Association of coronally advanced flap, protein derived from the enamel matrix and subepithelial connective tissue graft as a treatment for multiple gingival recessions: Case report

Authors

DOI:

https://doi.org/10.33448/rsd-v10i3.13190

Keywords:

Periodontics; Dental enamel proteins; Gingival recession; Connective tissue.

Abstract

Periodontal plastic surgery is a reconstructive therapy defined as surgical procedures performed to correct or eliminate anatomical, developmental or traumatic deformities of the gingiva or alveolar mucosa and is indicated for the treatment of isolated or multiple gingival recessions. Gingival recession is characterized as a mucogingival defect and occurs by apical migration of the gingiva and alveolar mucosa resulting in the exposure of the root portion of the dental element. The main complaints of this condition are dentin hypersensitivity and aesthetic dissatisfaction, which elect the choice of this treatment. The coronary repositioned flap associated with the use of subepithelial connective tissue graft is considered the gold standard among root covering techniques for its predictability and stability. The literature shows that the use of proteins enamel matrix derivative can potentiate periodontal regeneration, leading to favorable results. The present case report is related to a 43-year-old, female patient, with dentin hypersensitivity and multiple gingival recessions type 1 (RT1) and type 2 (RT2) in the upper central and lateral incisors. After the initial adjustments of the oral environment, the treatment chosen was the root coverage with coronary advanced flap technique associated with the subepithelial connective tissue graft and the use of the protein derivative from enamel matrix in the upper anterior teeth. The follow-up of the case in one year revealed success in root coverage by the technique and use of biomaterial, being effective for the treatment of multiple recessions type 1 (RT1) and type 2 (RT2).

Author Biography

Tuane Consalter de Mello Fernandes, Universidade Estadual de Londrina

Dentistry student at Londrina State University, Brazil.

http://lattes.cnpq.br/3858642647367100

References

American Academy of Periodontology. (1996). Consensus report on mucogingival therapy. Proceedings of the World Workshop in Periodontics. Ann Periodontol, v. 1, p. 702-706.

Bosshardt, D. D. (2008) Biological mediators and periodontal regeneration: a review of enamel matrix proteins at the cellular and molecular levels. J Clin Periodontol, v.35, n.8, p.87-105.

Cairo, F. (2017). Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontol 2000, v. 75, n. 1, p. 296-316.

Cairo, F.; Nieri, M.; Cattabriga, M.; Cortellini, P.; De Paoli, S.; De Sanctis, M.; Fonzar, A.; Francetti, L.; Merli, M.; Rasperini, G.; Silvestri, M.; Trombelli, L.; Zucchelli, G.; Pini-Prato, G. P. (2010). Root coverage esthetic score after treatment of gingival recession: an interrater agreement multicenter study. J Periodontol, v. 81, n. 12, p. 1752–1758.

Cairo, F., Nieri, M., Cincinelli, S., Mervelt, J., PAGLIARO, U. (2011). The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Periodontol, v.38, n.7, p.661-666.

Chambrone, L., Tatakis, D. N. (2015). Periodontal soft tissue root coverage procedures: a systematic review from the AAP regeneration workshop. J Periodontol, v.86, n.2 (suppl.), p.S8-S51.

Cortellini, P., Bissada, N. F. (2018). Mucogengival conditions in the nature dentition: Narrative review, case definitions, and diagnostic considerations. J Periodontol, v.89, n.1, p.204-213.

Dai, A., Huang, J. P., Ding, P. H., Chen, L. L. (2019). Long‐term stability of root coverage procedures for single gingival recessions: A systematic review and meta‐analysis. J Clin Periodontol, v.46, p.572-585.

De Rouck, T., Eghbali, R., Collys, K., De Bruyn, H., Cosyn, J. (2009). The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol, v.36, p.428-433.

Han, J. S., John, V., Blanchard, S. B., Kowolik, M. J., Eckert, G. J. (2008). Changes in gingival dimensions following connective tissue grafts for root coverage: comparison of two procedures. J Periodontol, v.79, n.8, p.1346-1354.

Henriques, P. S. G., Pelegrine, A. A., Nogueira, A. A., Borghi, M. M. (2010). Application of subepithelial connective tissue graft with or without enamel matrix derivative for root coverage: a split-mouth randomized study. J Oral Sci, v.52, n.3, p.463-471.

Mcguire, M. K., Scheyer, E. T., Schupbach, P. (2016). A prospective, case-controlled study evaluating the use of enamel matrix derivative on human buccal recession defects: a human histologic examination. J Periodontol, v.87, n.6, p.645-653.

Miller, P. D. (1994). Periodontal plastic surgical techniques for regeneration. In: Polson AL. Periodontal Regeneration - Current Status and Directions. Chicago: Quintessence, p. 53-70.

Miller, P. D., Allen, E. P. (1996). The development of periodontal plastic surgery. Periodontol 2000, v.11, p.7-17.

Miron, R. J., Sculean, A., Cochran, D. L., Froum, S., Zucchelli, G., Nemcovsky, C., Donos, N., Lyngstadaas, S. P., Deschner, J., Dard, M., Stavropoulos, A., Zhang, Y., Trombelli, L., Kasaj, A., Shirakata, Y., Cortelli, P., Tonetti, M., Raperini, G., Jepsen, S., Bosshardt, D. D. (2016). Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. v.43, p.668-683.

Oliveira, R. G., Junqueira, A., Picinini, L. S., Montesino, A. C., Pearce, M., Joly, J. C., Silva, R. C. (2017). Histological effects of enamel matrix derivative proteins (Emdogain®) on the healing of rats wounds. Dentistry Adv Res. v.2017, n.3, p.1-8.

Pereira, A. S., Shitsuka, D. M., Parreira, F. J., Shitsuka, R. (2018). Metodologia do trabalho científico. UAB/NTE/UFSM. https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica. pdf. Acesso em: 04/03/2021.

Pereira, V. G., Mendes, E. M., Rosa, A. D., Martins, V. M. (2017). Cirurgia plástica periodontal: retalho recolocado coronal modificado. Rev Odontol Contemp. v.1, n.2, p.29-37.

Pini-Prado, G., Franceschi, D., Cairo, F., Nieri, M., Rotundo, R. (2010). Classification of dental surface defects in areas of gingival recession. J Periodontol. v.81, n.6, p.885-890.

Rasperini, G., Roccuzzo, M., Francetti, L., Acunzo, R., Consonni, D., Silvestri, M. (2011). Subepithelial connective tissue graft for treatment of gingival recessions with and without enamel matrix derivative: a multicenter, randomized controlled clinical trail. Int J Periodontics Restorative Dent, v.31, n.2, p.133-139.

Santamaria, M. P., Queiroz, L. A., Mathias, I. F., Neves, F. L. S., Silveira, C. A., Bresciani, E., Jardini, M. A. N., Sallum, E. A. (2016). Resin composite plus connective tissue graft to treat single maxillary gingival recession associated with non-carious cervical lesion: randomized clinical trial. J Clin Periodontol, v.43, p.461-468.

Santamaria, M. P., Sauid, F. F., Nociti, F. H., Casati, M. Z., Sallum, A. W., Sallum, E. A. (2007). Periodontal surgery and glass ionomer restoration in the treatment of gingival recession associated with non-carious cervical lesion: report of three cases. J Periodontol, v.78, n.6, p.1146-1153.

Santamaria, M. P., Silveira, C. A., Mathias, I. F., Neves, F. L. S., Dos Santos, L. M., Jardini, M. A. N., Tatakis, D. N., Sallum, E. A., Bresciani, E. (2018). Treatment of single maxillary gingival recession associated with non-carious cervical lesion: randomized clinical trial comparing connective tissue graft alone to graft plus partial restoration. J Clin Periodontol, v.45, p.968-976.

Sculean, A., Cosgarea, R., Stahli, A., Katsaro, C., Arweiler, N. B., Brecx, M., Deppe, H. (2014). The modified coronally advanced tunnel combined with an enamel matrix derivative and subepithelial connective tissue graft for the treatment of a isolated mandibular Miller Class I and II gingival recession: a reporto f 16 cases. Quintessence Int, v.45, n.10, p.829-835.

Sculean, A., Cosgarea, R., Stahli, A., Katsaro, C., Arweiler, N. B., Miron, R. J., Deppe, H. (2016). Treatment of multiple adjacent maxillary Miller Class I, II and III gingival recession with the modified coronally advanced tunnel, enamel matrix derivative, and subepithelial connective tissue graft: a reporto f 12 cases. Quintessence Int, v.47, n.8, p.653-659.

Stefanini, M., Marzadori, M., Aroca, S., Felice, P., Sangiorgio, M., Zucchelli, G. (2018). Decision making in rootcoverage procedures for the esthetic outcome. Periodontol 2000, v.77, p.54-64.

Zucchelli, G., De Sanctis, M. (2000). Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol. v.71, n.9, p.1506-1514.

Zucchelli, G., Gori, G., Mele, M., Stefanini, M., Mazzotti, C., Marzadori, M., Montebugnoli, L., De Sanctis, M. (2011). Non-carious cervical lesions associated with gingival recessions: a decision-making progress. J Periodontol. v.82, n.12, p.1713-1724.

Zucchelli, G., Mounssif, I. (2015). Periodontal plastic surgery. Periodontol 2000, v.68, n.1, p.333-368.

Zucchelli, G., Testori, T., De Sanctis, M. (2006). Clinical and anatomical factors limiting treatment outcomes of gingival recession: a new method to predetermine the line of root coverage. J Periodontol. v.77, n.4, p.714-721.

Published

11/03/2021

How to Cite

FERNANDES, T. C. de M. .; SEGA, K. R. .; COSTA, P. P. .; ITO, F. A. N. .; MAIA, L. P. .; PEDRIALI, M. B. B. P. . Association of coronally advanced flap, protein derived from the enamel matrix and subepithelial connective tissue graft as a treatment for multiple gingival recessions: Case report. Research, Society and Development, [S. l.], v. 10, n. 3, p. e17510313190, 2021. DOI: 10.33448/rsd-v10i3.13190. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/13190. Acesso em: 18 apr. 2024.

Issue

Section

Health Sciences