete root coverage was achieved and kept throughout the whole period of tracing.

Root Coverage for Single Deep Gingival Recessions: Outcomes Based on a Decision-Making Algorithm

AIM

The aim of this study is to report root coverage outcomes in single deep gingival recessions (GR) following a proposed decision-making algorithm.

MATERIALS AND METHODS

A retrospective, practice-based study included single deep (≥5 mm) Miller Class II and III defects. The step-by-step decision-making algorithm led to a choice among three different flap designs (coronally advanced flap (CAF), double papilla envelope flap (DPE) or modified lateral sliding flap (LSF)) used with a connective tissue graft. Recession depth (RD) at 6 months follow-up and the corresponding root coverage (RC) were the primary outcomes assessed.

RESULTS

Sixteen GR defects were included, with baseline RD of 6.7 ± 1.8 mm. Six months postoperatively, RD was significantly reduced to 1.2 ± 0.8 mm (p < 0.05). Mean RC was 81.7 ± 13.0%, without significant differences between Miller Class II (87.1 ± 9.2%; n=9) and Class III (74.6 ± 14.5%; n=7) GRs (p=0.07). Postoperatively, keratinized tissue width increase was greater for LSF (3.5 ± 1.1) and DPE (4.2 ± 1.4 mm) than for CAF (1.9 ± 0.9 mm).

CONCLUSIONS

Following the proposed decision-making algorithm, root coverage outcomes for GR defects ≥5 mm were comparable to outcomes reported for shallow defects. Prospective clinical trials are needed to validate the proposed approach and techniques.

PRACTICAL IMPLICATIONS

The proposed algorithm allows the clinician to select the appropriate surgical technique for treatment of single deep gingival recessions with good predictability.

Comparison of conventional and semilunar coronally positioned flap techniques for root coverage in teeth with cervical abrasion restored with pink resin

Gingival recession is the most common mucogingival defect, characterized by apical migration of the gingival margin from the cementoenamel junction and root exposure. Several surgical techniques are reported for the treatment of gingival recession. Here we present a comparison of the conventional (coronally advanced flap) and semilunar coronally positioned flap techniques for root coverage in teeth with cervical abrasion restored with pink resin that mimics the color of the gingiva. Although the conventional technique is more predictable, we found that both techniques were effective in achieving satisfactory and esthetic root coverage.

A combined approach to non-carious cervical lesions associated with gingival recession

Non-carious cervical lesions (NCCLs) with gingival recession require specific consideration on both aspects of hard and soft tissue lesion. In the restorative aspect, careful finishing and polishing of the restorations prior to mucogingival surgery is the critical factor contributing to success. Regarding surgery, assessment of the configuration of the lesion and the choice of surgical technique are important factors. The precise diagnosis and the choice of the proper treatment procedure should be made on the basis of both restorative and surgical considerations to ensure the successful treatment of NCCLs.