Subepithelial connective tissue graft associated with apicoectomy and root-end fillings in the treatment of deep localized gingival recession with apex root exposure: case report.

Periodontal reconstructive surgery procedures seek to correct mucogingival defects, including gingival recession. This case report describes the use of a subepithelial connective tissue graft (SCTG) associated with root-end fillings using mineral trioxide aggregate (MTA) for the treatment of Miller Class II recession with root apex exposure. A partial-thickness double pedicle flap was made, followed by root preparation with curette and bur finishing. The exposed root apex was removed and the canal was filled with MTA. An SCTG taken from the palate was placed over the root surface and covered with the double pedicle flap. Twelve months after treatment, a reduction from 11 mm to 1 mm in gingival recession was achieved, covering 91% of the root. Repair in the periapical region was determined with radiographs. A 1.0-mm probing depth was measured, and no bleeding was observed on probing. There was an adequate keratinized tissue band, along with esthetic tissue contour and coloration. This case report serves as an example of how the grafting of subepithelial connective tissue can be successfully accomplished in tandem with MTA for the treatment of isolated Miller Class II gingival recession with root apex exposure. (Int J Periodontics Restorative Dent 2009;29:445-449.).

Relationship between the width of the zone of keratinized tissue and thickness of gingival tissue in the anterior maxilla.

The aim of this study was to evaluate whether there is a positive correlation between the width of the zone of gingival keratinized tissue and its thickness. Maxillary right canines, lateral incisors, and central incisors of 60 patients (30 men, 30 women) between the ages of 20 and 35 years were examined. Using an endodontic spacer with a rubber cursor and a digital caliper of 0.01-mm resolution, the values of the width of the zone of gingival keratinized tissue and gingival thickness were obtained. It was observed that the lateral incisor has the largest mean zone of gingival keratinized tissue (5.54 ± 1.09 mm), followed by the central incisor (4.62 ± 1.02 mm) and canine (4.32 ± 1.33 mm). The mean gingival thickness was greater in the central incisor (1.17 ± 0.20 mm), followed by the lateral incisor (1.04 ± 0.24 mm) and canine (0.87 ± 0.27 mm). No statistically significant difference was verified for the mean width of the zone of gingival keratinized tissue and gingival thickness between men and women. A positive correlation between gingival thickness and width of the zone of gingival keratinized tissue was observed in the maxillary canine (Pearson r = 0.398, P < .05), lateral incisor (Pearson r = 0.369, P < .05), and central incisor (Pearson r = 0.492, P < .05). In patients 20 to 35 years of age, there was a positive correlation between gingival thickness and width of the zone of gingival keratinized tissue for the maxillary right canine, lateral incisor, and central incisor.

Microcirurgia periodontal: uma visão brasileira / Periodontal microsurgery: a Brazilian overview

Objetivo: Realizar um estudo sobre o uso do microscópio operatório na cirurgia plástica periodontal no Brasil. Métodos: Foram realizadas entrevistas junto a 11 especialistas da área, para que fosse possível fundamentar e explorar o assunto. Resultados: Observaram-se as vantagens que a microcirurgia traz aos procedimentos de cirurgia plástica periodontal e outros procedimentos periodontais, como cicatrização por primeira intenção com mínimo incomodo pós-operatório, postura ergonômica de trabalho do operador, maior previsibilidade dos resultados pós-cirúrgicos, entre outras. Em contra partida, as desvantagens observadas, como tempo de treinamento, curva de aprendizado e custo inicial, também foram consideradas importantes para a introdução da microcirurgia na clínica diária. Conclusão: Verificou-se, portanto, que esta nova tecnologia possui um importante papel, pois aperfeiçoa os procedimentos clínicos e cirúrgicos, mas que ainda está sendo descoberto pelo profissional brasileiro. Mas, quando isso ocorrer, vai melhorar muito o desempenho do profissional e a satisfação dos pacientes

Objective: This article is aimed at studying the use of the surgical microscope in periodontal plastic surgery in Brazil. Methods: A bibliographical study was carried out and personal interviews conducted with 11 specialists in the , in order to substantiate and explorethe subject. Results: The advantages that Microsurgery brings to the proceedings of periodontal plastic surgery and other periodontal procedures were observed, such as wound healing by first intention with minimalleast post-operativeonal discomfort, ergonomic work posture of the operator at work, bettergreater predictionvision of post-surgical results, amongst others. On the other hand, the disadvantages observed, such as the time required for training, the learning curve and the initial cost, were also considered important for the introduction of microsurgery in the dayilyclinics. Conclusion: Hence, it was seen that this new technology plays an important role, as it perfects clinical and surgical procedures, though thisit still remains is still to be discovered by Brazilian professionals in Brazil. When this finally occurs, however, it will greatly improve the performance of professionals and the satisfaction of patients.

Enxerto de tecido conjuntivo subepitelial associado à recessão gengival em pilares de prótese parcial fixa: relato de caso clínico / Subepithelial connective tissue graft associated to gingival recession in pillars of fixed partial prosthesis: a clinical case report

Os procedimentos de cirurgia plástica periodontal têm como objetivo a correção de defeitos mucogengivais,dentre eles, a recessão gengival. Neste caso clínico foi utilizado enxerto de tecido conjuntivo subepitelial no tratamento de recessão gengival Classe III de Miller em um dente pilar de prótese fixa. Foi realizado um retalho de espessura parcial associado a duas incisões verticais. O enxerto de tecido conjuntivo subepitelial foi removido do palato e colocado sobre a superfície da raiz. O retalho foi reposicionado, recobrindo completamente o enxerto. Seis meses após o tratamento, foi observada a cobertura total da raiz do elemento dentário. Este caso clínico mostrou que o enxerto de tecido conjuntivo subepitelial pode ser utilizado com sucesso na cobertura de raízes de pilares de prótese fixa.

Periodontal plastic surgery procedures aim the correct of mucogingival defects, among which, gingival recession. This case involves the use of subepithelial connective tissue graft in the treatment of Miller Class III gingival recession in a dental pillar element of a fixed partial prosthesis. A partial thickness flap associated to two vertical incisionswas made. An subepithelial connective tissue graft taken from the palate was placed over the root surface. The flap was coronally positioned so as to cover the graft entirely. Six months after the treatment, complete root coverage of the dental element could be observed. This clinical study show how the grafting of supepithelial connective tissue can be successfully used in root coverage of adental pillar element of a partial fixed prosthesis with Miller Class III gingival recession.