Periodontal plastic surgery: treatment of multiple gingival recessions
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.