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Subepithelial connective tissue graft: a case report  [PDF]
Juliana Alcarás Saraiva,Edson Alves de Campos,Rodrigo Cavassim,Shelon Cristina de Souza Pinto
RSBO , 2011,
Abstract: Introduction and objective: Marginal tissue recession represents a common condition in Periodontology. Miller’s Classes I and II recessions, in which the etiological factors are well diagnosed and eliminated, show great predictability of total coverage when the technique of subepithelial connective tissue graft is used. This technique success has been mainly attributed to the double blood supply for graft’s nutrition, originating from the connective tissue of both the periosteum and flap. Case report and conclusion: The authors reported a clinical case in which a Miller’s Class I recession was treated by the surgical technique of subepithelial connective tissue graft, obtaining total coverage, eliminating the aesthetic deficiency and the dentin hypersensitivity complained by patient.
Esthetic Root Coverage with Double Papillary Subepithelial Connective Tissue Graft: A Case Report  [PDF]
Ramesh Babu Mutthineni,Ram Babu Dudala,Arpita Ramisetty
Case Reports in Dentistry , 2014, DOI: 10.1155/2014/509319
Abstract: Patients today have become excessively concerned about esthetics. These esthetic concerns of patients have become an integral part of periodontal practice. Gingival recession is an esthetic problem that can be successfully treated by means of several mucogingival surgical approaches, any of which can be used, provided that the biologic conditions for accomplishing root coverage are satisfied with no loss of soft and hard tissue height interdentally. There are currently different techniques for root coverage which include pedicle grafts, free gingival grafts, connective tissue grafts, and guided tissue regeneration (GTR). This paper reports a case in which a new double papillary connective tissue graft technique has been used in the treatment of gingival recession. 1. Introduction The principal aim in surgically treating gingival recession is to cover the exposed root surfaces and consequently improve esthetic appearance, although there are other objectives such as inhibiting the progression of active recession, increasing the width of attached gingiva, and reducing dental hypersensitivity. Several techniques such as free gingival graft [1–3], laterally positioned flap [4–6], coronally positioned flap [7, 8], and double papilla graft [9] have been proposed for the same. The objective of free gingival graft procedure is to prevent future recession by increasing the width of keratinized gingiva rather than covering the root surface. A double-step procedure consisting of a free gingival graft to obtain a sufficient amount of keratinized tissue, if not already present, and a coronally positioned flap performed after healing to cover the exposed root surface has been proposed. Many variations of the grafting technique have been proposed for predictable root coverage [10–12]. In 1985, B. Langer and L. Langer [13] presented a surgical combination of a pedicle flap and a free graft, proposing that subepithelial connective tissue graft covering the lesion is overlapped by a partial thickness flap to ensure vascularization of the free graft. Different flap procedures further modified this technique resulting in a high success rate and predictability as shown in various longitudinal observations and case reports [14–17]. Recently, double papillary connective tissue graft has been used for the treatment of root coverage procedures for better esthetics and predictability. Of the various graft and nongraft procedures used, this case report describes double papillary subepithelial connective tissue graft, a technique in which bilateral pedicle flaps with connective
Clinical comparision of semilunar coronally positional flap and subepithelial connective tissue graft in root coverage procedure
Mosavi Jazi M.,Haghighati F.,Saave G.
Journal of Dental Medicine , 2009,
Abstract: "nBackground and Aim: Several surgical approaches have been used to achieve root coverage. The Subepithelial Connective Tissue Graft (SCTG) procedure has been shown to be a predictable means to treat gingival recession. Semilunar Coronally Positioned Flap (SCPF) is a simple mucogingival surgery to cover the exposed root surface without harvesting the palatal connective tissue. The purpose of this study is to compare the outcome of gingival recession therapy using SCTG and SCPF. "nMaterials and Methods: Forty Miller class I buccal gingival recessions (≥2mm) were selected. Recessions were randomly assigned to receive either the SCPF or SCTG. Recession Height (RH), Recession Width (RW), Width of Keratinized Tissue (WKT), Probing Depth (PD), Clinical Attachment Level (CAL), were measured at baseline, 1, 3, and 6 months after surgery. The data were analyzed using independent t-test and Repeated Measure ANOVA. "nResults: The average percentages of root coverage for SCPF and SCTG were 88% and 71%, respectively; and the complete root coverage observed were 55% and 45%, respectively. There were no significance differences between the two groups with regard to RW, PD, CAL, WKT (except in the third month after surgery which was slightly greater in SCPF group). RH was significantly decreased from 2 to 6 months after surgery in SCPF group. "nConclusion: The findings from this study indicate that if the tissue thickness and initial width of keratinized tissue are sufficient, SCPF may be a good substitute for SCTG in treatment of Miller class I gingival recessions.
Optimizing Gingival Biotype Using Subepithelial Connective Tissue Graft: A Case Report and One-Year Followup
Harpreet Singh Grover,Anil Yadav,Priya Yadav,Prashant Nanda
Case Reports in Dentistry , 2011, DOI: 10.1155/2011/263813
Abstract: Gingival recession is the exposure of root surfaces due to apical migration of the gingival tissue margins. The principal objectives of treating a gingival recession are to achieve better esthetics and reduce hypersensitivity. The gingival biotype is an important modifying factor in the treatment of gingival recession. The purpose of this paper is to highlight the significance of changing the soft tissue biotype to a more favorable one while attempting root coverage, to achieve more stable and long-lasting results using subepithelial connective tissue graft.
Interproximal Papillae Reconstruction around Implant Using Subepithelial Connective Tissue Graft in Maxillary Anterior Region: A Case Series  [cached]
Satish Gupta,Vikas Deo,Cecil Williams
Journal of Oral & Maxillofacial Research , 2012,
Abstract: Objectives: The present study was undertaken to evaluate the effectiveness of interproximal papillae reconstruction around early loaded single implant using subepithelial connective tissue graft in maxillary anterior region.Material and Methods: Ten systemically healthy patients (mean age = 29.3 [SD 7.9] years) in need of dental implants in maxillary anterior region were included in the study. Interproximal papillae reconstruction around single implant using subepithelial connective tissue graft was applied. The donor palatal tissue was harvested by a ‘trap door approach’. Subepithelial connective tissue graft was inserted in the pouch created on mesial and distal site of implant. Clinical and radiographic parameters were recorded around the each implant, including papillary height and papillary gingival contour, at baseline, 3 and 6 months after operation. Results: The mesial papilla height was increased by 1.9 (SD 0.87) mm, P = 0.005 at 3 month and maintained at 1.5 (SD 0.97) mm, P = 0.007 at 6 months. The distal papilla height was increased by 2 (SD 0.66) mm, P = 0.004 at 3 month and maintained at 1.2 (SD 0.78) mm, P = 0.010 at 6 months. Assessment of papilla contour index showed 90% aesthetic success both for mesial and distal papilla at 6 months.Conclusions: It can be concluded that subepithelial connective tissue graft may be used to successfully augment the gingival papillae adjacent to single tooth implant restoration.
Laterally positioned flap associated with subepithelial connective tissue graft for coverage of isolated gingival recession  [PDF]
Thiago Marchi Martins,Alvaro Francisco Bosco,Guilherme Giovani Gazoni,Sabrina Feltrin Garcia
RSBO , 2011,
Abstract: Introduction: The coverage of denuded roots represents one of the challenges of periodontal treatment. Among the several techniques for this purpose is the laterally positioned flap, which has undergone some modifications since its first reports and is currently combined with other techniques such as subepithelial connective tissue graft. Objective: To report a case of a 41-year-old female patient who presented Miller class I gingival recession at labial surface of tooth #43. Case report: The main symptom of the patient was dentin hypersensitivity. Clinical and radiographic exams were performed and gingival inflammation due to the presence of bacterial plaque was diagnosed as the main cause of root recession. After basic periodontal treatment, surgery for root coverage was performed. Since the area adjacent to the recession showed a good amount of attached gingiva and no interproximal bone loss, the surgical technique of choice was a laterally positioned flap associated with a subepithelial connective tissue graft. Conclusion: Postoperative assessment showed complete root coverage, an increased keratinized gingival band, absence of dentin hypersensitivity, and an excellent esthetic outcome.
Comparative Clinical Evaluation of Subepithelial Connective Tissue Graft and Acellular Dermal Matrix Allograft for the Treatment of Gingival Recession  [PDF]
F. Haghighati,M. Mousavi,N. Moslemi
Journal of Dentistry of Tehran University of Medical Sciences , 2006,
Abstract: Statement of Problem: Various surgical procedures have been used to achieve root coverage and subepithelial connective tissue graft (SCTG) is identified as one of the most successful techniques. Recently, acellular dermal matrix allograft (ADMA) has been developed as a substitute for SCTG to avoid removing the palatal connective tissue.Purpose: The present study compared the clinical efficiency of ADMA and SCTG in the treatment of recession defects.Materials and Methods: This randomized controlled clinical study, consisted of nine patients with 32 Miller’s class I or II recession defects of ≥ 2 mm on the facial aspects of premolar teeth. Bleeding on Probing Index (BPI), Plaque Index (PI), Probing Depth (PD), Recession Depth (RD), Recession Width and Clinical Attachment Level (CAL)were measured at baseline and 6, 12 and 24 weeks post-surgery. Before operation, the samples were randomly allocated to ADMA (test) or SCTG (control) groups.Results: A statistically significant improvement was observed in RD, RW and CAL,but not in BPI, PI and PD. The mean values of changes in all clinical parameters from baseline to 24 weeks postsurgery were not significantly different between the two groups. There was no significant difference in the amount of mean root coveragebetween the ADMA (85.42%) and SCTG (69.05%) groups (P= 0.058).Conclusion: ADMA may be a useful substitute for SCTG in the treatment of shallow to moderate gingival recessions, if the financial aspect is not an issue for the patient.
A Comparative 6-Month Clinical Study of Acellular Dermal Matrix Allograft and Subepithelial Connective Tissue Graft for Root Coverage  [PDF]
S. Sadat Mansouri,N. Ayoubian,M. Eslami Manouchehri
Journal of Dentistry of Tehran University of Medical Sciences , 2010,
Abstract: Objective: Different surgical procedures have been proposed for the treatment of gingival recessions. The goal of this study was to compare the clinical results of gingival recession treatment using Subepithelial Connective Tissue Graft and an Acellular Dermal MatrixAllograft.Materials and Methods: The present study was performed on 5 patients with 9 bilateral Miller`s class I or II gingival recessions. This included 15 premolars and 3 canines. In each patient the teeth were randomly divided in two groups of test (ADMA) and control (SCTG).Clinical parameters including recession height (RH), recession width (RW), keratinized gingiva (KG), clinical attachment level (CAL) and probing depth (PD) were measured at baseline, 2, 4 and 6 months after surgery and data analysis was performed using the Wilcoxon signed rank test.Results: The mean changes (mm) from baseline to 6 months in SCTG and ADMA were 2.22±0.83 and 1.77±0.66 decrease in RH, 2.55±0.88 and 2.33±0.86 decrease in RW,1.44±0.88 and 2.0±1.11 increase in KG, 2.33±1.22 and 2.11±0.6 decrease in CAL and finally 0.22±0.66 and 0.33±0.7 decrease in PD, respectively. The differences in meanchanges were not significant between the two groups in any of the parameters. The percentage of root coverage was 85.7% and 71.1% for the control and test group,respectively. The changes from baseline to the 6 month visit were significant for both groups in all parameters but PD.Conclusion: Alloderm may be suggested as an acceptable substitute for connective tissue graft considering the root coverage effect and KG width increase.
Evaluation of Effectiveness of Acellular Dermal Matrix Allograft and Subepithelial Connective Tissue Graft in Combination with Coronally Positioned Flap in Treatment of Mutiple Gingival Recession in Aesthetic Areas : A Case Series
BK Somnath,,Pretti Charde,,ML Bhongade
People's Journal of Scientific Research , 2012,
Abstract: Obtaining predictable and aesthetic root coverage has become an important part of periodontal therapy. Severaltechniques have been developed to achieve these goals with variable out comes. The aim of this case series was toevaluate the effectiveness of Acellular Dermal Matrix Allograft (ADMA) and Subepithelial Connective Tissue Graft (SCTG)in combination with Coronally Positioned Flap (CPF) in the treatment of Miller’s class I and II multiple gingival recessionin aesthetic areas.A total of 10 patients aged between 18 to 40 years were selected for this study, meeting all the criteria forinclusion. Five patients were treated with ADMA and 5 patients with SCTG in combination with CPF. Various clinicalparameters were assessed viz. probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), widthof keratinized tissue (WKT) at base line and 6 months after surgery.No significant differences in gingival recession, reduction were noted between ADMA and gold standard SCTG.Within limits of this case series, the use of ADMA may represent an acceptable alternative to the SCTG for treatinggingival recession. The use of ADMA eliminates the need for the palatal donor site and it involves a less invasive surgeryfor treating multiple gingival recession. These results suggest that ADMA may be a useful substitute for SCTG to achievepredictable root coverage.
Use of subepithelial conjunctive tissue graft in root covering  [PDF]
Denis Clemente Rodrigues,Ricardo Alves,Takeshi Kato Segundo
RGO : Revista Gaúcha de Odontologia , 2010,
Abstract: Gingival recession may cause cosmetic changes and root hypersensitivity, which can alter mastication and tooth brushing, and thus contribute to the progression of periodontal disease. Treatment of gingival recessions with subepithelial conjunctive tissue grafting is very predictable due to its bilaminar nature. However, some factors may influence the success of the procedure, among them: selection of the lesion; characteristics of the defect with regard to the depth and width of the recession, the deeper and wider the recession, the worse the prognosis, and also the presence of restorations. Furthermore, it is necessary to control the etiologic factors of recessions, such as inflammation and traumatic brushing, control of systemic factors, occlusal trauma, smoking and harmful habits, technical considerations and asepsis. The success of the procedure must be based on observing the possible factors that might influence their predictability, as well as respecting the basic principles of mucogingival surgery.
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