Cosmetic procedures involving gingival reconstruction have become an integral part of current periodontal practice. The ability to cover unsightly exposed, sensitive roots and recontour soft tissue recessions have added an esthetic angle to the traditional concept of biological and functional periodontal health. The recession of the gingiva, either localized or generalized, may be associated with one or more surfaces, resulting in attachment loss and root exposure, which can lead to clinical problems such as diminished cosmetic appeal and aesthetic concern. Marginal gingival recession, therefore, can cause major functional and aesthetic problems and should not be viewed as merely a soft tissue defect, but rather as the destruction of both the soft and hard tissue. Treatment proposals for this type of defect have evolved based on the knowledge for healing the gingiva and the attachment system. This case report describes a clinical case of severe Miller Class II gingival recession treated by two stages of surgery that combined a free gingival graft and connective tissue grafting. First, a free gingival graft (FGG) was performed to obtain an adequate keratinized tissue level. Three months later, a connective tissue graft (CTG)was performed to obtain root coverage. The results indicated that the FGG allows for a gain in the keratinized tissue level and the CTG allows for root coverage with decreased recession level after 6 months. Therefore, for this type of specific gingival recession, the combined use of FGG and CTG still serves as a Gold Standard in predictable root coverage.
Background: Achieving adequate and broad occlusal contacts following orthodontic treatment usually is performed during retention phase, and it ensures good intercuspation of posterior teeth and post-treatment stability. Objective: To investigate the changes in occlusal contacts with the use of Hawley-type retainers (Hawley’s and wrap around retainers) and compare them with other retention appliances. Methods: The search included articles that were published until December 2018 in three popular databases. Selection criteria comprised studies evaluating number and area of occlusal contact changes during or at the end of retention phase, following orthodontic treatment. After study retrieval and selection, data extraction and individual study risk of bias assessment was performed using the Cochrane Risk of Bias tool. Results: A total sum of eight studies reporting on outcome comparison between Hawley-type retainers with other retention appliances and untreated controls were selected. In all the eight studies, the risk of bias was unclear since blinding and random sequence generation was not reported. In all the eight reported studies, it was concluded that the number of occlusal contacts improved during retention period with Hawley type retainers, but when comparisons were done in between retainers, only two studies reported that Hawley-type retainers were better. Conclusion: This systematic review concludes that the number and area of occlusal contacts improved during retention with Hawley-type retainers. The overall quality of available literature is poor and unclear to support the conclusion that Hawley-type retainers are better than other existing retainers in improving occlusal contacts.
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