A new volume-stable collagen matrix (VCMX) to treat single gingival recession associated with partially restored non-carious cervical lesions: a case series.

Collagen matrixes have been developed as possible connective tissue graft substitutes to overcome patient discomfort, undesired palatal healing, and the limited amount of donor tissue. The aim of this case series is to assess a coronally advanced flap (CAF) with a new volume-stable collagen matrix (VCMX) to treat single gingival recession (GR) associated with partially restored non-carious cervical lesions (NCCL). Twelve patients diagnosed with single GR RT1 + NCCL (B+) were included in this study and received a restorative - partial resin composite with apical margin 1 mm beyond the estimated cementoenamel junction (CEJ) - and a surgical approach - CAF+VCMX. Clinical and patient-centered assessments were recorded at baseline and 6 months postoperatively from ten patients. Significant recession reduction (RecRed:2.1mm), clinical attachment level gain (CAL:1.34mm), and combined defect coverage (CDC) of 51.67% were observed at 6 months. The estimate root coverage (RC) was 69.48%, obtained using the estimated CEJ. No difference in keratinized-tissue width (KTW) was observed over time. A gain in gingival thickness (GT) of 0.42 mm was observed after 6 months (p=.002) and an improvement in patient satisfaction due to better esthetics (p<.001). Within the present study's limits, CAF plus VCMX provided significant improvement in treating single GR combined with partially restored NCCL (B+).

Tratamento de periodontite estágio III localizado grau C em um indivíduo fumante: um relato de caso / Treatment of periodontitis stage III localized grade C in smoker individual: a case report

Objetivo: A periodontite é uma doença infecto-inflamatória que acomete os tecidos de inserção periodontal, e ser fumante representa um risco modificável significativo para todos os graus da doença. Ainda, indivíduos fumantes apresentam uma resposta inflamatória alterada quando comparados a não fumantes. Nesse contexto, o objetivo deste estudo foi reportar um relato de caso de tratamento periodontal de paciente fumante pesado. Relato de caso: O paciente DRS, sexo masculino, 22 anos, foi encaminhado à Faculdade de Odontologia da Universidade Federal de Pelotas (UFPel) com a queixa principal de necessidade de "realização de uma limpeza dentária". Na anamnese, relatou fumar 20 cigarros ao dia, há 7 anos (7 maços-ano). Na consulta inicial, foi encontrado índice de placa visível (IPV) de 100% e índice de sangramento gengival (ISG) de 66,67%. Foi encontrado cálculo supragengival como fator retentivo de placa (FRP) em 46,30% dos sítios. Estabeleceu-se o diagnóstico de periodontite estágio III localizado grau C. Os exames periodontais foram realizados por um único pesquisador calibrado e optou-se pelo tratamento periodontal não cirúrgico. Ao exame de 12 meses, o paciente apresentou IPV de 23,45% e ISG de 22,83%. Houve ausência de FRP. De uma forma geral, foi possível constatar a diminuição significativa das bolsas periodontais, bem como o ganho significativo de inserção clínica periodontal. Considerações finais: Dessa forma, é possível concluir a efetividade da terapia periodontal não cirúrgica, aliada à manutenção periodontal e instruções de higiene para o tratamento de periodontite estágio III, grau C, em paciente fumante.(AU)

Objective: Periodontitis is an infect-inflammatory diseases that affects the periodontal attachment tissues, and being smoker represents a significant modifiable risk for all degrees of the disease. Moreover, smokers have an altered inflammatory response when compared to non-smokers. Therefore, the aim of this study was to report a case report of periodontal treatment of a heavy smoker. Case report: A patient DRS, male, 22 years old, was referred to the School of Dentistry of the Federal University of Pelotas (UFPel) with the main complaint of the need to "perform a dental cleaning". During the anamnesis, he reported smoking 20 cigarettes a day for 7 years (7 pack-years). In the initial appointment, a visible plaque index (VPI) of 100% and a gingival bleeding index (GBI) of 66.67% were found. Supragingival calculus was found as a plaque retentive factor (PRF) in 46.30% of the sites. The diagnosis of periodontitis stage III localized grade C was established. Periodontal examinations were performed by a single calibrated researcher and non-surgical periodontal treatment was chosen. At the 12-month appointment, the patient had an VPI of 23.45% and an GBI of 22.83%. There was absence of PRF. In general, it was possible to observe a significant decrease in periodontal pockets, as well as a significant gain in periodontal clinical attachment. Final considerations: Thus, it is possible to conclude the effectiveness of non-surgical periodontal therapy, combined with periodontal maintenance and hygiene instructions for the treatment of periodontitis stage III localized grade C in a smoker.(AU)

Laterally Positioned Flap with Subepithelial Connective Tissue Graft Modified One-Stage Procedure for the Treatment of Deep Isolated Gingival Recessions in Mandibular Incisors.

The laterally positioned flap (LPF) has been proposed as a promising treatment for isolated gingival recessions (GRs) in mandibular incisors. Several modifications have been proposed to reduce the risk of gingival recession (GR) at the donor tooth site. Therefore, the aim of this was to describe a modified one-stage procedure of performing the LPF associated with the subepithelial connective tissue graft (LPF + SCTG) with the modifications for the treatment of deep isolated GR in mandibular incisors. The modified one-stage technique (LPF + SCTG) is unique because it was presented being bilaminar with tunneled connective tissue graft (CTG) in the adjacent tooth and extended to the flap donor site, without a submarginal incision in the adjacent tooth, taking the entire band of the keratinized tissue (KT) into the flap. In addition, 3 clinical cases were described using this surgical technique. Three healthy patients with Cairo RT1 or RT2 GRs on teeth 31 or 41 were treated with the LPF + SCTG technique. Probing depth (PD), clinical attachment level (CAL), complete root coverage (CRC), mean root coverage (MRC), recession depth (RD), and keratinized tissue width (KTW) were assessed at baseline and in the follow-up periods of 18, 24, and 48 months, in the cases 1, 2, and 3, respectively. The LPF + SCTG with the modifications presented is a predictable approach for the treatment of deep isolated RT1 and RT2 GRs in mandibular incisors that are well positioned in the bone envelope with the presence of KTW adjacent to GR and adequate vestibule depth in the donor area of the flap.

Effect of adjuvant bisphosphonates on treatment of periodontitis: Systematic review with meta-analyses.

BACKGROUND: Previous systematic reviews showed additional benefit of adjuvant bisphosphonates (BP) in the treatment of periodontitis. In contrast, it is unclear the effect of BP in patients with diabetes and smokers, its pooled effect when administered locally or systemically is also unknown. OBJECTIVES: This study aimed to systematically review the literature about the use of BP as adjuvant to nonsurgical scaling and root planning (SRP). METHODOLOGY: This study followed the PRISMA guideline. This study included randomized clinical trials that administered locally or systemically BPs as adjuvant for periodontal treatment. Five databases were used. Meta-analyses were performed, using the pooled mean differences (MD) for clinical attachment level (CAL) and probing pocket depth (PPD). Standard mean difference (SMD) was used for radiographic assessment (RADIO). Subgroup analyses were performed for locally delivered meta-analyses, considering diabetes and smoking exposure. RESULTS: Thirteen studies were included. It was showed MD of 1.52 â€‹mm (95%CI: 0.97-2.07) and 1.44 â€‹mm (95%CI: 1.08-1.79) for PPD reduction and CAL gain, respectively, for locally delivered BP. BP was not able to provide significant improvements in smokers (subgroup analysis) when considering CAL (MD: 1.37; 95%CI: -0.17-2.91) and PPD (MD: 1.35; 95%CI: -0.13-2.83). Locally delivered BP also improved significantly the RADIO assessments (SMD: 4.34; 95%CI: 2.94-5.74). MD for systemically administered BP was 0.40 â€‹mm (95%CI: 0.21-0.60), 0.51 â€‹mm (95%CI: 0.19-0.83) and 1.05 (95%CI: 0.80-1.31) for PPD, CAL and RADIO, respectively. CONCLUSION: The administration of BP in adjunct to SRP may result in additional clinical effects.

Effects of cervical restorations on the periodontal tissues: 5-year follow-up results of a randomized clinical trial.

OBJECTIVE: This study evaluated the effect of resin composite restorations of non-carious cervical lesions (NCCLs) on the occurrence/progression of gingival recession (GR), considering different tooth isolation techniques. METHODS: A randomized controlled split-mouth and blinded trial was carried out. Patients (n = 38) with at least two NCCLs were included. Before the cervical restoration placement, the NCCLs (181 teeth) were randomly allocated into two treatment groups according to the tooth isolation techniques: cotton roll or rubber dam. Experienced, trained, blinded, and calibrated examiners performed periodontal evaluations at baseline and 5-year follow-up, using a periodontal probe. Restorations were assessed with the FDI criteria. Thirty-two patients (154 teeth) were evaluated at 5 years. The occurrence/progression of GR between baseline and follow-up was considered the primary outcome. The relative risk (RR) and 95 % confidence interval (95 %CI) were calculated by Poisson regression (α < 0.05). RESULTS: After 5 year, 31 teeth (13.6 %) presented occurrence/progression of GR. In the multivariate analyses, the occurrence/progression of GR was associated with the use of rubber dam isolation (RR; 95 %CI: 2.65; 1.01-7.00) and a lack of marginal adaptation of the restoration (RR; 95 %CI: 10.98; 2.31-52.30). Toothbrush stiffness, use of abrasive dentifrice, tooth type, and the presence of biofilm or gingivitis did not present a statistically significant higher risk for occurrence/progression of GR. CONCLUSION: The use of rubber dam isolation associated with retraction clamp and the lack of a proper marginal adaptation of the composite restorations are risk indicators for the occurrence/progression of GR in individuals who received a restoration for an NCCL. CLINICAL SIGNIFICANCE: Isolation with a rubber dam and dental clamps may promote GR in sites with restored NCCLs. Moreover, clinical examinations for lack of marginal adaptations of the restorations may be included in a clinical setting.

Local delivery therapies as adjuvants to non-surgical periodontal treatment of periodontitis grade C: a systematic review.

OBJECTIVES: The aim of this article was to perform a systematic review on the effectiveness of local adjuvant therapies in the treatment of aggressive periodontitis (AgP), now reported as periodontitis grade C. MATERIALS AND METHODS: The authors selected randomized clinical trials of AgP patients who received local therapy as adjuvants to non-surgical periodontal with a duration of at least 90 days. Seven databases were searched up to January 2020. The gain in clinical attachment level (CAL) and reduction of probing depth (PD) were the outcomes of interest. RESULTS: Of the 3583 studies found, only five articles were included in the qualitative analysis. Among the substances analyzed, only 1.2 mg of simvastatin gel (SMV) (1.2 mg/0.1 ml), 1% of alendronate gel (ALN) (10 mg/ml), and 25% metronidazole gel (MTZ) (Elyzol@) showed a significant decrease in the probing depth when compared with their respective control groups. The gain CAL was shown using 1.2 mg SMV gel (1.2 mg/0.1 ml) and 1% ALN gel (10 mg/ml). CONCLUSION: Although 1.2 mg SMV gel (1.2 mg/0.1 ml), 1% ALN gel (10 mg/ml), and 25% MTZ gel (Elyzol) have shown better results, local therapies adjuvant to SRP the data found were limited. Future clinical studies with appreciable methodological quality should be conducted. CLINICAL RELEVANCE: Despite some benefits of local delivery therapy, up to now, it has not been possible to prove the efficacy of local therapy as an adjunct to standard treatment of AgP (periodontitis grade C).

Influence of low-level laser therapy on implant stability in implants placed in fresh extraction sockets: A randomized clinical trial.

BACKGROUND: Low-level laser therapy (LLLT) has been suggested to improve primary stability at the early stages of osseointegration in animal models. However, there is still scarce evidence about its influence on implant stability in humans. PURPOSE: To assess the influence of LLLT on implant stability in implants placed in fresh extraction sockets. MATERIAL AND METHODS: A randomized controlled trial was designed according to the SPIRIT guidelines and is reported following the CONSORT. Patients were randomly allocated according to control or LLLT groups. LLLT consisted in the application of GaAlAs laser (808 nm, avg. power density: 50 mW, circular spot diameter and area: 0.71 cm/0.4cm2 ) applied in six points in contact mode with peri-implant soft tissue (1.23 minutes in each point of application; dose per point 11 J) before bone perforation and after suturing. The total dose resulted in 66 J per application moment. This LLLT protocol was applied only in the dental implant placement session. Implant stability was by ISQ at implant placement (T0 ) and the abutment selection (Ta ). Digital radiographs for T0 and Ta were used to assess the distance between the implant platform and alveolar bone crest, in millimeters. T-test and Shapiro-Wilk test were used to analyze data between groups using the implant as a unit of analysis. RESULTS: Fifty implants were placed in 44 patients. The insertion torque ranged from 15 to 60 N.cm (mean 35.64 ± 13.34). Two implants of the LLLT and one of the control groups were lost to follow-up and one implant of the control group failed to osseointegrate (4.3%). ISQ at T0 ranged from 17 to 79 (mean 59.33 ± 13.05) and from 40 to 89 (mean 66.46 SD ± 11.56) at Ta . No differences were observed when comparing the groups with ISQ difference (P = .433) or radiographical peri-implant alterations (P = .261). CONCLUSIONS: LLLT did not influence implant stability in implants placed in fresh extraction sockets when assessed at healing abutment installation.

Treatment of experimental periodontitis with chlorhexidine as adjuvant to scaling and root planing.

OBJECTIVES: To assess whether subgingival irrigation with 0.12 % or 0.2 % chlorhexidine (CHX) immediately after scaling and root planing (SRP) enhances periodontal tissue repair compared to irrigation with saline solution (control). MATERIALS AND METHODS: Periodontitis was ligature-induced in rat molars for 7 days. Animals were distributed into three groups: 1) SRP group, SRP and irrigation with 0.9 % saline (n = 30); 2) SRP + 0.12 % CHX group, SRP and irrigation with 0.12 % CHX (n = 30); 3) SRP + 0.2 % CHX group, SRP and irrigation with 0.2 % CHX (n = 30). Animals were killed at 7, 15, and 30 days after treatment. Furcation region was histometrically analyzed to determine the bone area. Immunohistochemical reactions were performed for receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG) and tartrate-resistant acid phosphatase (TRAP). RESULTS: Both chlorhexidine groups presented less inflammation and improved tissue repair along the entire experiment when compared with the SRP group. In the histometric analysis at 7, 15 and 30 days, SRP group (4.58 ±â€¯2.51 mm2, 4.21 ±â€¯1.25 mm2, 3.49 ±â€¯1.48 mm2), showed statistically less bone area than groups SRP + 0.12 % CHX (1.86 ±â€¯1.11 mm2; 0.79 ±â€¯0.27 mm2; 0.34 ±â€¯0.14 mm2) and SRP + 0.2 % CHX (1.14 ±â€¯0.51 mm2; 0.98 ±â€¯0.40 mm2; 0.41 ±â€¯0.21 mm2). Both chlorhexidine concentrations modulated the expression of TRAP, RANKL and OPG. CONCLUSIONS: Subgingival irrigation with chlorhexidine contributed for a quicker shift from a proinflammatory destructive profile to healing of periodontal tissues.

Fusion of permanent teeth as post-traumatic sequelae of trauma in primary dentition: A case report with fifteen years of follow-up.

Traumatic dental injuries in primary dentition present risk of sequelae in the permanent dentition. In this case report, we describe the management and long term follow-up of sequelae affecting permanent central incisor due to prior intrusive luxation and subluxation of the corresponding primary tooth. A 5-year-boy was referred for treatment, with history of fall by the age of 21 months, which caused subluxation of the primary maxillary right and left central incisors, and intrusion of the maxillary right lateral incisor. Radiographic and clinical monitoring was regularly performed. Hypoplasia and crown dilaceration of the permanent maxillary right central incisor was detected, as well as an enamel bridge between the central and lateral right incisors was diagnosed by cone bean tomography. Gingevectomy followed by the breaking of the enamel junction between the crowns of lateral and central incisors and indirect facet in composite resin were used to treat the sequelae. A precise diagnosis, involving a multidisciplinary team, contributed to the success of treatment. Key words:Case reports, follow-up studies, pediatric dentistry, tooth, deciduos, complications.

Enxerto de tecido conjuntivo subepitelial e retalho coronal em recessões gengivais múltiplas / Subepithelial connective tissue graft and coronal fl ap in multiple gingival recessions

Algumas das principais indicações para o recobrimento de superfícies radiculares expostas por recessão gengival compreendem a hipersensibilidade dentinária cervical e o tratamento de defeitos estéticos. Este trabalho descreveu o tratamento de recessão gengival múltipla classe III de Miller em um periodonto delgado, após 36 meses de uma intervenção cirúrgica com enxerto gengival livre. O tratamento cirúrgico periodontal proposto foi o recobrimento radicular por meio de enxerto de tecido conjuntivo subepitelial associado a retalho reposicionado coronalmente na região vestibular dos elementos 31, 41 e 42. Após 90 dias, foi possível observar o recobrimento parcial da recessão, aumento da espessura tecidual e o controle do biofi lme pelo paciente, promovendo maior proteção da região e redução do risco de recidiva das recessões. Diante da resolução do caso clínico apresentado, pôde-se concluir que a técnica do enxerto de tecido conjuntivo subepitelial associado ao retalho reposicionado coronalmente, quando bem indicada e realizada, pode ser empregada com sucesso em áreas de recessões múltiplas e periodonto com espessura reduzida.

Some of the main indications for the root coverage of gingival recessions include cervical dentin hypersensitivity and treatment of aesthetic defects. This manuscript describes the treatment of a Miller's Class III multiple gingival recession 36 months after a free gingival graft surgical procedure. The periodontal surgical treatment proposed was the subepithelial connective tissue graft associated with a coronally repositioned fl ap at vestibular region of elements 31, 41 and 42. After 90 postoperative days, it was possible to observe an increase on tissue thickness and biofi lm control by the patient, promoting a greater protection of the region and reducing the risk of recession recurrence. It can be concluded that the subepithelial connective tissue graft technique associated with the coronal repositioned fl ap, when well indicated and performed, can be successfully used in multiple recessions and periodontal regions with reduced thickness.

Enxerto gengival livre para aumento da faixa de gengiva queratinizada em região com recessões múltiplas / Free gingival graft to increase the band of keratinized tissue in cases of multiple gingival recessions

Defeitos de recessões gengivais podem contribuir para a ocorrência de hipersensibilidade dentinária, cáries radiculares, desenvolvimento de abrasões cervicais e deficiência estética. O objetivo do presente trabalho foi relatar o tratamento de recessões gengivais múltiplas classe III de Miller, em região inferior anterior de mandíbula, utilizando a técnica de enxerto gengival livre. As recessões gengivais classe III de Miller nos dentes 31, 41 e 42 foram, provavelmente, causadas pela associação de um biotipo periodontal delgado e presença de inserções musculares na região anterior da mandíbula. Após a remoção de inserções musculares presentes e frênulos, um enxerto de epitélio conjuntivo foi cuidadosamente preparado para ser acomodado no leito receptor das recessões. Após 24 meses de proservação clínica, foi possível observar: recobrimento parcial das recessões, aumento da faixa de tecido ceratinizado e um excelente controle do biofilme. Diante da resolução do caso clínico apresentado, a técnica do enxerto gengival livre demonstrou um recobrimento parcial das raízes envolvidas e o aumento da faixa de gengiva inserida, corroborando com um menor acúmulo de biofi lme e facilidade de higienização pelo paciente.

Gingival recession defects may contribute to the occurrence of tooth sensitivity, root caries, development of cervical abrasions and aesthetic deficiency. The aim of this study was to report the treatment of multiple Miller class III gingival recessions in lower anterior mandibular region using the free gingival graft technique. The gingival recessions on teeth 31, 41, 42 were probably caused by the combination of a thin periodontal biotype and the presence of muscle insertions. After their removal, an epithelium-connective graft was carefully prepared to be accommodated at the recipient site. After twenty-four months of clinical proservation it was possible to observe partial coverage of these recessions, an increased keratinized tissue and excellent control of the biofilm by the patient. Given the resolution of the case presented, the free gingival graft technique showed partial root coverage and increase the attached gingiva, contributing to less biofi lm build-up and still facilitating patient hygiene procedures.

Adjuvant Therapy With Sodium Alendronate for the Treatment of Experimental Periodontitis in Rats.

BACKGROUND: This study assesses the effects of topical sodium alendronate (SA) as an adjuvant to the mechanical treatment of ligature-induced periodontitis in rats. METHODS: Ninety animals were subjected to the induction of periodontitis via the installation of a ligature around the mandibular left first molar. After 7 days, the ligature was removed, and the animals were distributed into the following groups: 1) NT group (n = 30), no treatment; 2) SRP group (n = 30), scaling and root planing (SRP) and local irrigation with physiologic saline solution; and 3) SRP/SA group (n = 30), SRP and local irrigation with SA (10(-5) M). Ten animals from each group were euthanized at 7, 15, and 30 days after treatment. Histologic and histometric analyses were performed in the furcation region. The percentage of bone in the furcation (PBF) was measured. Immunohistochemical analyses for detecting the receptor activator of nuclear factor-κB ligand (RANKL), osteoprotegerin (OPG), tartrate-resistant acid phosphatase (TRAP), and activated caspase-3 were performed at the furcation region. RESULTS: Compared with the other groups, the SRP/SA group showed less local inflammation and better tissue reparation during the entire experiment. There was more PBF in the SRP/SA group than in the other groups at days 7 and 15. Stronger OPG immunolabeling and weaker RANKL immunolabeling were observed in the SRP/SA group at 15 and 30 days. There were fewer TRAP-positive cells in the SRP/SA group than in the NT group at all of the time points. There was no difference in the number of activated caspase-3-positive osteocytes among groups and time points. CONCLUSION: It can be concluded that topical use of SA as an adjuvant to SRP is effective in the treatment of experimental periodontitis.

Root coverage of adjacent gingival recessions with a combination of two surgical techniques

Introduction: The dentin hypersensitivity associated with gingival recession is an occurrence of high prevalence in the clinical routine of dentists. Coverage of exposed root surfaces represents a challenge for periodontal treatment. Objective: The purpose of the present study is to describe an approach for adjacent gingival recession treatment using a combination of two surgical techniques: the subepithelial connective tissue graft (SCTG) with a laterally positioned double flap. Case report: This surgical treatment was conducted in a 45-yearold female patient who complained of sensitivity when brushing the lower right teeth. Clinical and radiographic examinations showed gingival recessions (Miller Class III) with traumatic origin promoted for tooth brushing and the presence of thin periodontium in the region. In addition, interproximal bone loss was noted on vestibular face of the right mandibular second premolar and mesial root of the right mandibular first molar. At 12 postoperative months, it was observed that the association of the two surgical techniques promoted an almost complete coverage of the gingival recessions, an increased keratinized gingival band and the elimination of initial dentin hypersensitivity. Conclusion: The appropriate choice of techniques and patient compliance to the periodontal support therapy led to treatment success and periodontal health maintenance in the region during the whole follow-up period.

Técnica cirúrgica de recobrimento radicular para tratamento de hipersensibilidade dentinária cervical / Surgical root coverage technique for treating cervical dentinal hypersensitivity

O tratamento de defeitos estéticos e da hipersensibilidade dentinária cervical (HDC) são as principais indicações para o recobrimento de uma superfície radicular exposta por recessão gengival. Este trabalho descreve o tratamento de uma HDC utilizando a técnica do “envelope” para recobrimento radicular em um dente com sensibilidade exacerbada devido à presença de recessão gengival classe I de Miller, na superfície vestibular do segundo pré-molar inferior esquerdo (35). O tratamento cirúrgico periodontal proposto foi de recobrimento radicular por meio de enxerto de tecido conjuntivo subepitelial pela técnica do “envelope” na região vestibular do 35. Após nove meses foi possível observar o recobrimento da recessão, aumento da faixa de tecido ceratinizado e ausência de HDC. Diante da resolução do caso clínico apresentado, a técnica do enxerto de tecido conjuntivo subepitelial em envelope, quando bem indicada e realizada, pode ser empregada com sucesso em casos de hipersensibilidade dentinária cervical.

Dor após a exodontia: caso clínico

Paciente procura a UBS, pois ainda sente muita dor após a extração dentária.

Complicações em cirurgia oral menor: caso clínico

Um paciente chega a UBS queixando-se de dor espontânea no lado direito da mandíbula após extração dentária, secreção purulenta no local e sensação de 'buraco' no dente.

Lesão em bifurcação induzida endodonticamente: caso clínico

Um homem queixa-se de dor aguda espontânea e está com uma 'bolinha' na gengiva e sente sensibilidade ao calor.

Alerta: sangramento gengival

Paciente com sangramento na cavidade oral e histórico de boca seca e ardor na língua

Use of the connective tissue graft for the coverage of composite resin-restored root surfaces in maxillary central incisors.

The purpose of this article is to report the use of the subepithelial connective tissue graft technique combined with the coronally positioned flap on a composite resin-restored root surface to treat Miller Class I gingival recessions associated with deep cervical abrasions in maxillary central incisors. Clinical measurements, including gingival recession height, probing depth, and bleeding on probing (BoP), were recorded during the preoperative clinical examination and at 2, 6, 12, and 24 months postoperatively. During the follow-up periods, no periodontal pockets or BoP were observed. The periodontal tissue of the teeth presented normal color, texture, and contouring. In addition, it was observed that creeping attachment had occurred on the restoration. This case report shows that this form of treatment can be highly effective and predictable in resolving gingival recession associated with a deep cervical abrasion.