Abstract
Introduction The prognosis for a successful treatment of gingival recessions (GRs) is one of the main criteria for deciding whether or not and how to perform root coverage surgery. The defect-related factors are the most important to predict root coverage outcomes. Thus, severe GR could make the root coverage (RC) challenging especially in cases with advanced interdental clinical attachment loss (ICAL). Case Presentation This case report demonstrates a challenging management of a deep localized Miller Class III GR with root apex exposure associated with ICAL. After initial therapy, the treatment had consisted of a multidisciplinary approach involving endodontic treatment, periodontal plastic surgery including a laterally positioned flap, and orthodontic treatment. The 6-year follow-up showed improvement in clinical outcomes (recession reduction (RR) and keratinized tissue (KT) augmentation) and a higher patient satisfaction. Conclusions This case report demonstrates the role of the multidisciplinary approach in the management of deep GRs associated with ICAL. A rational choice of the RC technique was critical to achieve good clinical outcomes.
Highlights
The prognosis for a successful treatment of gingival recessions (GRs) is one of the main criteria for deciding whether or not and how to perform root coverage surgery
If GR is associated with Pathologic tooth migration (PTM), an orthodontic therapy should be considered
The choice of a surgical technique in periodontal plastic surgery depends on several factors that can be categorized essentially as belonging to three groups: the local anatomical characteristics of the site to be treated, the patient’s requests, and the surgeon’s preferences [2]
Summary
Gingival recession (GR) can occur in subjects with either good or poor oral hygiene, and it is frequently observed in patients with destructive periodontitis [1]. In such situation, the complete root coverage may be difficult to achieve. The ultimate goal of a root coverage procedure is complete coverage of the recession defect with a good appearance related to the adjacent soft tissues and minimal probing depth following healing [1,2,3]. Some anatomic characteristics at baseline are considered possible predictors for root coverage outcomes, including the amount of baseline recession, the keratinized tissue (KT) around the defect, and the interdental bone level [4]. The present case report describes the decision-making process for the maintenance of a compromised tooth with poor prognosis as a result of the presence of a deep GR associated with interdental clinical attachment loss (ICAL)
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