Post-Orthodontic Lower Incisors Recessions: Combined Periodontic and Orthodontic Approach

Abstract

The bonded lingual retainer (BLR) is considered a favorable choice for retaining lower incisors’ alignment post-orthodontic treatment; however, it may cause some unwanted effects such as inadvertent tooth movement and torque changes. These often result in gingival recession (Miller class III-type) with exposure of the root surface, which compromises the esthetics and hinders the comfort of the patient. Fifteen post-orthodontic patients presenting Miller class III-type recessions with BLR were examined. Two protocols were used: the first included the removal of the BLR prior to surgery and the second included only a surgical approach. All patients underwent the same surgery of a modified tunnel double papilla procedure for root coverage. The gingival recession was measured using a dental probe before, and three to six months post-surgery. The average improvement in recession depth was significantly greater (p = 0.008) for the protocol that included removal of the BLR (4.0 ± 0.83 mm) with an improvement of 87.2% as compared to the second protocol that showed an improvement of 43.8% (1.88 ± 1.29 mm). Removing the BLR prior to surgery is beneficial for predictable root coverage in post-orthodontic Miller class III recessions.

Coronally Advanced Flap with Connective Tissue Graft for Treating Orthodontic-Associated Miller Class III Gingival Recession of the Lower Incisors: A One-Year Retrospective Study

“…According to this classification, all the treated Miller Class III recessions in this study were RT2. However, in Cairo and colleagues’ classification, the malposition of the root is not considered a prognostic criterion, although it is a limiting factor for the amount of root coverage achieved at the buccal site after surgery [ 14 ]. This may be associated with the blood supply provided by interproximal soft tissue to the buccal flap/graft during the healing process.…”

“…In addition, mandibular lingual fixed retention may be associated with a higher prevalence of GR, especially in proclined lower incisors [ 10 , 13 ]. Another possible cause of post-orthodontic GR in mandibular incisors may be tooth malposition due to an unwanted force extracted by distortion and activation of the retainer’s wire [ 14 ].…”

Coronally Advanced Flap With Connective Tissue Graft For Treating Orthodontic-Associated Miller Class III Gingival Recession of The Lower Incisors: A One-Year Retrospective Study

“…According to this classi cation, all the treated Miller Class III recessions in this study were RT2. However, in Cairo and colleagues' classi cation, the malposition of the root is not considered a prognostic criterion, although it is a limiting factor for the amount of root coverage achieved at the buccal site after surgery [14]. This may be associated with the blood supply provided by interproximal soft tissue to the buccal ap/graft during the healing process.…”

“…A recent study comparing clinical outcomes of CTG with and without enamel matrix derivative in the treatment of Miller Class III defects on mandibular anterior teeth reported 78% and 73% mean root coverage and 22% and 18% of CRC, respectively, 12-months post-treatment [30]. Another recent study presented results of modi ed tunnel double papilla procedure for root coverage of post-orthodontic Miller Class III recessions with either the removal or not of the bonded lingual retainer (BLR) [14]. An improvement of 43% was found without the removal of the BLR, compared to 87% once the BLR was removed prior to surgery; however, only a small number of cases was evaluated in each group.…”

“…In addition, mandibular lingual xed retention may be associated with a higher prevalence of GR, especially in proclined lower incisors [10,13]. Another possible cause of post-orthodontic GR in mandibular incisors may be tooth malposition due to an unwanted force extracted by distortion and activation of the retainer's wire [14].…”