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26 GENERAL DENTISTRY Dental Tribune Middle East & Africa Edition | 3/2017 Periodontal Plastic Surgery: Treatment of a Gingival Recession using a Tunnelling Technique, Connective tissue graft and amelogenins A clinical case report By Dr. Laura Delgado Rodriguez, Spain Abstract The therapeutic approach to gingi- val recession requires a treatment plan involving basic therapy, which will focus on its etiologies and the most suitable periodontal plastic surgery treatment in each specific case. The Oral Biofilm control, previous periodontal stabilization, the use of magnification and microsurgi- cal instruments to handle the tis- sues, bilaminar blood supply for the connective tissue graft, the release of the lower anterior frenu- lum, the root conditioning with enamel matrix derivative proteins, suture without tension and patient cooperation were key factors in the treatment outcome obtained. The aim of this paper is to present a clinical case of a gingival recession defect treated using a tunnelling technique with a connective tis- sue graft and amelogenins and its evaluation. Introduction Gingival recession (GR) has been defined as the exposure of the tooth root caused by the migration of the gingival margin to a point apical to the cemento-enamel junc- tion. It can appear in its localized or generalized form and frequently compromises dental and gingival aesthetics, and causes dental hyper- sensitivity (1,2). GR has a multifactorial etiology associated with different types of factors that aid their development. It has been demonstrated that at least four groups of factors can be associated with the development of GR: anatomical factors (lack of keratinized gingiva, muscle inser- tion close to gingival margin, in- adequate tooth alignment, thin or absent vestibular table, prominent root); factors relative to inflamma- tory disease (Gum disease because of plaque build-up, Periodontitis); factors relative to iatrogenesis (e.g. prosthetics, treat- ment); factors relative to trauma (traumatic brushing or other me- chanical traumas) (3). orthodontic The elimination of causal factors and the detailed explanation pro- vided to the patient are as impor- tant as the periodontal plastic sur- gery technique to implement (4-6). Your trusted Periodontic referral clinic According to the first European Periodontal meeting consensus in 1994 the indications for GR treat- ment are - Improvement of oral hygiene (prevention of gingivitis and root caries); - Esthetic or orthodontic concerns - Hypersensitivity. The root exposed in a GR is not nec- essarily compromising the tooth survival if the remanent bone is preserved and the oral biofilm is controlled. However, from a peri- odontal point of view, is indicated to treat it when is progressive and/ or difficult a correct oral hygiene (Freedman and cols, 1999). In the last decades many surgical techniques for the treatment of GR have been developed (Sullivan & Atkins 1968, Langer & Langer 1985, Raetzke 1985, Allen 1994, Zabalegui 1999 among others). The most widely accepted classifi- cation of gingival recession is Mill- er’s. It is based on the most apical gingival margin of the recession re- garding the mucogingival junction, and on the amount of tissue loss (gingiva and bone) in interproxi- mal areas adjacent to the recession site (7). is achieved Complete coverage when the gingival margin is placed at the same level as the cemento- enamel junction, the gingival sul- cus has a probing depth lower than 2 mm and when there is no bleed- ing on probing (8). The outcome of surgical treatment of gingival re- ÿPage 27