Mustafa Özay USLU, Serkan DÜNDAR, Abubekir ELTAS

LOKALİZE DİŞETİ ÇEKİLMESİ TEDAVİSİNDE KORONALE KAYDIRILAN FLEP VE TROMBOSİTTEN ZENGİN FİBRİN İLE KORONALE KAYDIRILAN FLEP VE SUBEPİTELYAL BAĞ DOKUSU GREFTİNİN KARŞILAŞTIRILMASI: BİR OLGU SUNUMU

Bu vakanın amacı olgumuzda maksiller kanin dişlerdeki Miller Sınıf-I dişeti çekilmelerinde koronale kaydırılan flep (KKF) ve subepitelyal bağ dokusu grefti (SBDG) tedavisi ile KKF ve trombositten zengin fibrin (TZF) tedavisinin sonuçlarını karşılaştırmaktı. Sistemik açıdan sağlıklı 31 yaşında bayan hasta, kliniğimize dişlerinde hassasiyet ve estetik şikayeti ile başvurdu. Maksiller sağ ve sol kanin dişinde Miller Sınıf-I dişeti çekilmesi mevcuttu. Hastadan alınan kandan TZF elde edildi. Dişeti çekilmelerinin tedavisi için her iki dişte önce tam kalınlık mukoperiostal flep kaldırıldıktan sonra mukogingival birleşimden itibaren yarım kalınlık flep kaldırıldı. Kök yüzeyi debridmanı gerçekleştirildikten sonra papil bölgesi deepitelize edildi ve TZF interdental papile süture edildi. Sol kaninde ise SBDG papillere süture edildi. Her iki mukoperiostal flep koronale kaydırılarak kök yüzeyi kapatıldı. Operasyon bölgesi öjenolsüz bir pat ile korundu. Hastaya operasyon sonrası antienflamatuvar ve klorheksidin glukonat içeren gargara reçete edildi. Operasyon sonrası erken dönemde herhangi bir komplikasyon izlenmedi. Pat ve süturlar operasyondan 10 gün sonra alındı. Bir ay sonra sağ kaninde %100 kök kapanmasının sağlandığı görüldü. Sol kaninde ise 1.5 mm dişeti çekilmesi mevcuttu ve keratinize dişeti kalınlığı TZF uygulanan dişe göre daha fazlaydı. On beş ay sonraki dişeti çekilmesi her iki tarafta da 1 mm olarak ölçüldü. Lokalize Miller Sınıf-I ve sınıf-II dişeti çekilmelerinde TZF kullanılarak yapılan tedaviler hakkında başarılı klinik sonuçlar bulunmaktadır. İkinci bir cerrahi müdahalenin olmaması, daha az zaman alması, donör saha morbiditesinin ortadan kalkması ve post-operatif rahatsızlığın olmaması gibi avantajlarıyla TZF SBDG’ye iyi bir alternatif olarak görülmektedir. Anahtar Kelimeler: Bağ dokusu grefti, Diş eti çekilmesi, Trombositten zengin fibrin THE COMPARISON OF CORONALLY ADVANCED FLAP WITH PLATELET RICH FIBRIN AND CORONALLY ADVANCED FLAP WITH SUBEPITHELIAL CONNECTIVE TISSUE GRAFT IN THE TREATMENT OF LOCALIZED GINGIVAL RECESSION: A CASE REPORT ABSTRACTThe purpose of this case was comparing the efficacy of coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) treatment and CAF with platelet-rich fibrin (PRF) in the maxillary canine teeth with Miller Class-I gingival recessions. Systemically healthy 31 year-old female patient was admitted to our clinic with a complaint of aesthetic and hypersensitivity. Miller Class-I gingival recession was present in maxillary right and left canine teeth. PRF was obtained from the patient’s blood. Full thickness mucoperiosteal flap was reflected followed by a partial thickness flap beyond the mucogingival junction for the treatment of gingival recessions at both tooth. The papilla area was deepitelized after root surface debridement and PRF was sutured to the interdental papilla. SCTG was sutured to papilla at left canine. Root surface was closed by sliding the both mucoperiosteal flaps coronally. The surgical area was protected using a non-eugenol dres- sing. After surgery anti-inflammatory and chlorhexidine gluconate mouthwash was prescribed. There were no complications in the early period after the operation. The dressing and sutures were removed 10 days after the operation. 100% root coverage was maintained at right canine one month later. There was 1.5 mm gingival re- cession at left canine and keratinized gingival thickness was higher according to the PRF applied teeth. The gingi- val recession was 1 mm at both sides fifteen month later. There are successful clinical results in the treatment of localized Miller Class-I and Class-II gingival recessions using PRF. PRF is seen as a good alternative to SCTG with advantages such as the absence of a second surgical intervention, less time consuming, the elimination of donor site morbidity and the lack of post-operative discomfort. Keywords: Connective tissue graft, Gingival recession, Platelet rich fibrin

Anahtar Kelimeler:

Bağ dokusu grefti, Diş eti çekilmesi

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