Root Coverage Procedures in the Treatment of Gingival Recession Hend AL-Harbi, BDS, Nadir Babay, DDS,MS, DESM Introduction: Gingival recession can be defined.
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Presentation on theme: "Root Coverage Procedures in the Treatment of Gingival Recession Hend AL-Harbi, BDS, Nadir Babay, DDS,MS, DESM Introduction: Gingival recession can be defined."— Presentation transcript:
Root Coverage Procedures in the Treatment of Gingival Recession Hend AL-Harbi, BDS, Nadir Babay, DDS,MS, DESM Introduction: Gingival recession can be defined as the displacement of the gingival margin apical to the cementoenamel junction. Exposition of the radicular surface of the tooth due to destruction of the marginal gingival and of the epithelial attachment that will be reestablished at a more apical position. Its prevalence among periodontal patients is high due to disease progression and mechanical trauma as a result of improper use of oral hygiene tools e.g. vigorous brushing. Buccal recessions are most common and more advanced at single-rooted teeth than at molars. Root coverage, 100% or partial, is possible in Class I-III gingival recession Aesthetic concerns are usually the reason to perform many surgical techniques to correct labial, gingival recession defects. Hypersensitivity and changing the tomography of the marginal soft tissue in order to facilitate plaque control are also indications for root coverage procedures. Classification of Gingival recession by Miller (1985): Cl.I: Marginal tissue recession which does not extend to the mucogingival junction - No periodontal bone loss in the interdental area Cl.II: Marginal tissue recession which extends to or beyond the mucogingival junction - No periodontal loss in the interdental area Cl.III: Marginal tissue recession which extends to or beyond the mucogingival junction - Bone or soft tissue loss in the interdental area or malpositioning of the teeth, preventing 100% root coverage Cl.IV: Marginal tissue recession which extends to or beyond the mucogingival junction - Severe bone or soft tissue loss in the interdental area and/or malpositioning of teeth Discussion and Conclusion: The factor most influencing the result is blood supply to the grafted tissue. The pedicle soft tissue graft technique allows for possible root coverage in retaining good apical blood supply. The free gingival graft procedure ensures thickness and keratinization which provides a suitable housing for the gingival margin of a tooth or crown. The subepithelial connective tissue graft combines the features of the pedicle and the free gingival graft. Connective tissue grafts receives abundant blood supply from two sources (the periostium and the overlaying flap) which gives high predictability and successful root coverage. In comparison to a typical free gingival graft, a connective tissue graft produces more esthetic results and its palatal donor sites are less invasive. Professional evaluation of degree of root coverage, color match of the tissues including (alveolar mucosa, preexisting keratinized tissues and gingival graft), soft tissue appearance and location of the mucogingival line are important factors for successful aesthetic outcome of root coverage procedures. The overall aesthetic outcome depends on final color and tissue blend of the grafted area. Nevertheless, careful decision making prior to root coverage procedures will enhance the success rate for these efforts. Funding Source Etiology: Uneven atrophy of the gingival margin Calculus deposits Trauma caused by tooth brushing Gingival lesions associated with plaque Direct trauma (accident, fingernails) Predisposing Factors: Inadequate attached gingiva Malpositioning of the teeth Orthodontic Movements Contraindication: free gingival graft: - Extensive gingival recession - Esthetic cases Connective tissue graft: - High predictability - Graft receives abundant blood supply from 2 sources - Wound closed at palatal donor site after harvest of connective tissue graft - Esthetically pleasing results - Applicable for gingival recession on multiple teeth Indication: Cl.I and Cl.II 100% ROOT COVERAGE Cl.III partial root coverage free gingival graft: All cases where root coverage is necessary except when a graft of sufficient thickness (1.5-2.0 mm) cannot be harvested. Connective tissue graft: 88% root coverage in areas of severe gingival recession Greater amount of root coverage and rate of complete coverage with the use of connective tissue grafts as compared to free gingival grafts. Case of free gingival graft: Disadvantages Poor ability to provide blood supply to the graft for root coverage Exposed deep and large wound on the palatal mucosa Inferior esthetic results due to scarring Surgery required in 2 areas Case of connective tissue graft: Disadvantages: Technically demanding - Gingivoplasty may be necessary postoperatively Criteria for successful root coverage: Gingival margin is on the CEJ. Depth of gingival sulcus is within 2 mm. No bleeding on probing No hypersensitivity Esthetically harmonious color match with adjacent tissue