Relevance. Gingival recessions are frequent during or after orthodontic treatment with fixed appliances (65.0-86.7%). They are usually observed in anterior teeth, especially in teeth bodily movements along an archwire outside the bone or in buccal/ labial tipping more than five degrees along the axis (35%). Pre-existing recessions worsen during orthodontic treatment with fixed appliances and up to 5 years after the treatment (47%). The treatment of recessions during or after the orthodontic treatment is not strategically reasonable: the relapse rate is high, and the treatment implies large-scale surgical interventions, including osteoplastic surgery; it is more often performed with free gingival de-epithelized graft after the treatment, which has many comparative disadvantages. Purpose – the study aimed to evaluate the effectiveness of a graft material (allogeneic dura mater) to eliminate gingival recessions before orthodontic treatment or to create/ thicken the volume of the gum buccally/ labially to prevent rec eding gum during or after orthodontic treatment.Materials and methods. The paper presents and closely analyzes preventive surgical treatment in a patient with pretreatment gingival recessions.Results. In all cases, using the dura mater demonstrates a positive clinical result by all parameters of the gingival recession assessment. The percentage of root coverage is 100% in all teeth.Conclusion. Preventive surgical treatment is reasonable in all cases as it eliminates the need for repeated interventions, excludes the onset of gingival recessions during or after orthodontic treatment, as well as the reappearance of gingival recessions. Dura mater is effective and safe in all cases; the response to surgery is normal, dura mater allows avoiding a second surgical field. We recommend including it in the standard protocol of orthodonti c treatment.
Relevance. Gum recession is a pathology often encountered both in Russia and worldwide. Modern surgical methods allow for the complete elimination of recession signs when adequately choosing strategy, tactics, methodology and surgical treatment protocol; for complication prevention and stable long-term outcome. Autograft and allogeneic dura mater as a grafting material for creating/increasing the volume of the attached gingiva in recession treatment have comparable results in all clinical indications. The reason for result stability and the absence of relapse is poorly studied; the data are scarce and do not give a full understanding. In the scientific literature, we did not encounter histological tissue composition analysis in the graft placement area. In recession coverage, the graft is partially placed subperiosteally (in the tooth root area) and partially in the thickness of the soft tissues of the gum. Purpose. The study aimed to determine the histological composition of tissues in the dura mater placement area, to compare with the control group without a graft, and to assess follow-up changes in the graft and surrounding tissue reaction as a result of cellular-level surgery.Material and methods. A laboratory histomorphological examination involved 60 laboratory rats. All underwent surgery adequate to gum recession surgical treatment technique: the control group had no graft, and the study group had allogeneic dura mater. The samples were collected on the 3rd, 7th, 14th, 28th, 90th and 107th days after surgery.Results. In all cases, the tissue complex regenerated, and the reaction to the operation was the same. The plastic material replacement was at the same period. Bone tissue replaced subperiosteally placed graft, connective tissue intragingivally. Gingival biotype thickening was considerably due to the surgical trauma, less – from the graft material. Allogeneic dura mater stimulated earlier ossification.Conclusion. In all cases, the use of grafting material for surgical gum recession coverage is justified if placed subperiosteally, forming a full-thickness mucoperiosteal flap surgically (with a scalpel) to preserve the cambium periosteum on the flap. Bone volume and buccal cortical plate reconstruction/ regeneration support soft tissues of the newly formed ligament of the tooth and prevent recurrent recession formation. The formation of bone and connective tissues in the dura mater placement area determines the result stability of gingival recession surgical treatment and a long-term favourable prognosis without complications and relapse.
Relevance. Gingival recession is the apical migration of the gingival tissues associated with the exposure of the roots and alveolar bone loss. The prevalence of single recessions in people over 18 years old is 86.7% whereas multiple recessions, i.e. where all teeth are affected, amount up to 28.6%. High prevalence of the pathology necessitates improvement of the approach and tactic of multiple recession treatment in patients with different phenotypes. Nowadays, the use of autograft is the gold standard of multiple recession treatment. However, the technique has its drawbacks. The purpose of the present work was to assess the response to surgery and evaluate the final result of multiple recession treatment in one subject where the combination of autogenic and allogenic grafts was used in the same study design.Materials and methods. The paper presents and describes a clinical case where auto- and allografts were used in one patient to treat multiple gingival recessions.Results. All parameters of the gingival recession assessment showed comparable clinical benefit in all sites of autograft and allograft (dura mater) application. The root coverage was more than 80% around 13 teeth and less than 80% around 11 teeth.Conclusion. The results of the autograft and allograft (dura mater) application were comparable, response to surgery was the same; besides, the allograft (dura mater) is attractive for combined and independent use during surgical treatment of multiple and especially full-mouth recessions.
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