periodontal surgery
Diagnostic Detail Understanding the Impact of Tooth Rotation in Correcting Mucogingival Defects Trevor F. Simmonds, D.D.S.; Stephanie M. Chu, D.M.D.; Mike Roig, D.M.D.; Kristian T. Poventud, D.M.D.
ABSTRACT
Introduction: The subepithelial connective tissue graft (S-CTG) is the gold standard in achieving root coverage, but it is not without limitations. The acellular dermal matrix (ADM) is an alternative source that can compensate for the S-CTG’s limitations. Body: Severe recession type 1 (RT1) defects were treated with a combined approach of autogenous and allogeneic soft-tissue grafting, optimizing the benefits of both types of materials to achieve maximum root coverage (MRC). Conclusion: Identifying the anatomical limitations of gingival recession as it relates to tooth rotation and its impact on vascular supply will best prepare both the clinician and patient for the expected outcome. In the 2017 World Workshop, the American Academy of Periodontology and European Federation of Periodontology defined gingival tissue recession as the apical shift of the gingival margin in respect to the cemento-enamel junction (CEJ), often associated with attachment loss. The etiology remains unknown; however, several predisposing factors have been suggested, such as toothbrush trauma, intrasulcular restorative margins, periodontal phenotype and secondary to orthodontic tooth movement.[1] 32
JANUARY 2024 . The New York State Dental Journal
The main indications for periodontal plastic surgery include correcting gingival recession, unsatisfactory esthetics, dentinal hypersensitivity, increased chance of developing plaque retention, gingival inflammation, root caries, and/or tooth abrasion.[2] It has been reported in the literature that the prevalence of gingival recession tends to increase with age. According to Albandar et al., 37.8% of people ages 30 to 39 have gingival recession, and this percentage increases to 90.4% in individuals 80 to 90 years of age.[3] In 1985, Miller[4] proposed a gingival recession classification system that measured the severity (as graded I-IV) of recession utilizing the amount of remaining keratinized tissue (KT) in relation to the mucogingival junction (MGJ) and the presence or absence of interproximal bone loss. In 2011, Cairo[5] and coworkers proposed a new gingival recession classification system (as graded 1-3) based on the level of interproximal clinical attachment level (CAL) in reference to direct facial or lingual CAL. There are some noticeable departures with the newer system: KT width in relationship to the MGJ is not a metric; and there is no prognostic value attached to the diagnostic recession type. A comparison of the two systems is illustrated in Table 1. According to Chambrone and Tatakis,[6] the S-CTG is the gold standard for Miller I-II (currently known as RT1[7]) defects in terms of achieving a gain in root coverage (RC), CAL and KT width. However, this technique is not without its limitations, as it requires not only the preparation of a recipient bed but the additional preparation of a donor site in order to obtain the connective-tissue graft, which has been
