Periodontal--Restorative Approach for Treating Non-Carious Cervical Lesions With Multiple Gingival Recessions: A Case Report

Abstract

Background: Non-carious cervical lesions (NCCLs) are commonly associated with multiple gingival recessions. These cases cause aesthetic issues, dentin hypersensitivity and increased plaque accumulation. Therefore, they require multidisciplinary treatments. Zucchelli proposed the combined periodontal–restorative approach using envelope coronally advanced flap (CAF) in managing multiple gingival recessions with NCCLs.
 Objective: This case report highlights the effectiveness of Zucchelli’s modified envelope CAF in combination with a restorative approach for the treatment of multiple Miller class- III gingival recessions with type-3 NCCLs.
 Case Report: Zucchelli’s approach was used to determine maximum root coverage (MRC). Restorative treatments in covering the NCCLs were limited to 1 mm apical to the calculated MRC. Modified envelope CAF was performed with full and partial thickness flap. After root exposure, root planning was done and restorative finishing was performed to acquire the ideal restorative finish line without marginal overhanging. Root surfaces were conditioned for 2 min. Adjacent interdental papillae were deepithelialized, and the flap was repositioned and secured using sling sutures to establish a tight seal, allowing the clot between the root concavity and the flap to mature. Periodontal dressing was applied.
 Results: After 12 days, healing was uneventful with good aesthetic and functional results. Complete root coverage according to MRC predictions was obtained, and periodontal health was normal.
 Conclusion: Zucchelli’s modified envelope CAF with restorative approach shows good outcomes in treating multiple gingival recessions with NCCLs, given the correct determination of MRC.
 Keywords: gingival recession, periodontal plastic surgery, root coverage