CASE OF THE MONTH JANUARY 2012

HISTORY 28 year-old male; medical history within normal limits. 28 year-old male; medical history within normal limits. 2- year history of periodic, progressive thermal hypersensitivity. Patient states progressive recession over the past year. 2- year history of periodic, progressive thermal hypersensitivity. Patient states progressive recession over the past year. Referral to periodontist for evaluation and potential treatment. Referral to periodontist for evaluation and potential treatment.

CLINICAL EXAM Teeth #9 through #11 revealed dentinal exposure, ranging from 2-4 mm. Teeth #9 through #11 revealed dentinal exposure, ranging from 2-4 mm. Recession is classified Miller’s Class I Recession is classified Miller’s Class I No bleeding upon probing, and probing depths were less than 3 mm. No bleeding upon probing, and probing depths were less than 3 mm. No perceptible tooth mobility was noted. No perceptible tooth mobility was noted. Radiographs presented no evidence of interproximal bone loss. Radiographs presented no evidence of interproximal bone loss. No history of tobacco use. No history of tobacco use.

TREATMENT PLAN Discussion of current plaque control regimen. Patient currently uses “medium” stiffness toothbrush. The patient will convert to toothbrush of “soft” stiffness. Discussion of current plaque control regimen. Patient currently uses “medium” stiffness toothbrush. The patient will convert to toothbrush of “soft” stiffness. Treatment options proposed to patient: Treatment options proposed to patient: – Autogenous soft tissue – Acellular dermal matrix (ADM) Patient selects ADM due to concern for second surgical site. Patient selects ADM due to concern for second surgical site.

ADM is “sized” to fit sites

ADM placed into “tunnel” developed from sulci

The following slide shows closure of the site and coverage of the ADM via expanded polytetrafluorethylene sutures (e-PTFE). The following slide shows closure of the site and coverage of the ADM via expanded polytetrafluorethylene sutures (e-PTFE). Individual sling sutures were placed, and tied on the palatal surfaces of the respective teeth. Individual sling sutures were placed, and tied on the palatal surfaces of the respective teeth.

21 months

SUMMARY PROBLEM PROBLEM – Periodic, progressive thermal hypersensitivity in areas of dentinal exposure. TREATMENT TREATMENT – Use of Acellular Dermal Matrix as graft material in a root coverage procedure. OUTCOME OUTCOME – 1 to 3 mm probing depths, with total root coverage, and no thermal hypersensitivity at 21 months post-surgery. 21 months post-surgery.