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Root Coverage Procedures in the Treatment of Gingival Recession
Hend AL-Harbi*,BDS , Nadir Babay**, DDS,MS, DESM
*Postgraduate Student ** Professor & Postgraduate Program Director. Division of Periodontics. Department. of Preventive Dental Sciences, College of Dentistry, King Saud University
Riyadh, Saudi Arabia.
Case No.1: Free Autogenous Gingival Graft:
Introduction:
Gingival recession is defined by Miller et al, as an exposition of the radicular surface
of the tooth due to destruction of the marginal gingiva and of the epithelial attachment
that will be reestablished at a more apical position. Buccal recessions are most common
and more advanced at single-rooted teeth. Aesthetic concerns are usually the reason
to perform many surgical techniques to correct labial gingival recession defects.
Indications for
Root Coverage:
• Class I & II gingival
recession.
• Multiple gingival
recessions.
• Inadequate donor site
for laterally pedicle flap.
Fig. 1a: Pre-operative view
recipient site (teeth# 43).
Fig. 2a: Recipient
site preparation.
Fig. 3a: Recipient bed demonstrating
a smooth surface and adequate
hemostasis for graft placement.
Class I
100 %
Root
Coverage
Class II
• Marginal tissue
recession which extends
to or beyond the
mucogingival junction.
• Marginal tissue recession
which does not extend to the
mucogingival junction.
Contraindications:
• No periodontal bone
loss in the
interdental area.
•Class IV gingival
recession.
Classification of
Marginal Tissue
Recession by P. D.
Miller (1985)
• No periodontal bone
loss in the
interdental area.
Class 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.
• Bone or soft tissue loss in the interdental
area or malpositioning of the teeth.
Fig. 6a: absence of
bleeding on probing
•Thin attached gingiva.
Case No.2 Subepithelial Connective Tissue Graft: (proposed by Langer
and Langer in 1985.
Contraindicated
for root
coverage
Partial
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
Fig. 1b: Pre-operative view Fig. 2b: Recipient site Fig. 3b: Recipient site
recipient site (tooth# 15 & preparation with vertical
Prepration.
14).
incisions.
Fig. 4b: Connective tissue graft Fig. 5b: overlying partial thickness flap Fig 6b: 2 months postsutured in position to cover the is then replaced over the donor tissue &
operative view.
denuded root surface.
interrupted sutures are placed.
Etiology:
• Uneven atrophy of the gingival
margin.
• Calculus deposits.
• Trauma caused by vigorous tooth
brushing.
• Gingival lesions associated with
plaque.
• Direct trauma (accident, fingernails).
Fig. 5a: ? Weeks
postoperative view.
Criteria for successful root
coverage:
Class III
• Marginal tissue
recession which
extends to or
beyond the
mucogingival
junction.
•Poor oral hygiene.
Fig. 4a: Well adapted sutures to
ensure good stability of the graft
Predisposing Factors:
•Inadequate attached gingiva.
•Malpositioning of the teeth.
•Orthodontic Movements.
Discussion and Conclusion:
The factor most influencing the result is the 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.