Button-assisted Coronally Advanced Flap: An Innovative Ortho-perio Amalgamation

Abstract

Introduction: Esthetics has become an essential criterion of the overall treatment plan in dentistry that comprises of a healthy and beautiful smile at any age. Multidisciplinary approach involving orthodontics and periodontics results in the maintenance of a beautiful smile and a healthy periodontium. The continuous endeavor for innovation of newer interdisciplinary treatment moda lities has resulted in the use of a passive object like the orthodontic button being used to provide the initial stabilization in cases of root coverage using a Coronally advanced flap (CAF).Objective: The objective of this case report is to evaluate the effectiveness of a new treatment approach which consists of coronally advanced flap (CAF) procedure combined with ortho dontic button application for the treatment of Miller's class III recession defects.Methodology: After the application of orthodontic buttons in middle third of tooth surface, a split-full split flap was raised from tooth #22 to #24 and the flap was sutured 3 to 4 mm coronal to cementoenamel junction and the central part of flap was suspended with sutures to the orthodontic button to maximize the stabilization of the immediate postoperative flap location. Clinical parameters were recorded at 1 and 3 months postoperatively.Results: Complete root coverage was achieved when evaluated from baseline to 3 months along with gain in clinical attachment level and keratinized tissue. The final esthetics, both color match and tissue contours, were highly acceptable. Conclusion:Three months postoperative results showed that the CAF combined with orthodontic button is a very effective approach even in the treatment of Miller's Class III recession defects.

Esthetic dentistry for multiple gingival recession cases: Coronally advanced flap with bracket application

“…This procedure has also been validated as a promising technique in terms of both clinical- (root coverage, keratinized tissue height, and minimum surgical time) and patient-centered (minimum surgical time and esthetics) parameters. [ 5 6 ] Since this approach accomplishes optimum root coverage and recuperation of the original morphology of the gingival margin along with good color matching,[ 9 ] esthetically pleasing results could be achieved as seen in the current case report. Yet, the technique is not without limitations, the major limiting factor being a lack of adequate width of keratinized and attached gingiva along with the requirement for a considerable amount of vestibular space adjacent to the recession defects.…”

“…[ 5 ] Complete root coverage was also reported on the maxillary canine tooth at 3 months following CAF+B technique by Maroo et al . [ 6 ]…”

“…[ 2 ] Subsequently, many case reports following CAF+B technique have been reported satisfactorily to complete root coverage in cases involving recession on one or few adjacent teeth. [ 5 6 7 ]…”

Coronally advanced flap with and without platelet-rich fibrin in the treatment of multiple adjacent recession defects: A randomized controlled split-mouth trial

“…Maroo et al in their ortho-perio amalgamation study showed postoperative results of coronally advanced flap (CAF) combination with orthodontic button to be very successful amalgamation, even in cases of Miller's Class III recession. [10]…”