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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 6  |  Issue : 1  |  Page : 50-52

Inclusion of guided tissue regeneration membrane for the management of multiple gingival recession


Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India

Date of Web Publication15-Feb-2017

Correspondence Address:
Divya Dureja
Department of Periodontology, Subharti Dental College and Hospital, Swami Vivekananda Subharti University, Meerut - 250 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_125_16

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  Abstract 

Gingival recession (GR) is not only a major esthetic concern but also is often associated with dentinal hypersensitivity. Correction of mucogingival recession deformities with a variety of periodontal plastic surgical procedures has been described, each demonstrating a variable degree of success. However, among the various treatment modalities, coronally advanced flaps are the most commonly employed for multiple teeth recession coverage. This case report describes the management of Class I GR due to faulty brushing technique associated with dentinal hypersensitivity with coronally advanced flap combined with guided tissue regeneration membrane.

Keywords: Barrier membrane, coronally advanced flap, multiple recession defects


How to cite this article:
Tomar N, Dureja D, Kaushik M, Wadhawan A. Inclusion of guided tissue regeneration membrane for the management of multiple gingival recession. Int J Health Allied Sci 2017;6:50-2

How to cite this URL:
Tomar N, Dureja D, Kaushik M, Wadhawan A. Inclusion of guided tissue regeneration membrane for the management of multiple gingival recession. Int J Health Allied Sci [serial online] 2017 [cited 2020 Jun 1];6:50-2. Available from: http://www.ijhas.in/text.asp?2017/6/1/50/200197

Gingival recession (GR) is defined as the location of the marginal tissue, apical to the cementoenamel junction (CEJ) with exposure of the root surface.[1] GR leads to the development of signs and symptoms including pain from exposed dentin, root caries, and various esthetic concerns. When compared with the traditional root coverage procedures, guided tissue regeneration (GTR)-based procedures not only achieve similar results but also demonstrate histologically new attachment formation.[2] Hence, the present case report demonstrates the use of the resorbable GTR membrane in combination with conventional coronally repositioned flap for treating multiple Miller's Class I GR defects.


  Case Report Top


A 35-year-old male reported with a chief complaint of hypersensitivity of teeth for the past 8 months in maxillary anterior region. Sensitivity increased on intake of hot and cold food and toothbrushing. Miller's Class I recession was evident on 11, 21, 22, and 23 [Figure 1] on clinical examination. The periodontium showed no inflammatory signs and was healthy. Faulty and vigorous toothbrushing was found to be predisposing etiology for the recession.
Figure 1: Preoperative view showing Miller's Class I recession on 11, 21, 22, and 23

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Scaling and root planing was done, and oral hygiene index was given. Proper brushing technique instructions were rendered, and adequate time was given to implement the technique. Coronally advanced flap with GTR membrane was planned after 2 months for recession coverage. Informed consent was obtained from the patient.

The surgical proceedings included betadine application to disinfect the surgical site. After local anesthesia (lignocaine HCL with 2% epinephrine 1:200,000) was administered, and surgery was started with a crevicular incision given in region 11–23 using number 12 blade, while de-epithelializing the interdental papillae to reflect the flap. After these horizontal incisions were carried out that connected the CEJ of one tooth to the gingival margin of the adjacent tooth. Vertical incisions on both the ends were given extending beyond the mucogingival junction [Figure 2], and a full-thickness flap was then reflected on facial aspect [Figure 3]. The root surface was then examined for remaining calculus followed by thorough scaling and root planing. Following this, a resorbable collagen GTR membrane (Cologuide ) was trimmed and placed to cover the recession [Figure 4] and sutured with resorbable sutures in place. The flap closure was done with sling sutures [Figure 5] to ensure the precise adaptation of the flap. The periodontal dressing (Coe Pac) was then given at the surgical site.
Figure 2: Incisions given

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Figure 3: Flap reflection done

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Figure 4: Guided tissue regeneration membrane placed on recession defects

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Figure 5: Suturing done

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Postoperative care

Patient was advised to not disturb the surgical site or remove the pack till the sutures were removed. Relevant postoperative instructions were given. Antibiotics (amoxicillin 500 mg TDS) and painkillers for 3 days postoperatively were prescribed to the patient. Use of 0.12% chlorhexidine rinse was also implemented in patient's oral hygiene regimen. The periodontal dressing and the sutures were removed after 2 weeks. Adequate root coverage with satisfactory healing was obtained. Recall after 3 months revealed stable results and no sensitivity was reported [Figure 6]. The achieved root coverage 3 months post operatively [Figure 7] was then compared with pre-operative calibration [Figure 8].
Figure 6: Three months postoperatively

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Figure 7: Pre-operative view with calibrated probe

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Figure 8: 3 months post-operative

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  Discussion Top


Exposure of root surfaces from GR often leads to dentinal hypersensitivity,[3] esthetic concerns such as interdental papilla loss which not only plays a critical role in esthetics acts but also serves as a biological barrier in protecting the periodontal structures.[4] Every treatment modality for recession coverage aims to cover the exposed root surfaces, of which most of them eventually ensued in healing with a long junctional epithelium with minor amounts of connective tissue attachment that render a good clinical result but fail to satisfy the goal of regeneration. With the advent of a method such as GTR, the regeneration of periodontium can be achieved more predictably.[5] The GTR membrane may add additional benefit of relieving the functional stresses on the gingival flap, which could else potentially disrupt the fragile adhesions of the maturing fibrin clot to the root during the early surface which is also the most critical phase of healing.[6]

Pini Prato et al.[7] in treating a wide range of root recessions with either a 2-stage soft tissue graft or nonresorbable membrane therapy, determined that recessions >5 mm responded more favorable to GTR therapy. However, Müller et al.[8] showed that shallow recession defects treated with connective tissue graft combined with modified envelope technique resulted in greater root coverage than did those treated with GTR.

Membrane prevents the migration of relatively faster-growing epithelial and connective tissue cells into the defect area;[9] therefore, GTR-aided root coverage procedure was employed in this case. A significant root coverage has been seen in this case report, and this finding is concurrent with Burns et al., 2000,[10] Peacock et al., 2001,[11] Kimble et al., 2004,[12] and Cardaropoli et al., 2012.[13]


  Conclusion Top


Coronally repositioned flap when combined with resorbable collagen GTR membrane has shown to be a promising and effective treatment modality for the treatment of GR in esthetic areas of the oral cavity which is in concurrence to the results obtained in the present case report. To further confirm the use of collagen membrane as a good alternative for the treatment of GR, more longitudinal studies are required in this field of periodontal plastic surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Wennström JL. Mucogingival therapy. Ann Periodontol 1996;1:671-701.  Back to cited text no. 1
    
2.
Wennstrom JL, Pini Prato G. Mucogingival therapy – periodontal plastic surgery. In: Lindhe J, Karring T, Lang NP, editors. Clinical periodontology and implant dentistry. 4th ed. Oxford: Blackwell-Munksgaard, Denmark; 2003. p. 576–649.  Back to cited text no. 2
    
3.
Watson PJ. Gingival recession. J Dent 1984;12:29-35.  Back to cited text no. 3
    
4.
Tomar N, Bansal T, Kaushik M, Batra M. Smile enhancement with reconstruction of interdental papilla – A case report. TMU J Dent 2014;1:33-5.  Back to cited text no. 4
    
5.
Trombelli L, Minenna L, Farina R, Scabbia A. Guided tissue regeneration in human gingival recessions. A 10-year follow-up study. J Clin Periodontol 2005;32:16-20.  Back to cited text no. 5
    
6.
Bottino MC, Thomas V, Schmidt G, Vohra YK, Chu TM, Kowolik MJ, et al. Recent advances in the development of GTR/GBR membranes for periodontal regeneration – A materials perspective. Dent Mater 2012;28:703-21.  Back to cited text no. 6
    
7.
Pini Prato G, Clauser C, Cortellini P, Tinti C, Vincenzi G, Pagliaro U. Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal recessions. A 4-year follow-up study. J Periodontol 1996;67:1216-23.  Back to cited text no. 7
    
8.
Müller HP, Stahl M, Eger T. Root coverage employing an envelope technique or guided tissue regeneration with a bioabsorbable membrane. J Periodontol 1999;70:743-51.  Back to cited text no. 8
    
9.
Gottlow J, Nyman S, Lindhe J, Karring T, Wennström J. New attachment formation in the human periodontium by guided tissue regeneration. Case reports. J Clin Periodontol 1986;13:604-16.  Back to cited text no. 9
    
10.
Burns WT, Peacock ME, Cuenin MF, Hokett SD. Gingival recession treatment using a bilayer collagen membrane. J Periodontol 2000;71:1348-52.  Back to cited text no. 10
    
11.
Peacock ME, Cuenin MF, Mott DA, Hokett SD. Treatment of gingival recession with collagen membranes. Gen Dent 2001;49:94-7.  Back to cited text no. 11
    
12.
Kimble KM, Eber RM, Soehren S, Shyr Y, Wang HL. Treatment of gingival recession using a collagen membrane with or without the use of demineralized freeze-dried bone allograft for space maintenance. J Periodontol 2004;75:210-20.  Back to cited text no. 12
    
13.
Cardaropoli D, Tamagnone L, Roffredo A, Gaveglio L. Treatment of gingival recession defects using coronally advanced flap with a porcine collagen matrix compared to coronally advanced flap with connective tissue graft: A randomized controlled clinical trial. J Periodontol 2012;83:321-8.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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