J Dent Rehabil Appl Sci.  2016 Dec;32(4):330-337. 10.14368/jdras.2016.32.4.330.

Laterally positioned flap using subepithelial connective tissue graft for iatrogenic gingival recession treatment

• Lee SJ

• KMID: 2369074
• DOI: http://doi.org/10.14368/jdras.2016.32.4.330

Abstract

Gingival recession could occur after orthodontic or endodontic treatment. This could influence not only functional and aesthetic problem, but also patient's treatment satisfaction. There are a lot of techniques for preventing gingival recession, but laterally positioned flap with subepithelial connective tissue graft could get definite advantages such as increase of keratinized gingival width and harmonious color match between graft tissue and surrounding tissue. Clinician should select a right patient case and diagnosis with clinical and radiography exam. In a surgical procedure, getting enough amounts of subepithelial connective tissue and flap coverage should be taken into consideration. The clinical outcomes in this case report shows laterally positioned flap with subepithelial connective tissue graft could be a treatment with predictive outcome.

Keyword

iatrogenic disease; gingival recession; surgical flaps; connective tissue; transplantation

MeSH Terms

Connective Tissue*
Diagnosis
Gingival Recession*
Humans
Iatrogenic Disease
Radiography
Surgical Flaps
Transplantation
Transplants*

Figure

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  Fig. 1 (A) Donor & recipient site design, (B) Mix-thickness flap. CEJ, cementoenamel junction; Split, split-thickness flap; Sharp, sharp horizontal incision & full-thickness flap.

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  Fig. 2 (A) Initial aspect of Case I showing Miller Class II localized gingival recession at the mandibular left central incisor, (B) Panoramic radiography of Case I.

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  Fig. 3 Clinical view of surgical procedure. (A) A lateral flap was positioned over the connective tissue graft and sutured, (B) Palatal donor site was sutured.

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  Fig. 4 Postoperative clinical view after 15 days. (A) Stable healing observed at recipient site and (B) palatal donor site.

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  Fig. 5 After 3 months clinical view of Case I.

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  Fig. 6 Initial aspect of Case II showing Miller Class II localized gingival recession with sequestrum at the maxillary left lateral incisor.

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  Fig. 7 Clinical view of surgical procedure for sequestrectomy. (A) Sequestrum observed below the recessed gingival margin, (B) Suture after trimming sequestrum.

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  Fig. 8 Clinical view of surgical procedure. (A) Showing 3 mm gingival receesion, (B) Partial thickness flap incision making for recitient site.

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  Fig. 9 Clinical view of surgical procedure. (A) Subepithelial connective tissue grafting from edentulous ridge, (B) The graft tissue positioned at recipient site, (C) A lateral flap was positioned over the connective tissue graft and sutured, (D) Edentulous donor site was sutured.

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  Fig. 10 (A) Postoperative clinical view after 15 days and (B) after 3 months. 1 mm gingival recession remained.

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  Fig. 11 After 1 year clinical view of Case II.

Reference

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