171/213. Bilateral creeping attachment using free mucosal grafts. A case report with 4-year follow-up. Two extensive periodontal recessive lesions in bilateral maxillary cuspid ares were treated surgically with free autogenous masticatory mucosal grafts. No attempt was made initially to achieve total root surface coverage. Evaluation of the sites during a 4-year postoperative period demonstrated unusual degrees of "creeping attachment." The maxillary left cuspid graft completely covered the root with 9 mm of gingival-equivalent tissue while the maxillary right cuspid area displayed 90% (7 mm) root surface coverage. ( info) |
172/213. The histology of new attachment utilizing a thick autogenous soft tissue graft in an area of deep recession: a case report. An area of deep, long-standing recession on a mandibular first premolar was treated for root coverage in a 40-year-old woman. The recession was 6.0 mm deep with a probing depth of 2.0 mm, and there was no attached gingiva. A thick (1.5-mm) free autogenous epithelium and connective tissue graft from the palate was placed to the cementoenamel junction of the tooth after instrumentation and tetracycline conditioning of the root surface. The tooth and facial soft tissues were removed in block section 10.5 months later. At the time of extraction, there had been a gain of 5.0 mm of root coverage, and there was 5.0 mm of keratinized gingiva on the facial aspect. The probing depth was 1 mm. Histologic measurement showed 4.4 mm of new attachment and 4.0 mm of new bone growth. The coronal extent of the new attachment and new bone were in an area previously exposed by recession. ( info) |
173/213. Resorbable membrane in the treatment of human buccal recession: a nine-case report. Recent studies have reported the successful use of guided tissue regeneration procedures with nonresorbable barrier membranes to treat buccal recession in humans. Nonresorbable membranes, however, require a reentry procedure for removal, disturbing the delicate healing process. Resorbable membranes were used in a guided tissue regeneration procedure in nine patients with one site of buccal recession each. The resorbable barrier yielded satisfactory clinical results, providing significant gains in probing attachment and root coverage. However, both the surgical technique and the design of the barrier used require improvement for application at sites of buccal recession. ( info) |
174/213. Ridge augmentation utilizing the subepithelial connective tissue graft: case reports. Ridge augmentation has become a common periodontal prosthetic procedure. This article reviews ridge augmentation utilizing the subepithelial connective graft for correction of Class I, II, and III defects. The correct surgical procedures for achieving successful and predictable ridge augmentation are discussed, and a technique for combining ridge augmentation with root coverage is outlined, using three cases to illustrate the procedure. The learning objective of this article is to review and update the knowledge of augmentation procedures and techniques. ( info) |
| Bioresorbable barrier material, used in guided tissue regeneration, changes the conventional two-stage surgery to a single-step procedure. This article presents a general surgical protocol for application of a bioresorbable matrix barrier (Guidor AB, Huddinge, sweden). Three case reports are used to illustrate the surgical treatment of a Class II furcation defect, an intrabony defect, and a recession type defect. The learning objective of this article is to enhance the knowledge of surgical procedures and bioresorbable barrier membranes available. ( info) |
176/213. Use of guided tissue regeneration to treat a mucogingival defect associated with interdental bone loss: a case report. guided tissue regeneration was successfully used to treat a patient who had a mucogingival defect associated with interdental bone loss. The defect involved the mandibular left central incisor, which exhibited 6.0 to 7.0 mm of attachment loss on the facial, mesial, and distal aspects. A regenerative procedure consisting of critic acid demineralization and placement of a demineralized freeze-dried bone allograft and Gore-Tex membrane was performed. At 8 months, a gain of 4.5 to 5.0 mm, or 64% to 83%, in clinical attachment levels was demonstrated. Root coverage was 86%. ( info) |
177/213. Periodontal complications following orthognathic surgery and genioplasty in a 19-year-old: a case report. Bimaxillary osteotomies and a sliding genioplasty were performed to correct mandibular micrognathia and maxillary vertical hyperplasia in a 19-year-old white male with a Class II, division 1 malocclusion and anterior open bite. At a follow-up appointment with the orthodontist 4 weeks after the surgical procedure, the mandibular anterior teeth showed severe gingival recession, exposing labial root surfaces on the mandibular central incisors. Grafting procedures were able to restore labial soft tissue on the affected teeth. It is suggested that wound healing contraction of gingival tissue in the area of the incision for the genioplasty caused this complication. ( info) |
178/213. The use of gingival autografts that contain submucosa in the repair of mucogingival defects in maxillary molars: case reports. Many studies have shown that deep and wide gingival recessions can be predictably covered by free gingival autografts. Most of the autografts in these studies were performed on single-rooted teeth. This article presents a rationale for a new technique that repairs this type of defect in maxillary molar areas by means of thick masticatory mucosa autografts that intentionally include not only the lamina propria, but also portions of the submucosa. In addition, a new suturing approach that allows adequate adaptation of the donor tissue to the recipient site and permits relocation of the graft is proposed. This new approach has been shown to be a significant advantage in the anatomically problematic maxillary molar area. ( info) |
179/213. Mucogingival orthodontic and periodontal problems. The absence of keratinized gingiva alone is not an indication for a periodontal surgical procedure. However, if recession increases during orthodontic treatment, then a gingival graft may be indicated. Orthodontic therapy and removal of a mandibular incisor where excessive gingival recession is present may be the indicated treatment. ( info) |
180/213. Utilization of composite resins and direct bonding following periodontal treatment. When restoring dentition compromised by periodontal treatment, good aesthetics must be achieved without compromising the periodontal health. Improved composite resin systems and new dentin bonding agents offer excellent restorative options. The learning objective of this article is a review of composite resins and direct bonding for aesthetic restorations. Two cases are presented to illustrate the procedure. ( info) |