Basem ALSHUJAA, Dicle ALTINDAL, Ahmet Cemil TALMAÇ, Mohammad ALNASRALLAH

Two-Stage Surgical Procedure with Free Gingival Graft and Coronally Advanced Flap in Treatment of Recession Type 1: A Case Series

Gingival recession is a multifactorial problem happened due to various reasons and could be defined as the apical shift of the gingival margin. It can be easily diagnosed when root exposure occurred as a result of previous alveolar bone loss under the gingiva. This condition may have important esthetic, functional, and periodontal health implications. Esthetic concerns and dentin hypersensitivity caused by gingival recession are the main reasons that encourage the patient to seek periodontal treatment. The primary goal of any surgical approach for treating gingival recession defects will be complete root coverage (CRC) resulting in pain relief and prevention of further progression. One of the common surgical procedures for gingival recession treatment is periodontal mucogingival plastic surgery using free gingival graft and subepithelial connective tissue graft. In this case series, three cases presenting with “Cairo recession type 1” isolated gingival recession were treated by free gingival graft and coronally advanced flap without subepithelial connective tissue graft using two-stage surgical technique. The result after follow-up of our cases showed a significant increase in attached gingiva, longterm root coverage (RC) has been obtained and the complaints of patients were resolved.

Keywords:

Free gingival graft, gingival recession, root coverage,

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1. Clauser C, Nieri M, Franceschi D, Pagliaro U, Pini-Prato G. Evidence-based mucogingival therapy. Part 2: Ordinary and individual patient data meta-analyses of surgical treatment of recession using complete root coverage as the outcome variable. J Periodontol. 2003;74(5):741–56.
2. Bouchard P, Malet J, Borghetti A. Decisionmaking in aesthetics: root coverage revisited. Periodontol 2000. 2001;27(1):97–120.
3. Rasperini G, Acunzo R, Limiroli E. Decision Making in Gingival Recession Treatment: Scientific Evidence and Clinical Experience. Clin Adv periodontics. 2011;1(1):41–52.
4. Bjorn H. Free transplantation of gingiva propria. Sven Tandlak Tidskr. 1963;22:684– 689.
5. Cohen ES. Atlas Cosmetic & Reconstructive Periodontal Surgery. Periodontology Dentistry Branches. Philadelphia: Williams and Wilkins, 1994:65‑135.
6. Imber JC, Kasaj A. Treatment of Gingival Recession: When and How? Int Dent J. 2021;71(3):178–87.
7. Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000. 2015;68(1):333–68.
8. Cairo F, Cortellini P, Nieri M, Pilloni A, Barbato L, Pagavino G, et al. Coronally advanced flap and composite restoration of the enamel with or without connective tissue graft for the treatment of single maxillary gingival recession with non-carious cervical lesion. A randomized controlled clinical trial. J Clin Periodontol. 2020 M;47(3):362–71.
9. Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol. 2011;38(7):661–6.
10. Miller PD. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985;5(2):8-13.
11. Pini-Prato G. The Miller classification of gingival recession: limits and drawbacks. J Clin Periodontol. 2011;38(3):243–5.
12. Nordland WP, Tarnow DP. A classification system for loss of papillary height. J Periodontol. 1998;69(10):1124–6.
13. Bernimoulin J ‐P, Lüscher B, Mühlemann HR. Coronally repositioned periodontal flap. Clinical evaluation after one year. J Clin Periodontol. 1975;2(1):1–13.
14. Camargo PM, Melnick PR, Kenney EB. The use of free gingival grafts for aesthetic purposes. Periodontol 2000. 2001;27(1):72–96.
15. Popova C, Boyarova T. Two-Step Surgical Procedure for Root Coverage ( Free Gingival Graft and Coronally Positioned Flap ). Journal of IMAB. 2007;2:21–4.
16. Bertl K, Spineli LM, Mohandis K, Stavropoulos A. Root coverage stability: A systematic overview of controlled clinical trials with at least 5 years of follow-up. Clin Exp Dent Res. 2021;7(5):692–710.
17. Santamaria MP, Neves FL da S, Silveira CA, Mathias IF, Fernandes-Dias SB, Jardini MAN, et al. Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions: a randomized clinical trial. J Clin Periodontol. 2017;44(5):540–7.
18. Prato GP, Tinti C, Vincenzi G, Magnani C, Cortellini P, Clauser C. Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession. J Periodontol. 1992;63(11):919–28.
19. Wang HL, Al-Shammari KF. Guided tissue regeneration-based root coverage utilizing collagen membranes: Technique and case reports. Quintessence Int. 2002;33(10):715-21.
20. Hıroshı N, Tadao O, Kunıharu S, Seıdaı M, Hıdekazu K, Kazumı S, et al. Clinical Evaluation for Collagen Membrane (BioMend) in Guided Tissue Regeneration. J Japanese Soc Periodontol. 1999;41(3):320–9.
21. Rath A, Varma S, Paul R. Two-Stage Mucogingival Surgery with Free Gingival Autograft and Biomend Membrane and Coronally Advanced Flap in Treatment of Class III Millers Recession. Case Rep Dent. 2016;2016.