Root coverage of a previously restored tooth. A case report with a 7-year follow-up
Identifieur interne : 001B82 ( Pmc/Corpus ); précédent : 001B81; suivant : 001B83Root coverage of a previously restored tooth. A case report with a 7-year follow-up
Auteurs : Alexander CorsairSource :
- Clinical, Cosmetic and Investigational Dentistry [ 1179-1357 ] ; 2009.
Abstract
This case report describes the treatment of a maxillary canine that had 4 mm of marginal gingival recession. The exposed root had been previously restored with a composite class 5 restoration. The restoration was removed and the root planed and demineralized. The root was then covered by a subepithelial connective tissue graft harvested from the palate. The flap was coronally positioned to completely cover the graft and exposed root. The healing was photographed post-operatively at one month, six months, and seven years. Root coverage increased to 100% after seven years. The zone of attached gingiva also increased.
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PubMed: 23674903
PubMed Central: 3652352
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Root coverage of a previously restored tooth. A case report with a 7-year follow-up</title><author><name sortKey="Corsair, Alexander" sort="Corsair, Alexander" uniqKey="Corsair A" first="Alexander" last="Corsair">Alexander Corsair</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23674903</idno><idno type="pmc">3652352</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652352</idno><idno type="RBID">PMC:3652352</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">001B82</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001B82</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Root coverage of a previously restored tooth. A case report with a 7-year follow-up</title><author><name sortKey="Corsair, Alexander" sort="Corsair, Alexander" uniqKey="Corsair A" first="Alexander" last="Corsair">Alexander Corsair</name></author></analytic><series><title level="j">Clinical, Cosmetic and Investigational Dentistry</title><idno type="eISSN">1179-1357</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>This case report describes the treatment of a maxillary canine that had 4 mm of marginal gingival recession. The exposed root had been previously restored with a composite class 5 restoration. The restoration was removed and the root planed and demineralized. The root was then covered by a subepithelial connective tissue graft harvested from the palate. The flap was coronally positioned to completely cover the graft and exposed root. The healing was photographed post-operatively at one month, six months, and seven years. Root coverage increased to 100% after seven years. The zone of attached gingiva also increased.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Langer, B" uniqKey="Langer B">B Langer</name></author><author><name sortKey="Langer, L" uniqKey="Langer L">L Langer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goldstein, M" uniqKey="Goldstein M">M Goldstein</name></author><author><name sortKey="Nasatzky, E" uniqKey="Nasatzky E">E Nasatzky</name></author><author><name sortKey="Goultschin, J" uniqKey="Goultschin J">J Goultschin</name></author><author><name sortKey="Boyan, Bd" uniqKey="Boyan B">BD Boyan</name></author><author><name sortKey="Schwartz, Z" uniqKey="Schwartz Z">Z Schwartz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Oates, Tw" uniqKey="Oates T">TW Oates</name></author><author><name sortKey="Robinson, M" uniqKey="Robinson M">M Robinson</name></author><author><name sortKey="Gunsolley, Jc" uniqKey="Gunsolley J">JC Gunsolley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Matter, J" uniqKey="Matter J">J Matter</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Harris, Rk" uniqKey="Harris R">RK Harris</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Harris, Rj" uniqKey="Harris R">RJ Harris</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, Ym" uniqKey="Lee Y">YM Lee</name></author><author><name sortKey="Kim, Jy" uniqKey="Kim J">JY Kim</name></author><author><name sortKey="Ku, Y" uniqKey="Ku Y">Y Ku</name></author><author><name sortKey="Rhyu, In" uniqKey="Rhyu I">IN Rhyu</name></author><author><name sortKey="Han, Sb" uniqKey="Han S">SB Han</name></author><author><name sortKey="Choi, Cp" uniqKey="Choi C">CP Choi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Griffin, Tj" uniqKey="Griffin T">TJ Griffin</name></author><author><name sortKey="Cheung, Ws" uniqKey="Cheung W">WS Cheung</name></author><author><name sortKey="Zavras, Ai" uniqKey="Zavras A">AI Zavras</name></author><author><name sortKey="Damoulis, Pd" uniqKey="Damoulis P">PD Damoulis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alkan, A" uniqKey="Alkan A">A Alkan</name></author><author><name sortKey="Keskiner, I" uniqKey="Keskiner I">I Keskiner</name></author><author><name sortKey="Yuzbasioglu, E" uniqKey="Yuzbasioglu E">E Yuzbasioglu</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Cosmet Investig Dent</journal-id><journal-id journal-id-type="iso-abbrev">Clin Cosmet Investig Dent</journal-id><journal-title-group><journal-title>Clinical, Cosmetic and Investigational Dentistry</journal-title></journal-title-group><issn pub-type="epub">1179-1357</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23674903</article-id><article-id pub-id-type="pmc">3652352</article-id><article-id pub-id-type="publisher-id">ccide-1-035</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Root coverage of a previously restored tooth. A case report with a 7-year follow-up</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Corsair</surname><given-names>Alexander</given-names></name><xref ref-type="corresp" rid="c1-ccide-1-035"></xref></contrib><aff id="af1-ccide-1-035">Private Practice, Rockville Centre, NY, USA</aff></contrib-group><author-notes><corresp id="c1-ccide-1-035">Correspondence: Alexander Corsair, 364 Merrick Road, Rockville Centre, New York, NY 11570, USA, Email <email>acorsair@verizon.net</email></corresp></author-notes><pub-date pub-type="collection"><year>2009</year></pub-date><pub-date pub-type="epub"><day>18</day><month>6</month><year>2009</year></pub-date><volume>1</volume><fpage>35</fpage><lpage>38</lpage><permissions><copyright-statement>© 2009 Corsair, publisher and licensee Dove Medical Press Ltd.</copyright-statement><copyright-year>2009</copyright-year><license><license-p>This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.</license-p></license></permissions><abstract><p>This case report describes the treatment of a maxillary canine that had 4 mm of marginal gingival recession. The exposed root had been previously restored with a composite class 5 restoration. The restoration was removed and the root planed and demineralized. The root was then covered by a subepithelial connective tissue graft harvested from the palate. The flap was coronally positioned to completely cover the graft and exposed root. The healing was photographed post-operatively at one month, six months, and seven years. Root coverage increased to 100% after seven years. The zone of attached gingiva also increased.</p></abstract><kwd-group><kwd>coronally positioned</kwd><kwd>subepithelial</kwd><kwd>connective tissue graft</kwd><kwd>keritinized gingiva</kwd><kwd>creeping reattachment</kwd></kwd-group></article-meta></front><body><sec><title>Introduction</title><p>Sub-epithelial connective tissue grafts have been used for many years to augment edentulous ridges, increase the zone of keratinized attached gingiva, and to cover exposed roots.<xref ref-type="bibr" rid="b1-ccide-1-035">1</xref> More recently, periodontists have been successful in covering exposed roots that had been previously restored or carious.<xref ref-type="bibr" rid="b2-ccide-1-035">2</xref>,<xref ref-type="bibr" rid="b3-ccide-1-035">3</xref> Few cases have been reported in the literature illustrating the long-term success of complete root coverage of a previously restored root.<xref ref-type="bibr" rid="b3-ccide-1-035">3</xref> This case report illustrates the long-term success of such a case.</p></sec><sec><title>Technique</title><p>Several techniques have been described in the literature to cover exposed roots.<xref ref-type="bibr" rid="b4-ccide-1-035">4</xref>,<xref ref-type="bibr" rid="b5-ccide-1-035">5</xref> A modification of the subepithelial connective graft as described by Langer and Langer<xref ref-type="bibr" rid="b1-ccide-1-035">1</xref> was used in this case report.</p><p>The technique used in this case report included local anesthesia with minimal epinephrine for the recipient site. The restoration is removed and then the preparation eliminated with burs and hand instruments. Then the root surface is demineralized with a citric acid solution. The recipient site is then prepared as described in the literature.<xref ref-type="bibr" rid="b1-ccide-1-035">1</xref> The preparation involves a crevicular incision which is blended into vertical incisions in the papillary area. The vertical incisions are extended deep into the vestibule and diverged apically to maintain a broad base to the flap for better blood supply. The flap is first reflected as a full-thickness mucoperiosteal flap with care not to traumatize the soft tissue. Once the flap is reflected past the exposed root to the crest of bone then a partial thickness dissection is accomplished to separate the periostium from the flap. This periosteal separation is extended apically until the flap is adequately mobile so that the flap margin can be coronally displaced so that the exposed root is covered without tension.</p><p>The adjacent papillas are de-epithelialized to expose the connective tissue. This allows the coronally positioned flap to attach and it also provides blood supply to the connective tissue graft. At this point the graft is harvested from the hard palate.<xref ref-type="bibr" rid="b6-ccide-1-035">6</xref></p><p>The graft site is sutured with 3–0 silk sutures and primary closure is accomplished. The graft is then placed over the exposed root to determine if the dimensions are accurate. After the required modifications, the graft is sutured in place so that it covers the exposed root, the adjacent papilla and about 3 mm of bone apically. The graft is sutured to the adjacent papilla with 5–0 chromic gut sutures, T28-tapered point needle. The overlying flap is then coronally positioned to cover the graft completely. This is a modification of the original technique and has been described in the literature by many authors. The flap is sutured with CV-5 Goretex sutures with a RT-16 needle. A sling suture is used, however, before the suture is passed between the teeth, the papilla is pierced on both the mesial and distal to prevent the suture from slipping off during the healing period. The vertical incisions over the recipient site are sutured with 5–0 plain gut. Both the donor and recipient sites are covered with periodontal dressing after hemostasis has been confirmed.</p><p>Patients are instructed not to eat on or brush the graft recipient site for six weeks. Sutures are removed from the palatal donor site after seven days. The sutures in the recipient site are removed after 14 days. Chlorhexidine gluconate 0.12% mouth rinse is prescribed. The patient is seen periodically to remove stain from the teeth.</p></sec><sec><title>Case report</title><p>The following case illustrates root coverage on tooth #11 where a composite class V restoration was present. The photographs illustrate the procedure as described above and include one-month, six-month, and seven-year postoperative photos. Four mm of recession was present and only one mm of attached keratinized gingiva was present (<xref ref-type="fig" rid="f1-ccide-1-035">Figure 1</xref>). The author explained the procedure and the risks and alternatives. The patient chose to have the restoration removed and root coverage attempted.</p><p>The restoration was removed as described above (<xref ref-type="fig" rid="f2-ccide-1-035">Figure 2</xref>). The recipient site was prepared and the connective graft sutured to the papilla as described. <xref ref-type="fig" rid="f3-ccide-1-035">Figure 3</xref> illustrates a graft sutured in place from a different but similar case. The flap was then coronally displaced and sutured to cover the graft completely as described above (<xref ref-type="fig" rid="f4-ccide-1-035">Figure 4</xref>). The connective tissue graft was harvested from the palate and then the palatal donor site sutured to control bleeding and facilitate healing (<xref ref-type="fig" rid="f5-ccide-1-035">Figure 5</xref>).</p><p>A one-month post-op is illustrated in <xref ref-type="fig" rid="f6-ccide-1-035">Figure 6</xref>. Almost 100% root coverage was obtained. The extent and thickness of the attached keritinized gingiva was increased significantly. However at this time-point there is some root exposure and the gingiva is too thick and the surface is not smooth. Over the next five months, the gingiva matured and blended in more with the adjacent tissues. Root coverage is less than 100% (six-month post-op; <xref ref-type="fig" rid="f7-ccide-1-035">Figure 7</xref>).</p><p><xref ref-type="fig" rid="f8-ccide-1-035">Figure 8</xref> shows the seven-year post-op root and illustrates complete root coverage and a restoration of attached gingiva and good esthetics.</p><p>There appears to be new root coverage on the facial of tooth #10 as well as a result of “creeping reattachment”.</p></sec><sec sec-type="discussion"><title>Discussion</title><p>The success rate of root coverage reported in the literature by Goldstein<xref ref-type="bibr" rid="b2-ccide-1-035">2</xref> was 97% for intact roots and 92% for carious roots over a 34-month follow up. In his study, 18 of the 27 roots treated had 100% root coverage. Short- and long-term results of root coverage with connective tissue grafts on intact roots tended to improve with time as reported in the literature by Lee and colleagues.<xref ref-type="bibr" rid="b7-ccide-1-035">7</xref></p><p>In their study, root coverage improved from 85% at three months to 91% at six months and finally 92% at 12 months. Adverse postoperative events are usually swelling, moderate pain, and rarely hematoma or post operative bleeding.<xref ref-type="bibr" rid="b8-ccide-1-035">8</xref></p><p>The surgery in this case report was done in June, 2000. Many new techniques have been developed and tested since that time. However a good long-term result was obtained with the original subepithelial connective tissue graft and coronally advanced flap. Not only was the previously restored root completely covered but the zone of attached gingiva was increased. No scar tissue is seen and the new gingiva blends in very well with the surrounding tissue. The seven-year post-op photo (<xref ref-type="fig" rid="f8-ccide-1-035">Figure 8</xref>) shows more root coverage than the one-month and six-month postoperative photos. This illustrates “creeping re attachment” which is also seen for tooth #10.</p><p>Connective tissue grafts have been used to cover resin ionomers in localized gingival recessions.<xref ref-type="bibr" rid="b9-ccide-1-035">9</xref> Are the new techniques more effective short- and long-term? Are they less invasive? Is it necessary to remove existing restorations? Studies will be required to answer these questions.</p></sec><sec><title>Conclusion</title><p>The subepithelial connective tissue graft can be used to cover previously restored roots. This case report illustrates complete root coverage of a previously restored root. The report illustrates a seven-year follow-up showing maintenance of complete root coverage and improvement of the result functionally and esthetically over this time period. The phenomenon of “creeping reattachment” is demonstrated.</p><p>This technique provides the dentist and the patient with an opportunity to replace unesthetic restorations and achieve a better esthetic and functional result.</p></sec></body><back><fn-group><fn id="fn1-ccide-1-035"><p><bold>Disclosure</bold></p><p>The author reports no conflicts of interest in this work.</p></fn></fn-group><ref-list><title>References</title><ref id="b1-ccide-1-035"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Langer</surname><given-names>B</given-names></name><name><surname>Langer</surname><given-names>L</given-names></name></person-group><article-title>Subepithelial connective tissue graft technique for root coverage</article-title><source>J Periodontol</source><year>1985</year><volume>56</volume><fpage>715</fpage><lpage>720</lpage><pub-id pub-id-type="pmid">3866056</pub-id></element-citation></ref><ref id="b2-ccide-1-035"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Goldstein</surname><given-names>M</given-names></name><name><surname>Nasatzky</surname><given-names>E</given-names></name><name><surname>Goultschin</surname><given-names>J</given-names></name><name><surname>Boyan</surname><given-names>BD</given-names></name><name><surname>Schwartz</surname><given-names>Z</given-names></name></person-group><article-title>Coverage of previously carious roots is as predictable a procedure as coverage of intact roots</article-title><source>J Periodontol</source><year>2002</year><volume>73</volume><fpage>1419</fpage><lpage>1426</lpage><pub-id pub-id-type="pmid">12546091</pub-id></element-citation></ref><ref id="b3-ccide-1-035"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Oates</surname><given-names>TW</given-names></name><name><surname>Robinson</surname><given-names>M</given-names></name><name><surname>Gunsolley</surname><given-names>JC</given-names></name></person-group><article-title>Surgical therapies for the treatment of gingival recession. A systematic review</article-title><source>Ann Periodontol</source><year>2002</year><volume>8</volume><fpage>12</fpage><lpage>37</lpage></element-citation></ref><ref id="b4-ccide-1-035"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Matter</surname><given-names>J</given-names></name></person-group><article-title>Free gingival graft and coronally repositioned flap. A 2-year follow-up report</article-title><source>J Clin Periodontol</source><year>1979</year><volume>6</volume><fpage>437</fpage><lpage>442</lpage><pub-id pub-id-type="pmid">295291</pub-id></element-citation></ref><ref id="b5-ccide-1-035"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Harris</surname><given-names>RK</given-names></name></person-group><article-title>A comparison of two techniques for obtaining a connective tissue graft from the palate</article-title><source>Int J Periodontics Restorative Dent</source><year>1997</year><volume>17</volume><fpage>260</fpage><lpage>271</lpage><pub-id pub-id-type="pmid">9497718</pub-id></element-citation></ref><ref id="b6-ccide-1-035"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Harris</surname><given-names>RJ</given-names></name></person-group><article-title>Root coverage with connective tissue grafts: an evaluation of short- and long-term results</article-title><source>J Periodontol</source><year>2006</year><volume>9</volume><fpage>1054</fpage><lpage>1059</lpage></element-citation></ref><ref id="b7-ccide-1-035"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lee</surname><given-names>YM</given-names></name><name><surname>Kim</surname><given-names>JY</given-names></name><name><surname>Ku</surname><given-names>Y</given-names></name><name><surname>Rhyu</surname><given-names>IN</given-names></name><name><surname>Han</surname><given-names>SB</given-names></name><name><surname>Choi</surname><given-names>CP</given-names></name></person-group><article-title>A 3-year longitudinal evaluation of subpedicle connective tissue grafts for gingival recession coverage</article-title><source>J Periodontol</source><year>2002</year><volume>73</volume><fpage>1412</fpage><lpage>1418</lpage><pub-id pub-id-type="pmid">12546090</pub-id></element-citation></ref><ref id="b8-ccide-1-035"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Griffin</surname><given-names>TJ</given-names></name><name><surname>Cheung</surname><given-names>WS</given-names></name><name><surname>Zavras</surname><given-names>AI</given-names></name><name><surname>Damoulis</surname><given-names>PD</given-names></name></person-group><article-title>Postoperative complications following gingival augmentation procedures</article-title><source>J Periodontol</source><year>2006</year><volume>77</volume><fpage>2070</fpage><lpage>2079</lpage><pub-id pub-id-type="pmid">17209793</pub-id></element-citation></ref><ref id="b9-ccide-1-035"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Alkan</surname><given-names>A</given-names></name><name><surname>Keskiner</surname><given-names>I</given-names></name><name><surname>Yuzbasioglu</surname><given-names>E</given-names></name></person-group><article-title>Connective tissue grafting on resin ionomer in localized gingival recession</article-title><source>J Periodontol</source><year>2006</year><volume>77</volume><fpage>1446</fpage><lpage>1451</lpage><pub-id pub-id-type="pmid">16881815</pub-id></element-citation></ref></ref-list></back><floats-group><fig id="f1-ccide-1-035" position="float"><label>Figure 1</label><caption><p>Pre-op tooth #11.</p></caption><graphic xlink:href="ccide-1-035f1"></graphic></fig><fig id="f2-ccide-1-035" position="float"><label>Figure 2</label><caption><p>Restoration removed.</p></caption><graphic xlink:href="ccide-1-035f2"></graphic></fig><fig id="f3-ccide-1-035" position="float"><label>Figure 3</label><caption><p>Graft sutured: a different case.</p></caption><graphic xlink:href="ccide-1-035f3"></graphic></fig><fig id="f4-ccide-1-035" position="float"><label>Figure 4</label><caption><p>Coronally positioned flap.</p></caption><graphic xlink:href="ccide-1-035f4"></graphic></fig><fig id="f5-ccide-1-035" position="float"><label>Figure 5</label><caption><p>Donor site sutured.</p></caption><graphic xlink:href="ccide-1-035f5"></graphic></fig><fig id="f6-ccide-1-035" position="float"><label>Figure 6</label><caption><p>One month post-op.</p></caption><graphic xlink:href="ccide-1-035f6"></graphic></fig><fig id="f7-ccide-1-035" position="float"><label>Figure 7</label><caption><p>Six months post-op.</p></caption><graphic xlink:href="ccide-1-035f7"></graphic></fig><fig id="f8-ccide-1-035" position="float"><label>Figure 8</label><caption><p>Seven years post-op.</p></caption><graphic xlink:href="ccide-1-035f8"></graphic></fig></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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