The crown lengthening double guide and the digital Perio analysis.

OBJECTIVE: This article describes a surgical crown lengthening double guide, which was digitally obtained to improve diagnosis, treatment outcome, and follow-up. CLINICAL CONSIDERATIONS: The rehabilitation of anterior dental esthetics should involve interdisciplinary and facially driven planning for achieving pleasant long-term outcomes. Surgical crown lengthening is one of the most common periodontal surgery, which can be assisted by digital tools to improve surgical planning and follow-up. CONCLUSION: The double guide for surgical crown lengthening allows the proper management of hard and soft tissues for achieving a predefined goal based on biological requirements and facially driven planning. In addition, the digital quality control allows the follow-up compared with the pre-operative condition and planned treatment plan. CLINICAL SIGNIFICANCE: The use of digital tools allow the clinician to develop a facially driven planning with proper communication with the team and patient, leading to a shorter, more predictable, and less invasive surgical technique, reducing postoperative inflammation and increasing patient comfort.

Gingival recession treatment with enamel matrix derivative associated with coronally advanced flap and subepithelial connective tissue graft: a split-mouth randomized controlled clinical trial with molecular evaluation.

OBJECTIVES: The goal of this study was to evaluate the impact of enamel matrix derivative (EMD) on periodontal healing after root coverage (RC) surgery, involving CAF in combination with SCTG, and to assess the molecular profile, verifying the inflammation level in early stage (1 and 2 weeks). MATERIALS AND METHODS: Thirty-two recessions (RT1) were submitted to periodontal surgery with (test) or without (control) EMD. The clinical parameters analyzed on the day of surgery and 6 months after the surgical procedure were as follows: recession height and width, keratinized tissue height, percentual root coverage, and the gingival thickness of keratinized tissue. Moreover, the main inflammatory biomarkers and growth factors (IL-1ß, IL-6, IL-8, FGF, MIP-1α and ß, PDGF, TNF-α, and VEGF) were evaluated at baseline, 7, and 14 days after procedures. RESULTS: The average root coverage was significantly higher in the test group as compared to the control group (86% vs. 66%, p = 0.008). The test side had significantly lesser final RH compared to the control side (p = 0.01). Also, there was a significant reduction of RW in both groups, with more significant results in the test group. KTH and GT were not significantly different at any time and group. After 14 days, the immunological analysis showed an increase of VEGF (p = 0.03) on the test group compared to the control side. CONCLUSION: The use of EMD in RC surgeries resulted in a significantly higher RC, as well as a significant increase in VEGF expression, suggesting that EMD may contribute to the angiogenic and healing process. CLINICAL RELEVANCE: EMD provided better results in root coverage treatment when associated with CAF and SCTG, beyond a greater releasing of angiogenic growth factor (VEGF), which enhanced the result.

Low-shrinkage composites: an in vitro evaluation of sealing ability after occlusal loading.

The objective of this in vitro study was to compare the microleakage of a flowable low-shrinkage-stress resin composite--in a Class II fatigue-loading design when used as a 4 mm dentin replacement--to a conventionally layered silorane-based resin composite. Eighty standardized 4 mm deep cavities, divided into 4 subgroups, were restored with the 2 tested materials. Half of the restorations were submitted to mechanical loading, and all of the restorations were prepared for microleakage evaluation. The evaluation of the marginal adaptation to dentin was performed with scanning electron microscopy. The results showed that both silorane-based composite groups had higher rates of microleakage in comparison to the low-shrinkage-stress resin composite groups.

Influence of periodontal biotype on the presence of interdental papillae.

The absence of interdental papillae can be a negative influence in aesthetics. Periodontal biotype (PB) is one of the factors that can possibly influence this relation and has to be considered in periodontal diagnosis and treatment planning. The objective of this study was to evaluate the influence of the periodontal biotype on the presence and absence of interdental papillae. Forty-seven patients were included in this transversal clinical study. The PB, presence and height of interdental papilla, loss of papillary height, and the distance between the base of the contact point and bone crest (CP-BC) were evaluated. The chi-square test was used to verify the significance level of the PB distribution frequency between groups. The Mann-Whitney test was used to compare the CP-BC measures between the different PB groups, and the correlation test was used to verify the relation between the CP-BC distance and the presence of papillae. The thin PB group presented a significantly higher presence of papillae (71.1%) than did the thick PB group (59.6%, P < 0.05). An inverse and proportional correlation between the CP-BC distance and the presence of papillae was found. The authors concluded that the PB influenced the presence and height of interdental papillae.

Endodontic and Periodontal Treatment of Complete Buccal Root and Apex Exposition: A Challenging Case Report With 17 Months Follow-Up.

INTRODUCTION: This case report demonstrated a challenging clinical case addressed within a multidisciplinary approach to achieve its maintenance, even though had a poor prognosis. It was associated with the endodontic treatment with mucogingival techniques, including periodontal microsurgery and connective tissue graft. CASE PRESENTATION: A patient presented a deep gingival recession with the apex-exposed non-vital tooth with interproximal bone loss (RT2) and without mobility. The treatment involved an initial endodontic approach and periodontal therapy (scaling and root planing), microsurgical techniques with coronally advanced flap, root preparation with PrefGel (24% EDTA), enamel matrix derivatives (Emdogain), and connective tissue graft. As a clinical result, it was verified an increase of keratinized tissue width and gingival thickness, and root coverage (RC), reaching good esthetics and a stable result after 17 months. CONCLUSION: The correct diagnosis and technique selection may affect directly the outcome, especially in challenging cases. Even though there was a poor prognosis, an adequate treatment plan, patient cooperation, and technique mastery help to achieve a high level of RC, esthetic recovering, and successful outcome.

Clinical evaluation and biological understanding of the early step-by-step healing after periodontal microsurgery: A case report with PES analysis comparing initial and 31-day result.

Microsurgery has evolved, permitting faster vascularization and healing than macro-interventions, reducing tissue trauma and obtaining precise wound closure. Therefore, this study aimed to detail the initial healing steps after the periodontal microsurgical procedure. A -26 year-old female had a localized recession (anterior lower tooth, recession type1-), with the absence of local keratinized tissue width (KTW) and adjacent gingival thickness (GT)<1 mm. After oral prophylaxis and occlusal adjustments, the pink esthetic score was performed (5 points), followed by the microsurgery procedure. Prior to inserting the subepithelial connective tissue graft (SCTG), the epithelial layer was removed, and the root surface was biomodified. Two days postoperatively, it was possible to observe a white layer from the SCTG in the gingival margin, decreasing after 4 days. In 6 days, the sutures were removed; no graft and volume loss was observed. For 9 days, the volume was the maintenance. Nevertheless, there was a reduction in tissue volume in the facial zone. After 11 and 13 days, an improved healing process was found, whereas, after 16 days, it was possible to report stable tissues, which was confirmed after 31 days, with a significant GR reduction and an increase in KTW and GT. Moreover, the final pink esthetic score (PES) was 9. Microsurgery had a faster healing and predictable outcome, suggesting reduced trauma, which may allow a quicker suture removal without jeopardizing the outcomes.

Use of Botulinum Toxin Before Surgical Lip Repositioning: A Randomized Clinical Trial.

This study aimed to determine whether administering botulinum toxin type A (BT) prior to surgery would stabilize surgical lip repositioning. A randomized controlled parallel-group clinical trial was performed. A total of 18 participants with excessive gingival display (EGD) were divided into two groups. For the test group (TG), BT was injected into the smile muscle locations 15 days before the surgical procedure. For the control group (CG), only lip repositioning surgery was performed. Gingival display (GD) and upper lip displacement (LD) were measured 3 and 6 months postoperatively. Data were submitted to ANOVA, Tukey, and t tests. For GD and LD, the changes were statistically significant between the measurements taken at the baseline, 3-month, and 6-month marks. The GD presented a reduction of 5.2 ± 1.1 mm in TG and 3.2 ± 1.4 mm in CG after 6 months. The LD measurements reduced 45% for TG and 26% for CG in 6 months. The injection of BT 15 days before lip repositioning surgery provided more stable results and effectively reduced the GD at 6 months.

Deepithelialized Connective Tissue Graft and the Remaining Epithelial Content After Harvesting by the Harris Technique: A Histological and Morphometrical Case Series.

INTRODUCTION: The remaining epithelial layer existent in connective tissue graft (CTG) harvested from the hard palate, which underwent de-epithelization outside the oral cavity, can be histologically detected unless it is completely removed. Its presence may cause adverse esthetics results, affecting thus the color and texture of the receptor site, and an increased risk of presence of scar tissues after surgical procedures. The proposal of this study was to evaluate the CTG (histological and morphometrically) collected from the hard palate using the Harris technique, removing the epithelial layer outside the mouth, assessing the remaining presence of epithelial tissue. CASE SERIES: Fourteen patients (14 CTGs) were included in the present case series study, therefore there were two dropouts. A small part of the tip of the graft was harvested and fixed in formalin solution for histological processing, staining, and then to be morphometrically analyzed. The epithelial tissue and CTGs were assessed by three calibrated and double-blinded professionals. All information was compiled, and the statistical analysis was performed. CTGs obtained had a width average of 1224.26 µm. There was no presence of any residual of the epithelium in three samples, whereas only one had the epithelium tissue covering the entire connective layer. Furthermore, seven samples (approximately 50%) had the presence of epithelium. CONCLUSION: Within the limitation of this study, there was incomplete removal of the epithelial layer after harvesting the CTG using the Harris technique (44.32%), most likely due to its histological persistency, suggesting to be inaccurate the clinical removal.

Histologic and histomorphometric analysis of connective tissue grafts harvested by the parallel incision method: a pilot randomized controlled trial comparing macro- and microsurgical approaches.

OBJECTIVE: The aim of this pilot randomized controlled trial was to assess the efficacy of macro- and microsurgical procedures in removing the epithelial tissue layer of subepithelial connective grafts (SCTGs) harvested by the parallel incision method. METHOD AND MATERIALS: Sixteen patients were randomized to receive macro-SCTG harvesting (n = 10, control group) or micro-SCTG harvesting (n = 10, test group) by the parallel incision technique. Histologic and histomorphometric analysis of the SCTG evaluated the percentage remnant of epithelium and connective tissue. The presence of remnant portions of the epithelium was identified in eight samples (three in the macro- and five in the microsurgery groups). RESULTS: Sixteen participants with 20 sites were included and 20 SCTG were collected and analyzed. SCTG harvested by microsurgical approaches displayed more portions of remnant epithelium compared to the conventional removal (50% versus 30%). There were no significant differences in mean remnant epithelial thickness for test (147.3 ± 89.3 µm) and control (209.0 ± 127.5 µm) groups (P = .57). Likewise, nonsignificant differences were identified in terms of the connective tissue thickness (macrosurgery: 1,511.0 ± 1,160.0 µm; microsurgery: 1,472.0 ± 1,063.0 µm) between groups (P = .96). CONCLUSION: The samples harvested by microsurgery had greater remaining epithelial portions than those harvested by macrosurgery, and similar connective layer thickness.

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.).

Clinical Considerations on the Root Coverage of Gingival Recessions in Thin or Thick Biotype.

Gingival biotype is a clinical term used to describe the thickness of the gingiva. It has been classified as being thick or thin and may be related to the clinical outcome of root coverage procedures. This study evaluated the impact of gingival biotype on the clinical outcome of root coverage procedures following subepithelial connective tissue graft plus coronally positioned flap. A total of 19 patients, 10 with thin and 9 with thick gingival biotype, were treated for localized Miller Class I or II gingival recessions. After 6 months, 14 patients achieved complete root coverage, 7 from each group. The overall mean pooled root coverage rate was 90.93%. The thin biotype cases yielded a reduced mean root coverage of 88.51% compared with 93.63% for patients who had the thick biotype classification. Although the thin gingival biotype may impair the clinical outcome of root coverage procedures, this limitation does not appear to have a strong influence on the success of the root coverage therapy when subepithelial connective tissue graft was associated with the coronal positioning of the flap.

Periodontal plastic microsurgery in the treatment of deep gingival recession after orthodontic movement.

Gingival recession is a condition that affects a large portion of the young and adult population and negatively affects the aesthetic aspects of the smile. Many factors are related to its development, including orthodontic movement beyond the osseous limits. Many treatment options have been proposed to cover the exposed root surface. The aim of this article was to describe three cases where a subepithelial connective tissue graft was performed, using a microsurgical technique, in the treatment of deep gingival recession after orthodontic treatment. This technique resulted in successful root coverage and keratinized tissue gain, improving the gingival esthetic pattern.

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.

[Oral infection control in hospitalized patients: an approach to cardiologist and intensive care units doctors]. / Controle de infecção oral em pacientes internados: uma abordagem direcionada aos médicos intensivistas e cardiologistas.

This paper aims to find the current level of periodontal med-care knowledge, as well as the possible existence of some oral infection control protocol regarding hospitalized patients. Our sample gathered 110 cardiologists and intensive care units doctors selected from medical teams of five Rio de Janeiro hospitals. Preliminary numbers: 75.4% said to have heard something about Periodontal Medicine, although only 30% out of this group admitted to have read something concerning such subject. On the other side, only 2.7% of the sample informed to do consistent information searching along their patients anamnese, while 58.2% out of this group admitted such procedure conditional to the patient's general state at the due moment. Through such numbers, we tend to come up to the conclusion that, be it either through direct or indirect Periodontal Medicine technical information (and consequently with regards to the absolut importance of preservation and control of oral biofilm and its impact on one's systemic health), the matter has been dimly spread among medical groups. The search also revealed the probability that Rio de Janeiro hospitals lack either units or agents designed for prevention and control of oral infection; consequently, such organizations do not have any kind of protocols, reliable or not, concerned to oral infections.

Influência do biótipo periodontal na Implantodontia e na Ortodontia / Influence of periodontal biotype in Implantology and Orthodontics

O objetivo do presente estudo foi realizar uma revisão de literatura para avaliar a importância da definição do biótipo periodontal nos tratamentos ortodônticos e de implantes. Observou-se que as diferenças das características periodontais são semelhantes tanto para pacientes dentados quanto para portadores de implantes, então essa informação deve ser importante para a definição do tratamento ortodôntico e com implantes para evitar transtornos funcionais e estéticos. A definição do biótipo periodontal é fundamental para a previsibilidade desses tratamentos.

The aim of this study was to conduct a literature review to assess the importance of the definition of the periodontal biotype in orthodontic and implants treatments. It was observed that the differences in periodontal characteristics are similar for both dentate patients and for patients with implants, then this information should be important to the definition of orthodontic and implants treatments to avoid functional and aesthetic inconvenience. And the definition of periodontal biotype is critical to the predictability of these treatments.

[Evaluating the existence of oral infection control in patients admitted in state hospitals in Rio de Janeiro]. / Avaliação da existência de controle de infecção oral nos pacientes internados em hospitais do estado do Rio de Janeiro.

The aim of the present study is to ascertain whether an oral infection control protocol is being used in Rio de Janeiro State hospitals. Sixty two hospitals, both public and private have been surveyed. When asked whether any procedure was being adopted with admitted patients (in case of ICU patients), 39% of the hospitals responded positively. Among all institutions surveyed, only 15% conduct a regular plaque control protocol in admitted patients. Studies have shown that there is an inter-relationship between periodontal disease and systemic diseases, such as cardiovascular disease, osteoporosis, preterm births and low birthweight, diabetes and respiratory diseases. The oral cavity is considered a potent reservoir of respiratory pathogens. Based on these findings, it has become evident that oral hygiene is an important means of preventing a number of diseases. Thus the need arises not only to create an oral cavity infection control protocol that will contribute to reduce mortality in admitted patients but also to propose preventive measures towards this end.

A doença periodontal materna associada ao nascimento de bebês de baixo peso e parto prematuro / The maternal periodontal disease associated with low birth weight and premature delivery ­ a literature review

Objetivo: revisar a literatura sobre a associação entre o nascimento de bebês de baixo peso e o parto prematuro, e esclarecer sobre os mecanismos que induzem esses acontecimentos em gestantes com doença periodontal. Material e métodos: foi realizada uma busca entre os anos de 1995 a 2015, na base de dados Pubmed, Lilacs e Medline, com as seguintes palavras-chave: periodontitis, pregnancy, periodontal disease, gingival fluid, prostaglandin. Resultados: das 229 referências inicialmente recuperadas, apenas 15 foram utilizadas, sendo dez séries de casos, um estudo coorte e um transversal retrospectivo. Oito artigos mostraram associação entre a doença periodontal materna e o nascimento de bebês de baixo peso e parto prematuro, enquanto quatro artigos não mostraram associação. Conclusão: dentro dos limites desta revisão, pôde-se concluir que a doença periodontal pode se apresentar como fator de risco para o nascimento de bebês de baixo peso e o parto prematuro, e esta associação ocorre através da liberação de mediadores inflamatórios, provenientes da doença periodontal, que alcançam a unidade fetoplacentária através da corrente sanguínea, induzindo o trabalho de parto prematuro e podendo afetar também o desenvolvimento fetal.

Objective: to review the literature on the association between low birth weight and premature delivery, and to clarify the mechanisms that induce these events in case of periodontal disease. Material and methods: a search between the years 1995-2015 was carried out in the Medline and Lilacs databases using the following key words: "periodontitis", "pregnancy", "periodontal disease", "gingival fluid", "prostaglandin". Results: of the 229 references initially recovered, only 15 were used (10 case series, 1 cohort, 1 retrospective). Eight articles demonstrated an association between periodontal disease, low birth weight, and premature delivery, while 4 articles not. Conclusion: within the limits of this review, we conclude that periodontal disease may present a risk factor for low birth weight and premature delivery, and this occurs through the release of infl ammatory mediators, reaching the fetal-placental unit through the bloodstream, leading to premature labor, and also affecting fetal development.

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.

Fibrina rica em plaquetas para recobrimento radicular no tratamento de recessões gengivais / Platelet-rich fibrin for root coverage on the treatment of gingival recessions

As principais queixas de pacientes com recessões gengivais são: aspecto antiestético e hipersensibilidade radicular. Diversas técnicas surgiram para recobrir raízes expostas, sendo o enxerto de tecido conjuntivo subepitelial (ETCS) considerado o padrão- ouro, devido à sua previsibilidade de resultado e manutenção em longo prazo. Outros biomateriais surgiram como alternativa ao ETCS, a fim de evitar suas principais desvantagens: segundo sítio cirúrgico e desconforto pós-operatório. É o caso da fibrina rica em plaquetas (PRF), biomaterial autógeno derivado do PRP, criado na França em 2001. Objetivo: realizar uma revisão da literatura sobre o uso do PRF para tratamento de recessões gengivais, para avaliar seu desempenho clínico no recobrimento radicular. Material e métodos: foi realizada uma pesquisa no PubMed com quatro palavras-chave, totalizando 819 títulos diferentes de artigos científicos. Através dos critérios de inclusão e exclusão, dez trabalhos foram selecionados. Conclusão: o PRF parece ser um biomaterial promissor no tratamento de recessões gengivais, por ter apresentado resultados satisfatórios de recobrimento radicular, semelhantes aos encontrados com o ETCS. Ele pode ser uma boa alternativa ao padrão-ouro, por evitar o segundo sítio cirúrgico, não gerar morbidade ou desconforto pós-operatórios e proporcionar uma melhor cicatrização inicial. Mais estudos devem ser feitos abordando análises histológicas, maior quantidade de indivíduos testados e maior tempo de acompanhamento.

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.