Four human teeth and their facial gingival attachment were removed en block 3 months after periodontal flap therapy and citric acid root conditioning and then prepared for histologic evaluation. At the time of periodontal surgery, and prior to citric acid application, the facial root surface was grooved at midline and citric acid was applied only to one-half of each root surface. Tissues were decalcified and histologically prepared as horizontally oriented, step serial sections from the level of the gingival margin to the level of the facial crest. The gingival margins demonstrated reformation of a crevice. The corium at this level showed a mild inflammatory infiltrate. Apical to this level, junctional epithelium adhered to both sides of the root surface and to the central groove. Further apically, supracrestal fiber groups were encountered. No new cementum was noted in these areas. Fiber attachment was present apical to this level. Since no new cementum was seen at this area of attachment, it may represent collagen attachment present prior to periodontal surgery. In the four specimens examined, no differences were seen in the soft tissue closures between the root-planed citric acid-treated root surfaces and root surfaces which received root planing alone.
Introduction: Root coverage procedures are not always predictable, and outcomes depend on several factors. This technique provides a predictable alternative to managing facial gingival recessions. Case Series: A new grafting technique is introduced that requires no incisions at the recipient site, thereby preserving the integrity of the local blood supply to optimize the healing process. The graft is placed through the gingival sulcus via a molar or canine access (MOCA) approach, and there is minimal tension on the coronally advanced flap through use of suspension sutures. Thirteen nonsmoking patients, between the ages of 27 and 57, with Cairo RT1 facial recession were studied, with a follow-up period of 1-60 weeks. This paper explains the step-by-step technique and highlights 13 cases. Conclusion: Complete root coverage was achieved in all 13 cases, although one case showed initial altered healing. While MOCA is technique sensitive, it provides optimal root coverage results. With no incisions at the recipient site, there is no uneven texture or scar formation, and healing proceeds with minimal interruption.
Introduction
Papilla reconstruction relies on similar principles as those applied to soft tissue grafting for recession defects; however, it is uniquely challenging from a surgical perspective because of the small size and lack of a blood supply. Several techniques have been used to reconstruct lost papilla; however, there are no prescribed techniques for this specific application.
Case Presentation
This report describes a novel technique, herein called, the “tube technique” for treating interproximal recession and reconstructing the interproximal papilla, and documents two cases using the tube technique. An increase in attachment levels was observed in Case 1 (5 mm) and in Case 2 (4 mm) after using this surgical technique for papilla reconstruction.
Conclusion
The tube grafting technique requires technical precision. Although when executed carefully, it results in predictable reconstruction of the interproximal papilla. Use of the tube technique helps mitigate issues associated with inadequate flap thickness, blood supply, and flap retraction.
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