The Effects of Orthodontic Movement on a Subepithelial Connective Tissue Graft in the Treatment of Gingival Recession

Abstract

Aim The purpose of this article is to report on the five-year follow-up of a case involving treatment of gingival recession with a subepithelial connective tissue graft prior to orthodontic tooth movement. Background Gingival recession has a global prevalence that varies from 3 to 100 perpcent depending on the population studied and the method of analysis. In addition, the frequency of recession seems to be positively correlated with age. Planned orthodontic tooth movement is not necessarily an etiological factor for gingival recession, so long as it does not move the tooth out of its alveolar process. When the tooth is shifted without adequate biomechanical control, bone dehiscence can develop, and the recession can occur as a consequence of the orthodontic treatment. Case Description A 19.6-year-old female patient was referred for orthodontic treatment due to severe anterior-inferior dental crowding and a mandibular right lateral incisor in linguoverson and 4.0 mm of gingival recession on the labial surface. Normal gingival architecture was restored with a subepithelial connective tissue graft used to cover the 4.0 mm defect, after which orthodontic treatment repositioned the malposed incisor into its correct occlusal alignment. Individualized torque was applied to the mandibular right central incisor during the orthodontic treatment. The patient was reevaluated five years after completion of the orthodontic treatment. Results At the five-year recall appointment, the patient exhibited normal tooth alignment and generalized normal gingival architecture; however, 2 mm of gingival recession was noted on the graft site. Summary This case demonstrated that periodontal surgical correction of facial gingival recession with a subepithelial graft may be performed prior to initiating orthodontic treatment. Clinical Significance The interdisciplinary association between orthodontics and periodontics contributes to good prognosis and acquisition or maintenance of the periodontal tissue health, masticatory function, esthetics, and patient satisfaction. The subepithelial connective tissue graft placed prior to the orthodontic movement showed satisfactory results five years after completion of the orthodontic treatment. Citation Tanaka OM, Avila ALR, Silva GM, Añez MCG, Taffarel IP. The Effects of Orthodontic Movement on a Subepithelial Connective Tissue Graft in the Treatment of Gingival Recession. J Contemp Dent Pract [Internet]. 2010 December; 11(6):073-079. Available from: http://www.thejcdp. com/journal/view/volume11-issue6-tanaka

Herbst–multibracket appliance treatment: is there an association between lower incisor position changes and the development of labial gingival recessions?

“…In addition to the esthetic impairment of lower incisors, recessions might cause tooth hypersensitivity and greater susceptibility for root caries [36]. Therefore, the aim of the present investigation was to assess a possible association between the development of LGR and lower incisor (32-42) inclination and position changes during class II Herbst-MBA treatment and a subsequent retention period of ≥24 months in a large, representative sample of consecutive patients.…”

“…Labial gingival recessions (LGR) result not only in esthetic impairment but are also associated with tooth hypersensitivity and a greater susceptibility to root caries [36].…”

The Periodontal Benefit of Orthodontic Tooth Movement in a Deep Facial Recession of a Mandibular Incisor

“…The radicular exposure resulting from the gingival recession, besides the esthetic impairment, poses multiple problems for the individual, such as the occurrence of radicular hypersensitivity, difficulty in brushing in the affected region with the ease of biofilm retention, and greater susceptibility to developing root caries [9].…”

“…Orthodontic movement is not a determining factor to result in gingival recession, but when associated with thin gingiva, thin bone board, dehiscence, bone fenestration, direction of orthodontic movement, presence of inflammation, or trauma of brushing, it creates a favorable environment for the development of gingival recession. Tanaka et al successfully advocated the grafting of subepithelial connective tissue of the palate prior to orthodontic movement, restoring the clinical crown (from 9.0 mm to 5.0 mm) on the vestibular face of the right lower central incisor [9], and most recently, Sculean and Allen presented a substantial recession coverage with laterally closed tunnel technique for the treatment of deep isolated mandibular recession [14].…”

Controversy Related to Interdisciplinary Periodontal-Orthodontic Approach in Gingival Recession Coverage

“…Reference [12] depicted that gingival grafting procedures can be done before the beginning of orthodontic treatment.…”