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ePaper created 2016-11-22, 11:57:56 | version 1.38.0
10 Dental Tribune Asia Pacific Edition | 11/2016 TRENDS & APPLICATIONS Treatment of localised gingival recession A clinical case utilising ZEISS EyeMag Pro F loupes with Feather Light LED By Dr Matthew Garnett, UK A 32-year-old female patient com- plaining of discomfort and pain from her mandibular anterior region was referred for a specialist periodontal opinion.She was experiencing sensi- tivity of the teeth, tenderness and intermittent gingival bleeding. She felt that there had been progressive deterioration over the last two years (Fig. 1). The patient regularly saw her general dental practitioner, who was undertaking supportive care that included scaling, polishing and desensitisation with the use of fluoride varnishes. Having been given oral hygiene advice, she was using a soft-bristled manual tooth- brush on a twice daily basis in order to maintain her plaque levels. Medically, she was a fit and healthy non-smoker, working as a primary school teacher. As far as she was aware, she did not have any para- functional habits such as clenching or grinding her teeth. There was no history of previous orthodontic treatment. Clinical examination using the ZEISS EyeMag Pro F loupes (Carl Zeiss) established that all perma- nent teeth were present, excluding her third molars, and she had a car- ies-free dentition. She showed a good level of oral hygiene, although there were some small plaque and calculus deposits present through- outthedentition.Assessmentofthe area of main concern found there wasareducedvestibularsulcuswith a relatively broad mandibular labial frenal insertion. The superior inser- tion of the frenum was at the mu- cogingival junction of teeth #41 and #31. There were 3 mm of labial reces- sion associated with tooth #41 and 4 mm associated with tooth #31. Both the mandibular central inci- sors were sensitive to cold air at the cervical aspects of the teeth, where calculus deposits were present. Although there was no signifi- cant pathological pocketing, the gingiva in the region of teeth #41 and #31 was erythematous and swollen; this was tender and bled easily upon probing. The inter- dental papillae were intact, albeit the midline papilla particularly in- flamed. There was very little in the way of attached keratinised tissue apical to the recessive defects. Teeth #41 and #31 were labially displaced owing to mild overcrowd- ing and there was mild attritive tooth surface loss affecting both the maxillary and mandibular central incisors. Protrusive and lateral guid- ance involved these teeth, but there was no significant mobility (Fig. 2). Radiographically,therewasnoapical pathology and there was minimal interdental crestal bone loss. The in- terdental bone between teeth #41 and #31 was, however, limited owing to the mild overcrowding (Fig. 3). A diagnosis of Class IIb Miller’s defects affecting teeth #41 and #31 was made, along with the associ- ated marginal gingivitis. This had probably been exacerbated by a high mandibular labial frenal inser- tion and pre-existing labial bone deficiency (dehiscence or fenestra- tion) as a result of the mild over- crowding. The condition may have been exacerbated by some occlusal overload and attrition (Figs. 4 & 5). After the diagnosis, the patient was advised on additional preven- tative measures with appropriate toothbrushing techniques. She was subsequently reviewed after further simple scaling and polishing proce- dures. She then consented for mu- cogingival surgery to the mandibu- lar anterior region. The proposed treatment was an internal frenot- omy procedure utilising a tunnelling technique, to allow for an autogenous connective tissue graft and coronal advancement flap. Surface relieving incisions were to be avoided. Surgical treatment First, the creation of a partial- thickness supra-periosteal pouch www.dental-tribune.com The Dental Tribune International Magazines Shipping Address Name Address Zip Code, City Country E-mail Date, Signature PayPal Credit Card Credit Card Number Expiration Date Security Code CAD/CAM Clinical Masters* cosmetic dentistry** implants laser ortho** roots Journal of Oral Science & Rehabilitation*** Fax: +49 341 48474 173 E-mail: subscriptions@dental-tribune.com EUR 44 per year (4 issues per year; incl. shipping and VAT for customers in Germany) and EUR 46 per year (4 issues per year; incl. shipping for customers outside Germany). * EUR 12 per year (1 issue per year; incl. shipping and VAT for customers in Germany) and EUR 14 per year (1 issue per year; incl. shipping for customers outside Germany). ** EUR 22 per year (2 issues per year; incl. shipping and VAT for customers in Germany) and EUR 23 per year (2 issues per year; incl. shipping for customers outside Germany). *** EUR 200 per year (4 issues per year; incl. shipping and VAT). 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