A Clinical Measurement of Root Coverage and Papillae Reconstruction of Miller's Class III & IV Gingival Recessions by a Coronally Positioned Flap (with an Intact Papillae) and Palatal Free Connective Tissue Graft

Sh. Faghihi, F. Farokhinia


Background: Gingival recession or apical migration of gingival margin, is a common periodontal lesion. A number of methods have been used to treat Miller's Class I & II gingival recessions with a notable success in root coverage. Howevers in the treatment of Miller's Class III & IV gingival recessions, a predictable method has not been presented. It seems that the application of connective tissue grafts combined with various kinds of pedicle flaps may bring about satisfying results. In this study, a combination of palatal free connective tissue graft and a special kind of coronally positioned flap was used to treat Miller's Class III & IV gingival recessions.
Materials and Methods: Eight patients including 6 females and 2 males with a total number of 28 anterior affected teeth with an average age of 35 years old were included in this study. The depths of recessions were between 0.8 and 5.6 mm (with an average depth of 3.2 mm). The following parameters were measured before and 1,3 and 6 months after the procedure: probing pocket depth, the depth of gingival recession from C.E.J and stent, width of attached gingiva, clinical attachment level (CAL) and root sensitivity. In
the surgical procedure, a coronally positioned flap was done with the first incision MGJ and continued with an apically directed partial thickness incision up to 5 mm. Then, it
was followed by a second incision, which dissected the periosteum from the bone at the bottom of the buccal vestibule. Consequently, an intracervicular incision ran around the affected teeth, and the flap complex was pushed coronally. Prepared free connective tissue graft was placed beneath the flap on interdental areas and denuded root surfaces, and then it was sutured to the superficial flap. The apical end of the flap was sutured to the depth of vestibule.
Results: The results showed an average of 1.21-mm root coverage on the distobuccal side of the teeth. The amount of root coverage on midbuccal, mesiobuccal, mesial papilla and
distal papillaes were 1.74, 1.25, 1.17and 0.93 mm respectively. The increase of CAL on mesiobuccal and midbuccal sides was significant with p<0.001. The width of keratinized gingiva remained unchanged but the width of attached gingiva increased considerably, from 4.5 mm at the baseline to 8.27 mm after the procedure.
Conclusion: The surgical procedure can be used successfully for papilla reconstruction and root coverage in Calss III and IV gingival recessions.
Key words: Papillae reconstruction, Root coverage, Gingival recession

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