Combined Surgical and Restorative Procedures to Treat Maxillary Canine with Gingival Recession and Cervical Wear

Abstract

Introduction: Gingival recession (GR) with cervical tooth wear is a major concern for patients on the prominent maxillary canines, from both esthetic and dentine hypersensitivity points of view. Hypersensitivity could be treated nonsurgically; however, esthetics remain the major patients' concern that mostly requires surgical intervention for covering the denuded root surface. Several surgical procedures are applied successfully for covering single and multiple gingival recession; however, these procedures are sensitive procedures and not always predictable. Semilunar coronally repositioned flap (SCRF) is a very simple procedure that found to be very predictable for covering a single recession in presence of sufficient keratinized gingiva apical to the recession. The procedure provides better clinical outcome by involving less adjacent papillary tissue that maintains greater blood supply and achieves maximum flap stability with mattress sutures with minimal postoperative complications. Therefore, this case report is aimed at explaining the simplicity of this surgical procedure in the presence of wide keratinized tissue around the recession and starting the restorative procedure after a sufficient soft tissue healing period. Case Presentation. 42-year-old systemically healthy female patient referred with a single wide gingival type 1 (RT1) and cervical wear around tooth #43. A semilunar coronally repositioned flap was released and advanced coronally to cover the denuded root totally; then, the flap stabilized by three mattress sutures, and complete root coverage was achieved. Six months later, the cervical lesion was restored with composite filling material. Sixteen-month and 32-month postoperative follow-up revealed full coverage of the denuded root surface with firm stable gingiva; later, the gingiva in the area looked stable and healthy.

Conclusion: Using SCRF in treating RT1 recession in the presence of wide keratinized gingiva is very promising surgical intervention for receded root coverage that requires less technical skill.

Figure 1

Tooth #43 class I Miller recession with root exposure and abrasion.

Figure 2

(a, b) Vertical and horizontal dimensions of the recession using Michigan probe. (c) Measuring the amount of attached keratinized gingiva around the recession by using Marquis periodontal probe.

Figure 3

(a) Root planing using sharp Gracey curette. (b) Root detoxification using EDTA gel for 2 minutes. (c) Using 15C blade to make partial thickness flap. (d) The coronally repositioned semilunar flap was secured by three horizontal mattress sutures and fixed with flowable composite to the crown of the tooth.

Figure 4

(a) Ten days after removing the periodontal dressing and sutures. (b) Two months later, the gingiva was very stable and showed resistance to the periodontal probe. (c) At six months, the gingiva remained very stable with small amount of scar tissue on the donor area and was filled with composite filling. (d) 32 months postoperatively, the gingiva looked very stable and healthy.