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Patient cases:
(Maxilla)

Periodontal plastic surgery: treatment of multiple gingival recessions

Lead:  
Francesco Cirillo

The treatment of gingival recessions represents a daily clinical challenge due to the main aesthetic problems associated with it. The recession is determined by the apical migration of the gingival margin with respect to the cemento-enamel junction (CEJ) causing the exposure of the radicular surfaces.

The main causes are often associated with incongruous brushing. This condition is widespread and often associated with cervical abrasions (lesion of the hard enamel and dentin tissues in the coronal and radicular portion). The cervical abrasions can predispose the individual to functional problems such as hypersensitivity and radicular caries.

A 44-year-old male patient presented multiple recessions on the elements #11, #12, #13, #14, #15 and #16 FDI associated with cervical lesions and multiple recessions of #23, #24, and #25 FDI all attributable to an incongruous brushing. The patient was unhappy with the aesthetic deficit and, due to the radicular sensibility, had difficulties to maintain a proper oral hygiene.  The proposed treatment aimed to reduce the patient discomfort and increase the aesthetics.

In order to effectively reconstruct the coronal portion of the teeth affected by cervical lesions, the CEJ of the contralateral teeth was taken as a reference for composite reconstruction.

A trapezoidal flap, released by vertical incisions and a connective tissue graft of homologous origin were the preferred choice to treat the multiple adjacent recessions and achieve total root coverage.

The combined technique of CEJ cervical composite reconstruction, muco-gengival surgery and homologous soft tissue graft is a viable solution for treating extensive gingival recession cases, associated with radicular and coronal cervical abrasions. While reducing the number of surgeries, the surgery time, the stress on the patient and dental professional as well as the post-op morbidity, it was possible to achieve a stable total root coverage.

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asked by Anonymous

please explain homologous graft in detail , how do you apply that in your clinic?

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please explain in detail about procedure to take homologous graft and its application in the area of defect.
Profile picture for user cirillofranc
Puros dermis allograft by Zimmer retains the natural collagen matrix of native dermis,it has been demonstrated successful for soft tissue response and maturation.The process executed by Tutoplast process preserve the valuable collagen matrix and tissue integrity and gently removing unwanted materials,such as cells,antigens and viruses.the Clinical advantage is avoid surgical procedures on the palate and is good result improving the thickness of gingiva.I use this product like scaffold to protect the flap maintaining space for angiogenesis tissue remodeling..and increased volume
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asked by Barry Edwards

Diagnosis

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I wish to compliment you on a very expert surgical procedure. However, you state that after 8 months observation you have created a stable total root coverage. Where did you harvest the considerable amount of homolgous soft tissue graft and how did you deal with the discomfort and morbidity in the donor sites. You do not mention if you diagnosed the causes of the gingival recession and whether you took any steps to eliminate or treat the causes of the condition before you provided this treatment.   
Profile picture for user cirillofranc
20.01.2020 | 14:43

In reply to by Barry Edwards

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I used homologous tissue graft to avoid the discomfort and morbidity...As you suggested taking connective tissue from the palat in this case the morbidity would be high...the etiology is trauma from brushing the patient used to brush with hard brush orizontally for long time.me and my Dental Hygenist (my wife) instruct the patient on the use of xsoft brush in the first 3 mounths.after the 3 using soft toothbrush using the roller technique 
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asked by Matthew Hyde

Specifically what composite  or gerastore type materials and bonding techniques were used in these restorations 

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Specifically what composite  or gerastore type materials and bonding techniques were used in these restorations 
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asked by Anonymous

Did you prime root exposed surface to get attached tissue?

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asked by PAULO DO CARMO

Orthodontics previously

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Did you considered an Orthodontic treatment before your intervention?

Team members

Oral surgeon
Vincenzo Curcio
Prosthodontist