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30 Dental Tribune Middle East & Africa Edition | July-August 2015Referral Clinic > Page 31 BRAND PR MISE Q U A L I T Y S E L E C T I O N P E R F O R M A N C E Rely On Us for Quality, Selection and Performance. Henry Schein is a name you can trust. Our Brand Promise We provide the broadest selection of relevant products in the industry at the best possible value, to help you run your business more profitably. We stand behind all of our products with a 100% guarantee of satisfaction. Our products offer you maximum value without compromising on quality. We offer over 8,000 products you can trust to fulfill your needs—each bearing the Henry Schein Seal of Excellence— your guarantee of satisfaction. • Growing selection of value-priced products • All essential categories including diagnostics and infection control • High standards of quality and effectiveness Contact: Antonio Plata Phone: 631-843-5325 email: antonio.plata@henryschein.com 14ER3194 Dental Tribune_A4_Layout 1 12/2/14 4:15 PM Page 1 Management of gingival recession defects - a case report By Dr. Olivier Carcuac, Sweden I ntroduction Gingival recession, refer- ring to the exposure of the root of a tooth caused by loss of gingival tissue and/or apical dis- placement of the gingival mar- gin from the cemento-enamel junction (Wennström 1996), is a common clinical observa- tion. According to Kassab et al. (2003), more than 50% of the population exhibits gingival recessions. Gingival recession has a multifactorial etiology as- sociated with anatomical factors or pathological factors (Figure 1). Plaque-related inflamma- tion and traumatic brushing have been considered primary or triggering factors in gingival recession. Furthermore, predis- posing factors have also been identified: bone fenestration and dehiscence, position of the tooth within the dental arch, thickness of the marginal gingiva, high at- tachment of the labial frenulum and iatrogenic factors (uncon- trolled orthodontic movement related to force, direction, or dental tipping and inappropriate restorations). Gingival recessions can be lo- calized or generalized, involv- ing one or more tooth surfaces. Among various classifications proposed to describe the clinical features of gingival recessions, Miller’s classification (Miller 1985) of gingival recession is probably the most widely used. This classification, based on (i) the height of the interproximal papillae and interdental bone adjacent to the defect area, and (ii) the relation of the gingival margin to the mucogingival junction (Figure 2), allows for a relatively reliable prediction of the outcome of treatment. The exposure of the root surface is generally associated with aes- thetic issues, a radicular hyper- sensitivity as well as difficulties to maintain an optimal bucco- dental hygiene (Susin et al. 2004, Daprile et al. 2007). In many cas- es, these symptoms may require treatment. Treatment Treating gingival recessions is a challenge for the dental prac- titioner who must consider the objective clinical signs, subjec- tive symptoms, and the patient’s expectations regarding the treatment outcome. The management of gingival recession is based on a thor- ough assessment of the degree of tissue involvement and the etiological factors. The control of the causative factors in the de- velopment of gingival recession should always be addressed dur- ing the initial treatment phase and will in most cases prevent further progression of the reces- sion. Vigorous brushing should be addressed by advising pa- tients to carry out an appropriate brushing technique (i.e. modi- fied Bass technique) with a soft/ medium toothbrush, a less abra- sive dentifrice. When tooth mis- positioning is a contributing fac- tor, appropriate consideration to orthodontic correction should be considered. If the recession is related to a piercing, its removal should be recommended. If the recessions have been suc- cessfully stabilized by identifying and avoiding causative factors, and by eliminating hypersensi- tivity, no further treatment might Figure 1. Gingival recession has a multifactorial etiology: vigorous brushing (a), plaque-related inflammation (b), uncontrolled orthodontic movement related to force (c), piercing (d). Figure 2. Miller’s classification of gingival recession : Class I (a), Class II (b), Class III (c), Class IV (d). be needed. However, in cases of objectionable aesthetic altera- tions, progressive recessions, or increased hypersensitivity, sur- gical correction using mucogin- gival plastic surgical techniques such as gingival grafting should be considered. The objectives of gingival graft- ing are (i) to provide a degree of root coverage and (ii) to en- hance the amount of kerati- nized attached gingival tissue around the tooth. While the latter of these two objectives is very predictable, the amount of root surface coverage may vary depending on the severity of the recession defect. Periodontal plastic surgery is technique sensitive and involves delicate handling of the mucog- ingival tissues, demanding a great dexterity of the surgeon, a selection of specific instruments and innovative surgical and su- turing approaches. The use of magnification and microsurgi- cal instruments to handle the tis- sues improves vascularization of connective tissue grafts and in- creases root coverage compared to macrosurgical techniques (Burkhardt & Lang 2005, Cortel- lini et al. 2007). Two main types of periodontal plastic surgical procedures have 14ER3194 Dental Tribune_A4_Layout 112/2/144:15 PM Page 1