Case Of Gingival Recession Research Articles

Diode Laser-Assisted Bridge Flap

Mucogingival problems are associated with recession of gingival margin, shallow vestibular depth, and gingival margin pull by aberrant frenum. Till now, various individualistic and successful surgical techniques have been described in the literature for mucogingival problems. These case series enumerate the gingival recession cases, managed by bridge flap technique using diode laser which is a single-step procedure to cover the earlier exposed root surfaces and extend the width of the attached gingiva. Postsurgical parameters were recorded at 6 months and 1 year.

Pink Aesthetics: Gummy Smiles and Gingival Recession.

The ideal smile is one where there is harmony between the 'white' (tooth) and 'pink' (periodontal) aesthetics. The developments in the field of periodontology have enhanced aesthetic outcomes when managing excessive gingival exposure in a 'gummy' smile or excessive tooth exposure in gingival recession cases. This paper aims to outline the aetiology, classification, and management of both a 'gummy' smile and gingival recession, putting a spotlight on aesthetics.

PROSTHETIC MANAGEMENT OF GINGIVAL AESTHETICS - A CASE REPORT

Gingival replacement prostheses have been used to replace lost tissue when other methods like surgery or regenerative procedures were considered unpredictable or unfeasible. With this method, large tissue volumes are easily substituted. Gingival prostheses take several forms. This article presents a case of gingival recession successfully managed by acrylic gingival veneer.

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.

Comparative Evaluation of Connective Tissue Graft with Pouch/Tunnel Technique versus Connective Tissue Graft with Coronally Advanced Tunnel Flap for the Treatment of Maxillary Recession Cases in Severe Periodontitis.

The long-term stability for both the patient and periodontist remains an important priority after connective tissue graft to manage the gingival recession cases. The goal of this analysis was to assess and compare the connective tissue graft with Pouch/Tunnel technique versus connective tissue graft with coronally advanced tunnel flap for the treatment of maxillary recession cases in severe periodontitis. The total sample size was comprised of 200 subjects. The control group, coronally advanced flap along with connective tissue graft (CTG) was comprised of 100 samples and test group, pouch/tunnel technique with connective tissue graft (POT + CTG) was also comprised of 100 samples. The clinical findings included medium root coverage (MRC) and absolute root (CRC) coverage, gingival (GT) distribution and keratinized tissue (KT) gain. Esthetic findings were also evaluated. All findings analyzed initially after 6th months and have been expanded to 4years. There were no major variations between the MRC and CRC patient classes with non significant values. In the POT + CTG category, GT and KT improvements were slightly greater at 4years, with a substantial improvement in texture in control group. Pouch/Tunnel technique along with connective tissue graft allows for the clinical coverage of gingival recessions that is equivalent to Coronally advanced flap with CTG, however this may improves the gingival thickness, KT and esthetic performance.

Comparative assessment between bio-adhesive material and silk suture in regard to healing, clinical attachment level and width of keratinized gingiva in gingival recession defects cases.

The objective of this study was to compare the silk suture with a cyanoacrylate adhesive to stabilize the free gingival graft in conjunction with Er: YAG laser-assisted recipient site preparation to augment the keratinized tissue in gingival recession cases. This randomized trial comprised of 300 recession defects patients. All the included patients were diagnosed using Miller class I and II gingival recession defects classification. Group I sites were treated with a free gingival graft (FGG) harvested using an Er: YAG laser and further sutured with silk. Group II sites were stabilized with isoamyl 2 cyanoacrylate bio-adhesive material. Clinical parameters, such as gingival recession depth, clinical attachment level, gain in gingival tissue thickness, and width of keratinized gingiva were recorded at baseline, and at third month, sixth month, and 12th month postoperatively. The mean changes in gingival recession from months 3 to 6 and months and 6 to 12 were significant (p < 0.05) in both groups. However, the improvement in recession depth was better in group II than in group I. The mean change in clinical attachment level did not differ significantly between the groups at the different time intervals. However, values tended to be higher in group II than in group I. The width of the keratinized gingiva tended to be higher from baseline to 3 months, baseline to 6 months, baseline to 12 months, 3 to 6 months, and from 6 to 12 months in group II as compared with group I (p > 0.05). Cyanoacrylate could be used as a substitute to silk sutures to stabilize FGGs. Cyanoacrylate was easy to apply, consumed less operating time, and was considered equally efficacious for stabilizing FGGs.

Comparative Evaluation of Connective Tissue Graft and Platelet Rich Fibrin for The Management of Gingival Recession: A Split Mouth Study in 40 Cases with Long Follow Up of 3 Years

Introduction: Periodontal problems have taken top priority for treatment in patients suffering from periodontal diseases including gingival recession. This study aimed to compare Connective Tissue Graft (CTG) along with Coronally Advanced Flap (CAF) versus Platelet Rich Fibrin (PRF) along with Coronally Advanced Flap (CAF) in 40 sites of miller’s class I and II recession sites over a period of 3 years. Materials and methods: 40 bilateral Miller's class I and class II gingival recession cases were selected for the study and divided into two groups. Group A was treated with PRF and CAF whereas Group B was treated with CTG and CAF. Following clinical parameters i.e., change in recession depth, change in probing depth, change in clinical attachment level, change in width of keratinized gingiva were assessed at baseline 3, 6 and 36-months post-surgery. Results: 1. Group A showed root coverage of 71.00% whereas in Group B it was 83.33%. Group B subjects showed clinically higher and statistically significant amount of root coverage as compared to Group A. 2. Group B was associated with better clinical outcomes in terms of keratinized tissue gain. Conclusion: Current study concludes that CTG along with CAF is a better option for root coverage procedure as compared to PRF along with CAF.

Lateral pedicle graft: A treatment modality for root coverage of localized gingival recession: A case report

Gingival recession has been defined as the apical shift of gingival margin from its physiologic level (1 to 2 mm coronal to cementoenamel junction) causing pathologic exposure of root surfaces. Mucogingival esthetic surgery is all about treatment of mucogingival esthetic alterations. Mucogingival problems may be caused by gingival recession often in association with non-carious cervical lesion or by root caries or by altered passive eruption. Patient with gingival recession frequently report to dental clinics which could lead to pain or hypersensitivity, esthetic problem, retention of plaque hence inflamed gingiva, root caries, abrasion and fear of tooth loss. Gingival recession can be treated by surgical or non-surgical means. Nonsurgical means include - restorations, crowns, veneers and gingival masks whereas surgical approaches includes various methods of increasing the width of keratinized tissue such as frenectomy in case of high frenal attachment & root coverage procedures. The lateral displaced pedicle flap was first described by Grupe and Warren in 1956. It was used to cover the isolated, denuded root surfaces that have adequate amount of donor tissue adjacent to the recipient site. The vestibular depth must be adequate to laterally slide the pedicle. A case of gingival recession is presented that was managed using LPG technique. This technique was selected because of certain advantages – single surgical area, preservation of blood supply of flap, the postoperative color being in harmony with surrounding tissue. Keywords: Lateral pedicle, Graft, Gingival recession.

Can Epitheliazed Graft Be Used to Achieve Absolute Root Coverage When Combined with Coronally Advanced Flap (CAF) for a Case of Gingival Recession? – A Case Report of a Mandibular Molar

Gingival recession poses a multitude of problems like root sensitivity, plaque accumulation, root caries and other functional problems. Treatment options range depending on the type of recession to the condition of mucogingival tissues. Connective tissue graft in combination with coronally advanced flap has been described as a gold standard in treatment of gingival recession. This case report describes a case of absolute root coverage achieved with epithelialized graft (which was subsequently de-epithelialized) when combined with coronally advanced flap for a case of gingival recession in a Mandibular molar.

Effect of Collagen-Chitosan-Glycerol Composition in Scaffold for Gingival Recession Therapy

The case of gingival recession has a high prevalence, about 88% of the population of the United States in one or more locations suffering from gingival recession. One of the handling cases of gingival recession is to use scaffold that includes the development of tissue and cell engineering. This study aims to determine the best composition variation scaffold of collagen-chitosan with the addition of glycerol. The process of synthesis of collagen-chitosan-glycerol scaffold using freeze dry method that can form pores on the scaffold. Characterization was also carried out on the results of the synthesis of collagen-chitosan scaffold with the addition of glycerol include the morphological characterization, tensile, cytotoxicity, swelling, degradation, and thickness. The results of morphological characterization showed pore size ranged from 26.68 - 191.7 μm with a thickness of 0.51 - 0.65 mm which was suitable for handling of gingival recession cases. The result of tensile test showed that the variation of 9: 1 has the lowest value that is 2.87 MPa where the value is close to tensile strength value for periodontal which has a value ranging from 2.75 to 5.13. The characterization of cytotoxicity shows a value that is less in line with the literature, where live cells &lt;50%. This is because collagen and chitosan have an acidic pH so that the cells cannot reproduce. Characterization of degradation shows all the variations experienced a severe reduction process from day to day. The characterization of the swelling of all samples was equilibrated at 7 minute. Chitosan-collagen scaffold with the addition of glycerol has good potential as a scaffold candidate for gingival recession therapy based on morphological characterization (thickness and surface structure), the mechanical strength (tensile strength), degradation, and the degree of swelling.

Subepithelial connective tissue graft in combination with enamel matrix derivative for root coverage within different case of gingival recession: Case report

Root coverage can be an efficacious treatment not only in aspect of dental symptoms like root caries and hypersensitivity, but also in aspect of esthetic problem. There are several predictable methods for gaining a connective tissue attachment to an exposed root surface. Among them, this case report will deal with three cases using enamel matrix derivative and connective tissue graft to recover esthetic and physiological periodontal environment and its form. This case report deals with three patients with gingival recession which has occurred by different causes. They were treated with de-epithelialized graft accompanied by application of enamel matrix derivative. 6-12 months later, all three patients showed considerable root coverage and clinically stable condition of healing. In conclusion, within the limitation of this study, de-epithelialized connective tissue graft accompanied by application of enamel matrix derivative shows stable and clinical acceptable results in aspect of root coverage.

Clinical Application of Modified Apically Repositioned Flap in Class III/IV Gingival Recession Cases

ABSTRACTAimMucogingival conditions may be detected during a comprehensive or problem-focused periodontal examination. The aim of periodontal therapy is to help maintain the dentition or its replacements in health with good function and esthetics, and may include restoring anatomic form and function. A further goal is to reduce the risk of progressive recession. Among the procedures, root coverage has attracted the most interest. A predictable gain can be achieved in class I or II recession cases, but prognosis tends to be poor for class III and IV. The purpose of this case series was to clinically evaluate the efficacy of modified apically repositioned flap in increasing the dimensions of the keratinized tissue in apical direction in class III or IV gingival recession.Materials and methodsA total of seven systemically healthy patients with class III or IV recession involving one or more teeth in mandibular anterior region were selected for the study. Primary parameters assessed were width of keratinized gingiva and pocket depth.ResultsThe mean apicocoronal gain in the keratinized tissue at 6 months was 2.14 mm with mean baseline value of 1.43 mm and 6 months value at 3.57 mm. The clinical gain was statistically significant with p-value &lt;0.05.ConclusionModified apically displaced flap offers an easy and predictable approach for increasing the width of keratinized tissue.How to cite this articleSingh H, Kosala M, Mandlik VB. Clinical Application of Modified Apically Repositioned Flap in Class III/IV Gingival Recession Cases. J Contemp Dent 2017;7(2):130-134.

Connective Tissue Graft for Gingival Recession in Mandibular Incisor Area: A Case Report.

We report a case of gingival recession in the mandibular incisor region requiring a connective tissue graft. The patient was a 17-year-old girl who visited the Tokyo Dental College Chiba Hospital in 2014 with the chief complaint of gingival recession in the lower incisor region. She had received orthodontic treatment for 5 years and noticed the gingival recession on completion of active orthodontic treatment in 2013. Gingival recession in tooth #31 extended 3 mm beyond the muco-gingival junction (MGJ) and was clinically diagnosed as Miller Class II recession; probing depth was 6 mm. Following initial periodontal therapy, a connective tissue graft procedure was implemented. The connective tissue was harvested from the left palate. Healing was uneventful, and the grafted site showed a favorable outcome at 6 months postoperatively. We are continuing to carefully monitor the condition of periodontal tissue.

Classification systems of gingival recession: An update

Gingival recession is defined as “the displacement of marginal tissue apical to the cementoenamel junction (CEJ)”. Various classifications have been proposed to classify gingival recession. Miller's classification of gingival recession is most widely followed. With a wide array of cases in daily clinical practice, it is often difficult to classify numerous gingival recession cases according to defined criteria of the present classification systems. This article outlines the limitations of present classification systems and also the new classifications that have been proposed to classify gingival recession.

Periodontal plastic pioneering procedures revisited

BackgroundVarious periodontal plastic procedures are available for treatment of localized gingival recessions. However, in the mirage of newer techniques and materials available, it is difficult for clinicians to decide on the treatment modality. Pioneering techniques provide a cost effective and effective means of maintaining esthetics in recession cases. Materials and methodsTwenty-two subjects with localized gingival recessions were divided in equal groups and treated with lateral pedicle graft (Group A) and Free mucosal graft (Group B). Clinical parameters of length and width of recession and apico coronal length of keratinized gingiva (ACKG) was measured at baseline, 30 and 90 days. Root coverage percentage was calculated. ResultsBoth groups were effective in recession coverage and gain in ACKG. Root coverage gained in Group A was 65.0 ± 25.2% and for Group B was 61.6 ± 20.5%. ConclusionLateral pedicle graft and Free mucosal graft provide not only effective means of gaining in root coverage of localized gingival recession cases but also result in gain of ACKG. These techniques remain an important part of periodontal plastic surgery.

A new classification system for gingival and palatal recession

Various classifications have been proposed to classify gingival recession. Miller's classification of gingival recession is most widely followed. With a wide array of cases in daily clinical practice, it is often difficult to classify numerous gingival recession cases according to defined criteria of the present classification systems. To propose a new classification system that gives a comprehensive depiction of recession defect that can be used to include cases that cannot be classified according to present classifications. A separate classification system for palatal recessions (PR) is also proposed. This article outlines the limitations of present classification systems and also the inability to classify PR. A new comprehensive classification system is proposed to classify recession on the basis of the position of interdental papilla and buccal/lingual/palatal recessions.

Root Coverage with a Free Gingival Autograft using an Er, Cr: YSGG Laser

The mucogingival problems encountered, are addressed by various periodontal plastic surgical procedures one of which is the free gingival autograft. Grafting procedures can be performed traditionally by use of a scalpel or by the use of lasers. A case of gingival recession with a shallow vestibule, treated with a free gingival graft using an Er, Cr: YSGG laser with a wavelength of 2780 nm is presented here. The objective was to achieve complete root coverage with increased width of attached gingiva in relation to 31 and 41. The recipient bed preparation and harvesting of graft from donor site were done with the Er, Cr: YSGG laser using the appropriate laser parameters so as to ensure proper healing of the free gingival graft. The results showed uneventful healing of donor site with complete root coverage and increased width of attached gingival in the recipient site. The results of the therapy were assessed after 3 months.

Root coverage with a free gingival autograft using a diode laser

Gingival recession is a most common condition affecting the supporting structures of the teeth, in which the change in the position of the gingiva affects the esthetics and also hypersensitivity due to the exposure of the cementum. Coverage of denuded roots has become one of the most challenging procedures in periodontal mucogingival surgery. The principal objective in the treatment of gingival recession is to cover the exposed root surfaces to improve esthetics and to reduce hypersensitivity. Grafting procedures can be performed traditionally by use of a scalpel or by the use of lasers. A case of gingival recession with a shallow vestibule, treated with a free gingival autograft using a Diode laser is presented here. The recipient bed preparation and harvesting of graft from donor site were done with the Diode laser using the appropriate laser parameters so as to ensure proper healing of the free gingival graft. The results showed uneventful healing of donor site with complete root coverage and increased width of attached gingiva in the recipient site. The results of the therapy were assessed after 3 months.

Restoration of Noncarious Cervical Lesions: When, Why, and How

At this time, restoration of noncarious cervical lesions (NCCLs) is a common occurrence in clinics nowadays. Some reasons for this are the growth of the elderly population, a smaller rate of tooth loss, and possibly the increase of some etiologic factors. These factors include inadequate brushing techniques in gingival recession cases, corrosive food and drink consumption, and occlusal stress concentrating factors (occlusal interferences, premature contacts, habits of bruxism, and clenching). Unfortunately, Class V restorations also represent one of the less durable types of restorations and have a high index of loss of retention, marginal excess, and secondary caries. Some causes for these problems include difficulties in isolation, insertion, contouring, and finishing and polishing procedures. This work aims to help dentists in choosing the best treatment strategy, which necessarily involves steps of problem identification, diagnosis, etiological factor removal or treatment, and, if necessary, restoration. Finally, appropriate restorative techniques are suggested for each situation.

Management of localized gingival recession by two-stage surgical procedure - Double pedicle flap with CTG and coronally advanced flap: A novel technique

Cosmetic treatments have become an integral part of periodontal treatment. One of the commonly used esthetic periodontal procedures is coverage of denuded root surface. While considering the elimination of these defects two criteria should be considered, the esthetic aspects and the functional aspects. This case report has describes a two stage surgical technique using double pedicle flap with connective tissue graft followed by coronally advanced flap for the treatment of a severe localized gingival recession measuring 15 mm. The recession measurement at the end of 12 months was 1 mm. It showed a predictable result at the end of one year. The advantages of this technique are excellent colour matching, dual blood supply to graft and very predictable results. The promising result suggest that this technique can be used in severe gingival recession cases with minimum amount of keratinized tissue.