445_kahn

The International Journal of Periodontics & Restorative Dentistry 2009 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. Subepithelial Connective Tissue GraftAssociated with Apicoectomy and Root-End Fillings in the Treatment ofDeep Localized Gingival Recession withApex Root Exposure: Case Report Marcos de Oliveira Barceleiro, DDS, MSD, PhD** apical to the cementoenamel junction(CEJ).1 This condition may be causedby various factors, such as periodon-tal disease, traumatic toothbrushing, 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, followedby 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 sensitivity as well. Thus, various surgi- was achieved, covering 91% of the root. Repair in the periapical region was deter- mined with radiographs. A 1.0-mm probing depth was measured, and no bleed- ing 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 gin- gival recession with root apex exposure. (Int J Periodontics Restorative Dent with the development of other appro-priate techniques that make use ofsubepithelial connective tissue grafts,gingival recession treatments haveresulted in more predictable out- *Professor, Department of Periodontology, Universidade Veiga de Almeida, Rio de Janeiro, **Professor, Department of Dentistry, Centro Universitario Serra dos Orgaos, Teresópolis, I and II sites, ie, in the absence of inter- proximal bone loss.8–13 In cases of gin-gival recession treatment, 100% defect Correspondence to: Dr Sergio Kahn, Rua Voluntarios da Pátria 48/105, Botafogo, Rio deJaneiro, RJ, Brazil CEP 22270-000; fax: +55(21)22853846; email: skahn@openlink.com.br.
2009 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. lateral incisor showing a deep Miller Class II combined with root coverage surgery.
vide a better seal and it has lower cyto- The International Journal of Periodontics & Restorative Dentistry 2009 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. connective tissue graft on the exposed root.
of the flaps (Fig 5). The mesial and dis- 2009 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. related to the type of recession that the repair in that area. This result is related The International Journal of Periodontics & Restorative Dentistry 2009 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. 13. Harris RJ. The connective tissue and par- Renato Almeida and Dr Tatiana Poyares for defects. J Periodontol 1994;65:448–461.
14. Sullivan HC, Atkins JH. Free autogenous gingival grafts. III. Utilization of grafts in thetreatment of gingival recession. Perio-dontics 1968;6:152–160.
15. Torabinejad M, Hong CU, Pitt Ford TR, Kettering JD. Cytotoxicity of four root end filling materials. J Endod 1995;21:489–492.
tology. Glossary of Periodontal Terms, ed4. Chicago: American Academy of 16. Torabinejad M, Hong CU, Lee SJ, Monsef M, Pitt Ford TR. Investigation of mineral tri-oxide aggregate for root-end filling in 2. Wennström J. Mucogingival therapy. Ann 17. Mitchell PJC, Pitt Ford TR, Torabinejad M, 3. Grupe HE, Warren RF. Repair of gingival defects by a sliding flap operation.
of mineral trioxide aggregate. Biomaterials 4. Patur B, Glickman I. Gingival pedicle flaps for covering root surfaces denuded bychronic destructive periodontal disease.
J Periodontol 1958;29:50–57.
5. Nabers JM. Free gingival grafts. Perio- 6. Cohen DW, Ross SE. The double papillae repositioned flap in periodontal therapy.
J Periodontol 1968;39:65–70.
7. Miller PD Jr. A classification of marginal tis- sue recession. Int J Periodontics Restor-ative Dent 1985;5:8–13.
8. Langer B, Langer L. Subepithelial connec- tive tissue graft technique for root cover-age. J Periodontol 1985;56:715–720.
tissue graft. A bilaminar reconstructive pro-cedure for the coverage of denuded rootsurfaces. J Periodontol 1987;58:95-102.
10. Harris RJ. The connective tissue and par- tial thickness double pedicle graft: A pre-dictable method of obtaining root cover-age. J Periodontol 1992;63:477–486.
11. Bruno JF. Connective tissue graft tech- nique assuring wide root coverage. Int JPeriodontics Restorative Dent 1994;14:126–137.
12. Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treat-ment of localized gingival recessions: Asystematic review. J Clin Periodontol 2002;29(suppl 3):178–194.
2009 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

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