Advanced surgical techniques in gingival recession treatment

Abstract

Background Mucogingival deformities result from anatomical and morphological irregularities in the mucogingival region. Gingival recession is the most common mucogingival deformity, and it represents a displacement of gingival margin apically from cement enamel junction. It presents itself with both a loss of soft and of hard tissues. The treatement of gingival recession is surgical. A ideal goal of gingival recession treatment is complete restauration of lost periodontal tissues. Subepithelial connective tissue graft in combination with coronally advanced flap is most common therapeutic approach in treatment of maxillary recession. On the other hand, Free gingival graft is first choise in treatment of mandibular recessions. Material and methods 20 patients from Department of Periodontology, School of Dentistry, University of Belgrade, have been enrolled in the study. Inclusion criterion was the bilateral presence of Miller class I or II single or multiple maxillary or mandibular gingival recessions. Split mouth design was used in the study. Patients were divided in two groups, in first group were patients with recessions localized on maxillary teeth and in second group were patients with recessions localized on mandibular teeth. In experimental group- first group of patients, gingival recessions were treated with Subepithelial connective tissue graft in combinatiom with split thickness flap (Tunel technique). In control group, gingival recessions were treated with Subepithelial connective tissue graft placed under a coronally advanced flap (Allen 1994). In experimental group, second group of patients, gingival recessions were treated with Subepithelial connective tissue graft in combination with split thickness flap (Tunel technique). In control group, gingival recessions were treated with Free gingival graft. Clinical parameters such as gingival recession coverage (RC), keratinized tissue width (KG), clinical attachment level (CAL), gingival index (GI) and plaque index (PI) were recorded at baseline, and three and six months postoperatively...

Uvod Mukogingivalne anomalije se ispoljavaju kao posledica anatomo-morfoloških nepravilnosti u mukogingivalnom kompleksu parodontalnih tkiva i predstavljaju odstupanje od normalne dimenzije i morfologije u meĊusobnom odnosu gingive i alveolarne mukoze, a takoĊe mogu biti povezane i sa deformitetima alveolarne kosti. S obzirom na veliku uĉestalost u humanoj populaciji, one predstavljaju znaĉajan socio-epidemiološki problem. Gingivalna recesija predstavlja najĉešću mukogingivalnu anomaliju i nastaje usled morfoloških nepravilnosti u mukogingivalnom kompleksu. Gingivalna recesija ima uticaj na nastanak i prognozu parodontopatije i ukoliko se ne leĉi moţe da dovede do gubitka zuba. Odlikuje se gubitkom mekih i ĉvrstih tkiva u mukogingivalnom regionu, što dovodi do povećane osetljivosti eksponiranog korena zuba na nadraţaje i nepovoljnog estetskog izgleda. Terapija gingivalne recesije je hirurška. Realan cilj terapije gingivalne recesije jeste kompletno, predvidivo i u znaĉajnom periodu vremena stabilno prekrivanje površine korena zuba. U hirurškom leĉenju gingivalne recesije gornjih zuba najĉešće korištena terapijska metoda je Transplantat vezivnog tkiva u kombinaciji sa koronarno pomerenim reţnjem i vertikalnim relaksacijama, dok se u terapiji gingivalne recesije donjih zuba najĉešće primenjuje Slobodni mukozni autotransplantat. Materijal i metod U studiju je ukljuĉeno 20 pacijenata Klinike za Parodontologiju i oralnu medicinu Stomatološkog fakulteta u Beogradu. Kriterijumi za ukljuĉivanje u studiju bili su bilateralno prisusutvo izolovanih ili multiplih gingivalnih recesija klase I ili II po Miller-u u gornjoj vilici. Primenjen je metod podeljenih usta (“splith mouth”).svi pacijenti su podeljeni u dve grupe, prvu grupu su saĉinjavali pacijenti sa gingivalnim recesijama na gornjim zubima dok su drugu grupu ĉinili pacijenti sa gingivalnim recesijama na donjim zubima...