Dental Tribune Asia Pacific Edition No. 11, 2016

intheregionofteeth#42to#32was achieved with the use of tunnelling instruments. There were partial pa- pilla separation and internal fren- otomy (Fig. 6). After this, an autoge- nous connective tissue graft was harvested from the left anterior lat- eral aspect of the palate. This was subsequently guided through the tunnel to rest over the exposed root surfaces of teeth #41 and #31. In ad- dition to this, the graft would pro- vide supplemental support for the overlying soft tissue in the region (Fig. 7). The gingival soft tissue lay passively over the connective tissue graft prior to suturing and wound closure (Fig. 8). Coronal advancement of the overlying pouch/flap was achieved with a continuous suture tech- nique. Tension-free closure of the wound was possible; however, spe- cific caution was required particu- larly in the region of tooth #31 owing to the previous separated frenal insertions. Were there to be excessive coronal advancement of the pouch/flap, this could have led to potential wound breakdown due to increased tension in the region. The connective tissue graft was intentionally left exposed to allow for an increase in the zone of kera- tinised tissue after healing (Figs. 9 & 10). At the two-year review, the patient reported no sensitivity or tenderness in the region and was delighted with the outcome. She was able to fully clean the teeth and excellent gingival health was ob- served (Fig. 11). At the review stage, there were no signs of inflamma- tion, no bleeding on probing, and no swelling or oedema present. Al- though there was still minor reces- sion (1 to 2 mm) present affecting teeth #41 and #31, it was not possi- ble to achieve full root coverage owing to the general positioning of the teeth, the attritive wear present, and the limited support and width for the interdental papillae, espe- cially in between teeth #41 and #31. The persistent mild recession was no cause of concern for the patient. The thickness of the gingiva and the zone of attached kerati- nised tissue had been increased, in addition to the vestibular sul- cus being deepened. All of these features enabled the patient to fully maintain the area. The cru- cial aspects for a successful out- come for the case were to ensure careful soft-tissue handling, good adaptation and stability of the con- nective tissue graft at the recipient site, and tension-free wound clo- sure. At three months post-treat- ment, the hard palate donor site was fully healed with no signs of scarring (Fig. 12). 11 Dental Tribune Asia Pacific Edition | 11/2016 TRENDS & APPLICATIONS 02 Accelerated type B cycle type B cycle 01 Intuitive user interface 03 Wi-Fi connection and Mobile App 04 Smooth external design Now available from your dental supplier or via wh.com New Lisa: Nothing compares to her AD Dr Matthew Garnett is a specialist peri- odontist and currently works as a consultant in restorative dentistry at Newcastle Dental Hospital. He also works independently in private prac- tice in the North East region of Eng- land. Garnett can be contacted at matthew.garrett@uclh.nhs.uk. 9 10 11 12 9101112

Dental Tribune Asia Pacific Edition No. 11, 2016

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