Wednesday 5 October 2016

Think Pink: An Esthetic Root Coverage with Laterally Displaced Flap

                                                       www.mathewsopenaccess.com


Gingival recession is the displacement of marginal gingival tissue apical to the cemento-enamel junction with exposure of root surface to the oral environment. The gingival recession is found most commonly on facial and buccal surface as a result of vigorous tooth brushing, whereas it may affect other tooth surfaces also because of poor oral hygiene. It has been proposed that recession is multi-factorial, with one type being associated with anatomic factors such as bone dehiscence, malpositioning of teeth, trauma associated with malocclusion. Another type of recession is associated with physiological (aging) or pathological factors (where it occurs as part of pathogenesis of periodontal disease or smoking). More than 50% of population has one or more sites of gingival recession ≥ 1 mm3 . The process by which gingival recession occurs is still unclear; however, it seems that gingival recession probably occurs in the presence of inflammation. Tissue destruction in plaque-induced periodontal disease in different scenarios causes apical migration of the epithelium and destruction of the periodontal ligament along with bone resorption. 

Therefore, gingival recession may be a consequence of this stage of disease, or it may be seen as a part of the healing process in response to periodontal treatment. Which results in reduction of probing depth and shrinkage of the tissue that leads to tightening of the gingival cuff and formation of long junctional epitelium. In studying the etiology of gingival recession Gronman concluded that tooth malalignment and tooth brushing are most common factors associated with gingival recession. Sangnes and Gjermo confirmed that different types of traumatic injuries may result in a variety of gingival lesions. The lateral pedicle graft was described by Grupe and Warren in 1956. The purpose was to gain attached gingiva and to cover areas of gingival recession, especially those on the facial surfaces of mandibular anterior teeth. The lateral positioned flap can be used to cover the isolated, denuded roots that have adequate donor tissue laterally and vestibular depth. Prognosis for Miller class I and class II is good to excellent whereas,

A 23-year old healthy female presented to the department of periodontics, government dental college Aurangabad with chief complaint of receding gum in the lower front teeth region. On examination there was Miller’s class II gingival recession in the lower left central incisor region with a recession of 6mm in depth and 2 mm in width it was due to malposition. Trauma from occlusion with respect to the involved tooth was ruled out clinically.Patient was motivated and educated and oral hygiene instructions were given. Scaling and root planing was done and the patient was periodically recalled to assess his oral hygiene and gingival status before taking up the case for periodontal surgery and allowing the creeping attachment for 3-4weeks. Blood and radiographic investigation was carried out. No interproximal bone loss was seen.


The root surface was thoroughly scaled and planned to remove plaque, accretions and surface irregularities. Profound analgesia was obtained using local anesthesia for the recipient site. A no.15 scalpel blade was used to prepare the recipient bed. The epithelium was dissected preserving the connective tissue for the graft acceptance in the coronal-apical direction several millimeters below the mucogingival junction. The high frenum attachment was relieved thereafter. 

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