A Two-Step Surgical Approach with Flattening of the Root Surface to Treat Localized Gingival Recessions Affecting Mandibular Incisors: A Case Series Report

Núñez, Lucía González; Sanz‐Esporrín, Javier; Caffesse, Raúl G.; Sanz, Mariano

doi:10.11607/prd.3566

Cited by 6 publications

(8 citation statements)

References 14 publications

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“…Endodontics today. 2020; 18 (3):82-86. DOI: 10.36377/1683DOI: 10.36377/ -2981DOI: 10.36377/ -2020 Как известно успех лечения рецессий десны III класса по Миллеру считается частичным и может достигать 50% [2].…”

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Complex Treatment III class of gum recession

Ananieva

Runova

2020

Èndodontiâ today

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The recessions of the 3 Miller class are the most difficult in the prediction of the result during surgical treatment. Such recession in the anterior region of the mandible is often combined with a small vestibule of the oral cavity. The treatment of combined pathology in the standard protocol was provided in 2 stages: correction of small vestibule of the oral cavity and elimination of the recession by the method of the coronal advanced flap.Aim. To develop the protocol of one-stage operation for patients with III miller class gum recession in combination with small vestibule.Materials and metods. Surgical protocole. after conducting anesthesia at the region of the lower teeth held tunnel access to the region of teeth with gingival recession, formed split-thikness flap, discharge below the periodontal line connection 3 mm, mobilization of the flap.The flap is fixed with sutures Polyprophylene 6-0. Taken from the palatal free gingival graft. Placed in the region of holding vestibuloplasty fixed to the periosteum of the simple suture and suturing the donor area in the palate.Results. The patients were found to have closing of the recession, the increase in the area keratinisation gums and keeping of the vestibule in the recovery area.Conclusions. The development of a new one-stage treatment of recession 3 class at Miller in combination with vestibuloplasty allows you to more quickly treat patients with this pathology.

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Section: Conflict Of Interestsunclassified

Complex Treatment III class of gum recession

Ananieva

Runova

2020

Èndodontiâ today

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“…LPF + SCTG and CAF + SCTG are commonly used surgical approaches to treat deep localized GR in mandibular incisors. However, in the presence of a shallow vestibule, Cairo RT3 GRs or lack of the keratinized tissue (minimum of 2 mm) adjacent to GR results using these approaches has clear limitations [28]. These clinical situations may represent the main indications for the two-step surgical approach with flattening of the root surface and later LCT [28].…”

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“…However, in the presence of a shallow vestibule, Cairo RT3 GRs or lack of the keratinized tissue (minimum of 2 mm) adjacent to GR results using these approaches has clear limitations [28]. These clinical situations may represent the main indications for the two-step surgical approach with flattening of the root surface and later LCT [28]. In this twostep approach, flattening of the root surface creates a new emergence in order to treat anterior mandibular localized GRs in the prominent teeth.…”

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“…In this twostep approach, flattening of the root surface creates a new emergence in order to treat anterior mandibular localized GRs in the prominent teeth. This approach will provide more space for the graft, increase the thickness of the gingival margin, and provide extra soft tissue at the margins of the GR [28].…”

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“…The mandibular incisors of the cases described were relatively well positioned in the bone envelope. Although we did 7 Case Reports in Dentistry not perform the cone-bean computed tomography to observe the buccal-lingual inclination of the roots and the occurrence of bone dehiscence in the teeth adjacent to the GR defect, this is considered an important complementary exam for making the treatment decision about whether to perform orthodontic treatment or concomitant odontoplasty to the surgical technique of root coverage [28].…”

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Laterally Positioned Flap with Subepithelial Connective Tissue Graft Modified One-Stage Procedure for the Treatment of Deep Isolated Gingival Recessions in Mandibular Incisors

Bosco

Almeida

Retamal‐Valdes

et al. 2021

Case Reports in Dentistry

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The laterally positioned flap (LPF) has been proposed as a promising treatment for isolated gingival recessions (GRs) in mandibular incisors. Several modifications have been proposed to reduce the risk of gingival recession (GR) at the donor tooth site. Therefore, the aim of this was to describe a modified one-stage procedure of performing the LPF associated with the subepithelial connective tissue graft (LPF + SCTG) with the modifications for the treatment of deep isolated GR in mandibular incisors. The modified one-stage technique (LPF + SCTG) is unique because it was presented being bilaminar with tunneled connective tissue graft (CTG) in the adjacent tooth and extended to the flap donor site, without a submarginal incision in the adjacent tooth, taking the entire band of the keratinized tissue (KT) into the flap. In addition, 3 clinical cases were described using this surgical technique. Three healthy patients with Cairo RT1 or RT2 GRs on teeth 31 or 41 were treated with the LPF + SCTG technique. Probing depth (PD), clinical attachment level (CAL), complete root coverage (CRC), mean root coverage (MRC), recession depth (RD), and keratinized tissue width (KTW) were assessed at baseline and in the follow-up periods of 18, 24, and 48 months, in the cases 1, 2, and 3, respectively. The LPF + SCTG with the modifications presented is a predictable approach for the treatment of deep isolated RT1 and RT2 GRs in mandibular incisors that are well positioned in the bone envelope with the presence of KTW adjacent to GR and adequate vestibule depth in the donor area of the flap.

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Influence of vestibular depth on the outcomes of root coverage therapy: A prospective case series study

Blasi

Monje

Muñoz-Peñalver

et al. 2022

Journal of Periodontology

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Background The purpose of this study was to investigate the influence of vestibular depth (VD) on the outcomes of root coverage therapy. Methods Patients presenting gingival recession defects (GRD) with a minimum depth of 2 mm underwent root coverage therapy consisting of a coronally advanced flap plus a connective tissue graft (CAF + CTG). Clinical examinations were performed, and intraoral scans were obtained at baseline, 3 and 6 months after surgery to assess changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), GRD area, marginal gingival thickness (MGT), and VD. The influence of VD on percentage of root coverage (%RC) and the likelihood of achieving complete root coverage (CRC) were explored. Results A total of 20 patients were enrolled, and 44 teeth were treated. RD decreased and MGT increased in all treated sites. At 6 months, mean %RC was 87.47 ± 18.37 and CRC was observed in 61.4% of sites. Mean baseline VD was 7.33 ± 2.67 mm. Mean VD reduction from baseline to 6 months was 1.98 ± 1.27 mm. %RC and CRC were significantly correlated with baseline VD. Each additional 1 mm of baseline VD implied a gain of 6.58% for %RC and increased 2.75 times the probability of achieving CRC. Narrow baseline KTW and mandibular arch location were associated with inferior treatment outcomes. Conclusion Lower %RC and likelihood of achieving CRC can be expected after root coverage therapy via CAF + CTG in sites presenting a shallow vestibulum.

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A Two-Step Surgical Approach with Flattening of the Root Surface to Treat Localized Gingival Recessions Affecting Mandibular Incisors: A Case Series Report

Cited by 6 publications

References 14 publications

Complex Treatment III class of gum recession

Complex Treatment III class of gum recession

Laterally Positioned Flap with Subepithelial Connective Tissue Graft Modified One-Stage Procedure for the Treatment of Deep Isolated Gingival Recessions in Mandibular Incisors

Influence of vestibular depth on the outcomes of root coverage therapy: A prospective case series study

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