[Surgical treatment of gingival recession].
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A connective tissue graft technique described by Langer and Langer for treating gingival recession was attempted in 22 clinical cases using connective tissue above. 100% root coverage was obtained where only 3 mm of recession existed, 94% when recession was 3 to 5 mm and 58% root coverage occurred where recession was greater than 6 mm. This technique was compared with the classical technique of free gingival grafts and the connective tissue graft technique for covering exposed root surfaces proposed by Nelson.
Part I of this series described the history and reviewed various techniques of free gingival graft usage without citric acid. Part II of this series on periodontics describes 10 successful case reports.
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After a description of advantages and disadvantages of traditional surgical techniques for the correction of gingival retractions, a new surgical techniques is indicated: the subepithelial connective tissue graft. The latter technique is assessed and described in detail and its relative efficacy in comparison with the traditional techniques is emphasized.
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In our study 150 referred patients were assessed for the presence of gingival recession and root caries. The mean age of the patients was 40 +/- 9 years. On average they failed 6.8 teeth. Gingival recession was present in all patients, with mean value of 55.5% denuded dental root surfaces, the most frequently expressed on buccal root surfaces. Number of denuded dental root surfaces increases with patient's age. The root caries lesion was found in 75% of patients. Patients had on average 5.7 treated and untreated caries lesions. The number of root caries lesions increases with age of the patients as well. The mean Index of total root caries was 9.4%. Most frequently root caries of lower molars and premolars was found, mostly on the buccal surfaces, rather than on approximal and lingual surfaces.
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Out of a group of 30 patients aged from 11 to 15 years, 10 each were treated with either fixed appliances, or removal plates, or by functional orthodontics. Prior to the beginning of the treatment, and one week and six weeks thereafter, pocket depth, SB index, sulcus fluid flow rate, and OH index were recorded. The inflammatory symptoms of the gingiva were shown to be a function of the OH index. Moreover, the OH index grew worse during orthodontic treatment, especially in the group with fixed appliances.
Secondary tumors of the mouth are rare and especially seated on the maxillaries. Metastasis to the soft tissues of the mouth, especially of cancers situated far from ORL and buccal areas are exceptional. The authors report an observation of a bronchial carcinoïd tumor with metastasis to the gums in a 24-year old man. The rapidity of the evolution of the tumor, the precocity and the very exceptional site of the metastasis as well as certain particularities of the histological pattern of the primitive bronchial tumor, once again states the problem of the confines with the Oat-Cell Carcinomas.
The qualitative and quantitative character of the marginal gingiva is not the only cause of root exposure, as mechanical factors can favorize and/or aggravate gingival recession. Suggested therapy is dependent on patient motivation and the evolution of the lesions. Even though there are multiple possibilities for the treatment of gingival recession, one must remain prudent when restoring areas of root exposure, as no protocol exists today which can assure constant success.
The Authors refer in this note about a new technic to recover root recessions particularly those wide and deep: the subepithelial connective tissue graft.
The Authors refer in this second note about the indications and surgery technic of the semilunar coronally repositioned flap.
Free mucosal grafting is a simple, safe and predictable procedure. It is indicated in the treatment of progressive recessions in patients with reduced attached gingiva, in recurrent traumatic marginal lesions inspite of correct tooth brushing, in refractory dental neck hypersensitivity and for cosmetic reasons in patients with recessions. In these situations advancement grafting is done as a secondary procedure. To prevent the potential occurrence of recessions free mucosal grafting may also be indicated prophylactically before orthodontic or prosthetic management. The management concept in patients with recessions as well as the indications of the procedure, the technique used at our department and aspects of planning surgery are discussed.
In Part I of this series, the author summarizes the current diagnosis of and treatment techniques for covering denuded root surfaces with free gingival grafts for an esthetic result. The author reviews historical background and shares the philosophical differences within the periodontal community concerning the use of citric acid root conditioning in these cases.
The purpose of this study was to show that an intensified prevention in dentistry is not new to the 20th Century, but rather that man for more than 100 years considered the positive influence of prophylaxis on oral health to be extremely important. Three publications from Süersen (1867), Detzner (1830) and Jantzen (1865) document impressively that nothing has changed today with regard to the actuality of the questions and problems they raised. As one reviews these studies, one is astonished what profound knowledge all three authors already had regarding the etiology, origin, and consequences of caries and gingival disease.
Bilaminar procedures represent an evolution in the treatment of marginal tissue recessions. A connective tissue graft removed from the palate and over which a pedicle flap is sutured, is used in these procedures. The advantages of these new procedures are: 1) sure predictability of graft survival to which a double-blood supply is guaranteed; 2) primary intention healing at the donor site, with minimum post-operative discomfort; 3) excellent esthetic results consisting of better color blending between graft and adjacent tissues and absence of keloid- like scars, very common after free gingival grafts.