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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 71-73

Recession coverage using coronally repositioned flap with bioresorbable collagen membrane


Department of Periodontics and Oral Implantology, Santosh Dental College, Santosh Deemed to be University, Ghaziabad, Uttar Pradesh, India

Date of Submission11-Apr-2022
Date of Decision11-Apr-2022
Date of Acceptance25-Apr-2022
Date of Web Publication21-Jul-2022

Correspondence Address:
Priyanka Aggarwal
Department of Periodontics and Oral Implantology, Santosh Dental College, Santosh Deemed to be University, Ghaziabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sujhs.sujhs_11_22

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  Abstract 


The Coronally Advanced flap is one of the most commonly used procedures for recession coverage because it is simple to perform and produces good results when compared to other techniques. In this case report, a 40-year-old male patient complained of receding gums and localized sensitivity to hot and cold in the upper left anterior tooth region, as well as aesthetic discomfort in the gingival recession site. The Coronally advanced flap with collagen membrane is used to treat the recession site, follow up of 3 months showed satisfactory results.

Keywords: Coronally advanced flap, gingival recession, mucogingival surgical procedures


How to cite this article:
Pal K, Aggarwal P, Bali S, Nautiyal A, Singhal D. Recession coverage using coronally repositioned flap with bioresorbable collagen membrane. Santosh Univ J Health Sci 2022;8:71-3

How to cite this URL:
Pal K, Aggarwal P, Bali S, Nautiyal A, Singhal D. Recession coverage using coronally repositioned flap with bioresorbable collagen membrane. Santosh Univ J Health Sci [serial online] 2022 [cited 2022 Aug 11];8:71-3. Available from: http://www.sujhs.org/text.asp?2022/8/1/71/351559




  Introduction Top


In recent years, periodontal therapy has been increasingly focused on esthetic benefits for patients that include the soft-tissue component in addition to tooth replacement and color.

Periodontal plastic surgery is a surgical procedure that is used to treat anatomic, developmental, or traumatic defects of the gingiva and alveolar mucosa. The goal of periodontal plastic surgery is to replace missing tissue up to the cementoenamel junction (CEJ) and to restore a natural, healthy gingival sulcus.

The apical displacement of soft tissues from the CEJ is known as gingival recession (CEJ). Laterally, positioned flaps, double papillae flaps with or without guided tissue regeneration (GTR), free gingival autografts, and autogenous subepithelial connective tissue grafts are among the therapies available. Coronally advanced flap (CAF) is one of them.

Miller's Class I and Class II gingival recessions can be treated using the CAF. It is a predictable mucogingival surgical technique that achieves root coverage. The best clinical results regarding root coverage have been observed when the gingival edge is positioned at the CEJ, and the flap is passively fitted to the exposed root surface.

Root prominence, presence of frena, type of periodontium, recession depth (RD), and vestibular depth are some of the anatomical factors that may impact the movement of the coronally and advanced flap toward the CEJ. Norberg[1] was the first to introduce the CAF, which was later described by Mutschelknauss and Restrepo,[1] and other researchers used surgical techniques to cover denuded roots in cases of marginal periodontitis by coronal repositioning of mucoperiosteal flaps.[1]

GTR-based methods produced comparable clinical results as previous root covering treatments and resulted in the development of new attachments. To avoid a second surgical procedure to remove nonresorbable membranes, resorbable membranes were chosen over them.

Gingival recession is treated with a range of nonresorbable and resorbable membranes.

In this case report, root coverage has been done in Class I Miller's gingival recession by CAF along with the collagen membrane.[2]


  Case Report Top


A male patient aged 40-years patient reported to the department of periodontics and oral implantology, santosh deemed to be university ghaziabad with a complaint of receding gums and localised sensitivity to hot and cold in the upper left anterior tooth region . The patient was in good health, with no systemic diseases or bad habits like smoking. The patient was identified with Class I gingival recession in relation to 13 on clinical examination and surgical procedure was explained to the patient and a written informed consent was obtained. In 1st visit Phase-I therapy was SRP done with Gracey curettes on the exposed root surface (Hu-Friedy) and recalled after 15 days.

Clinical procedure

On patient scheduled visit after SRP the Recession depth (RD), sulcus depth (PD), breadth of keratinized gingiva (KG), and gingival thickness (GT) were clinical parameters that were collected to assess the outcome of the patients Keratinized tissue had a width of 3 mm and a thickness of 1.5 mm [Figure 1]a and [Figure 2]c. At the interdental papillae of teeth with the recession, split-thickness horizontal incisions were made. To measure the thickness of keratinized gingiva apical to the recession reamer with stopper was used, after the application of local anesthetic (2 percent lignocaine with adrenaline (1:2,00,000). On the line angle of distal teeth, two oblique vertical releasing incisions with beveled edges that extend into the alveolar mucosa were provided without engaging the neighboring papilla. The flap was raised in the coronally apical direction using a split-full-split -thickness technique [Figure 1]b. At the interdental papilla and 3–4 mm apical to the recession defect partial thickness flap was reflected . To generate vascular beds for the CAF surgical papilla, the facial interdental papilla was de-epithelized coronal to the horizontal incisions. Curettes were used to instrument the root surface, root conditioning was done using tetracycline solution 125 mg tetracycline/ML saline Removing the smear layer, coating the surface with antibiotics, inhibits collagenase, and leads to development of type I collagen. After conditioning, root surfaces were washed with normal saline and air-dried. The collagen membrane was sutured to the root surface and surrounding [Figure 1]c. The reflected flap was coronally reposition 1 mm coronal to the CEJ. vertical incisions were closed with interrupted sutures using 3-0 Vicryl sutures and sling sutures were used at the interdental papillae [Figure 2]a. Because the superficial releasing incision retains enough blood supply, it was used to relieve the lip pull on the gingiva. After the Coe pack was placed on the surgical site [Figure 2]b.[4],[5],[6]
Figure 1: (a) Preoperative view of recession in relation to 13, (b) flap raised 13, (c) membrane placed over the defect

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Figure 2: (a) Flap coronally sutured, (b) periodontal dressing given, (c) Post-operative view, (2d) Pre-operative view

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Postoperative care

Post op patients was adviced to use mouth rinse containing 0.12 percent chlorhexidine gluconate for two weeks. Patients were administered systemic antibiotics (Augmentin 625 twice daily for three days) and told to follow normal postoperative periodontal mucogingival guidelines, including not tugging on their lips to inspect the surgery site. At baseline, one month, and three months, clinical data such as recession length and width were recorded [Figure 2]c.[3]

Clinical observation

The result showed a significant reduction in length and width of recession with the use of the collagen membrane 3 months postoperatively, there was a reduction in recession length, recession width, and clinical attachment level gain. The width of KG was also found to be increased, the patient was extremely satisfied with the final clinical outcome and appearance.[2]


  Discussion Top


The collagen membrane closely resembles the foundation membrane of human mucosa, which aids gingival cell attachment.

It offers numerous therapeutic benefits, including good handling qualities, reduced operatory time since it does not require a second surgical site, the availability of an endless amount of uniformly thick barrier material, and postoperative maintenance. As compared to healing by long junctional epithelium, more stable new attachment is produced by root coverage using coronally advanced flap and collagen membrane.[3] Collagen is the most abundant structural protein in the connective tissues of the body. Collagen helixes are made up of amino acids linked together to create a triple helix of elongated fibrils that are primarily seen in the fibrous tissue. The CAF can treat Miller Class I and II recession with excellent consistency and stability.

The findings of this technique demonstrate that collagen membrane can be used along with CAF to treated gingival recession and further increasing the thickness of KG also.


  Conclusion Top


The current findings indicate that a combination of CAF and collagen membrane is a predictable therapeutic option for treating gingival recessions.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sharma A, Wadhawan A, Joshi CS. Coronally advanced flap design in management of isolated gingival recession: A case series. International Journal of Applied Dental Sciences 2021;7:382-7.  Back to cited text no. 1
    
2.
Mishra P, Dhruvakumar D. Recession coverage using coronally advanced flap with pericardium® membrane (collagen Type I) – A case report. J Adv Clin Res Insights 2018;5:203-6.  Back to cited text no. 2
    
3.
Bolla V, Reddy PK, Kalakonda B, Koppolu P, Manaswini E. Coronally advanced flap with amniotic membrane in the treatment of gingival recession: Three case reports. Int J App Basic Med Res 2019;9:111-4.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Mishra D, Kalapurakkal VB, Misra SR. Improving gingival aesthetics using platelet rich fibrin and synthetic collagen membrane: A report of two cases. J Clin Diagn Res 2015;9:D01-4.  Back to cited text no. 4
    
5.
Singh P, Thakral R, Kaur M, Narula T. Combination of platelet rich fibrin membrane with coronally advanced flap in treatment of gingival recession: A case report. Int J Res Health Allied Sci 2016;2:35-39.  Back to cited text no. 5
    
6.
Bernimoulin JP, Luscher B, Muhlemann HR. Coronally repositioned periodontal flap. J Clin Periodontol 1975;2:1-13.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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