Coronally Advanced Flap with Connective Tissue Graft for Treating Orthodontic-Associated Miller Class III Gingival Recession of the Lower Incisors: A One-Year Retrospective Study

(1) Background: To assess the clinical outcome of coronally advanced flap combined with connective tissue graft for the treatment of orthodontic-associated Miller Class III gingival recession of the lower incisors. (2) Methods: This study included 15 patients who had undergone orthodontic treatment prior to development of recession. Measurements of recession depth, recession width, probing depth, and width of keratinized tissue were performed clinically immediately before surgery and after one year. In addition, digital measurements of recession depth, recession width, and root coverage esthetic score were performed on intraoral photographs. (3) Results: Significant reduction was observed for probing depth, recession depth, and recession width at one year, with significant increase in width of keratinized tissue. Mean root coverage was 83 ± 24% for recession depth, while complete root coverage was achieved in 10 out of 21 recessions (48%). The average root coverage esthetic score at 12 months was 7.1 ± 2.6. An interaction was found between initial recession depth and mean root coverage. (4) Conclusions: Within the limitations of this study, our results confirm that combination of coronally advanced flap and connective tissue graft is effective in reducing post-orthodontic Miller Class III recessions of the mandibular incisors, even when the correction of the tooth malposition, is unattainable.

Modified Coronally Positioned Flap for Isolated Gingival Recession, Evaluated with Root Coverage Esthetic Score System

Background: Various modifications of the coronally displaced flap have been proposed in the literature with the attempt of treating gingival recession. This study is undertaken to evaluate the predictability of the modified coronally positioned flap in isolated gingival recession not only in terms of root coverage but also with the esthetic outcome. Materials and Methods: Fifteen isolated gingival recessions with at least 1mm of keratinized tissue apical to the defect were treated with a modified coronally advanced flap. All recessions fall into Miller class I. The clinical re-evaluation was performed 3 months and 1year after the surgery. Statistical analysis was performed using statistical application software (SPSS16.0). Multivariate ANOVA was used for analysis. Results: At the 1-year examination, the average root coverage was 94.6% of the pre-operative recession depth. There was a mean clinical attachment gain of 3.3±0.1 mm at 1 year follow-up.The average increase of keratinized tissue between the baseline and the 1-year follow-up amounted to 1.53±0.13 mm. Root coverage esthetic score (RES) was recorded at the end of follow-up period. 13/15 cases showed RES score of 9 and 2/15 cases showed RES score of 6. Conclusion: The modified coronally advanced surgical technique is effective in the treatment of isolated gingival recession in the upper jaw.

Aesthetic root coverage with acellular dermal matrix allograft: a shield for gingival recession

Awareness about root coverage is increasing in day-to-day clinical practice. Patients are more motivated and concerned about aesthetics nowadays along with the issues of sensitivity of teeth. The conventional flap designs and techniques including lateral sliding flaps, coronally advanced flap, subepithelial connective tissue grafts and free gingival grafts are being adopted for root coverage. The newer material including resorbable and non-resorbable guided tissue regenerative membranes, amniotic membrane, platelet-rich fibrin membrane, enamel matrix derivative protein, xenogenic collagen matrix graft along with the soft tissue substitute like acellular dermal matrix allograft are also being used for recession coverage. The present case report describes a case of 22-year-old female patient with the chief complaint of denudation of gums exposing the root surface over the mandibular left central incisor. The soft tissue substitute acellular dermal matrix allograft was used for root coverage as the patient was not willing to procure an autogenous palatal graft. The results were satisfactory with complete root coverage.

Use of 17% EDTA as an Adjunct in Management of Class I Recession with Semilunar Coronally Advanced Flap - A Case Report

Gingival recession is usually characterized by the apical displacement of the gingival margin, exposing the root surface when related to cemento-enamel junction. It has turned out to be one of the most common perturbations for the patients, apart from esthetic, root sensitivity, progression of periodontal diseases and root caries are the major fields of concern. The goal of periodontist is not only to treat gingival recession but also to rectify the functional and esthetic deficiencies to further combat the periodontal destruction. Semilunar flap is one of the procedures followed to cover recession, being a simple, minimally invasive and effective technique with higher patient acceptance and provides satisfactory results for Miller’s class I recession. Semilunar flap when combined with EDTA, as root conditioner provides a biocompatible cell surface for tissue attachment. Here we are presenting a case report where semilunar coronally advanced flap was used for treatment of Miller’s Class I recession in maxillary central incisor. Keywords: EDTA, Esthetics, Gingival Recession, Semilunar Flap.

Treatment of localized gingival recession with chorion membrane- A case report

Aim of root coverage procedure is to restore the tissue margin to the Cemento-enamel junction. Many surgical techniques have been developed throughout the years and Guided tissue regeneration (GTR) based rootcoverage using different allograft membranes has been utilized to treat gingival recession with excellent results.This case report describes a case of gingival recession managed by chorion membrane with coronally advanced flap.

Surgical management of RT2 gingival recession using sub epithelial connective tissue graft and coronally advanced flap: A case report

Apical migration of the gingival fiber attachment and marginal gingiva leads to gingival recession and can be caused due to many factors such as faulty tooth brushing, masochistic habits, periodontal disease etc. This causes dentinal hypersensitivity, aesthetic problems, root caries, cervical abrasion, and difficulty in maintaining oral hygiene and often possess a challenging situation for the clinician to deliver best care to the patients. This case reports about the use of SCTG along with coronally advanced flap. To report a case of RT2 recession, older term – Millers Class II recession which showed promising result when root coverage procedure was done using sub-epithelial connective tissue and coronally advancing the flap. A 62-year-old male patient was referred to the Department of Periodontology, with a chief complaint of hypersensitivity and downward shifting of gum in upper front left teeth region which was progressive in nature with no obvious medical history.After achieving profound anaesthesia over the concerned region the recipient site was prepared. After which the donor tissue was retrieved from the palatal area using trap door method and placed over the recipient site. No root biomodification agents were used. The graft was stabilised using interrupted suture and then criss-cross suturing was done, and non-eugenol periodontal dressing was given. The follow up results showed good outcome with predictable root coverage achieved using Sub-epithelial Connective Tissue Graft (SCTG) and coronally advanced flap in the canine region which is often the most difficult one to achieve complete root coverage because of canine prominence. SCTG can be used successfully along with coronally advanced flap and clinicians must opt for such treatment modalities for patients benefit.