Clinical evaluation/ Diagnosis *:
The patient came to our department sent by her private dentist. She is a 25 years old non smoker healthy patient with nothing in the recent or past medical anamnesis. Sensitivity and Bleeding especially in the third and forth quadrants due to gingivitis and recessions.
At the clinical examination the patient presented diffuse Plaque, calculus in the lingual aspect of the 5ht sextant, and multiple recession class I,II and III of Miller in the 3rd and 4th quadrants with loss of attached gingiva and thin gingival biotype.
Full mouth plaque score was ~ 40% and bleeding score was ~30% and all the site showed a probing depth ≤ 4 mm.
No Furcation involvement and No mobility.
The diagnosis was “Gingivitis”, according to the AAP classification.
Treatment goals *:
The first phase (etiologic treatment) was to give correct instruction of oral home hygiene and to motivate the patient. Scaling and polishing was done on a quadrant protocol in 2 weeks, without the use of adjunctive therapies. During etiological therapy temporary filling were placed on decayed tooth (3.6).
At re-evaluation the periodontal situation improved and the patient was ready to the second phase of the treatment (Surgical phase) to cover the recession, increase the attached gingiva and improve the gingival biotype.
Description of clinical/surgical procedures *:
In 3rd and 4th quadrant, the clinical analysis show multiple teeth recession(3.1to 3.4 and 4.1 to 4.4) with class I,II,III of Miller and loss of attached gingiva,we decide for a Tunnel technique (Zabalegui 1999, Zuhr 2007) with Connective tissue graft from the palate.
Following initial sulcular incisions with a microsurgical blade, tunnelling knives were used to undermine the buccal gingiva by means of a split-thickness flap preparation and preserve the papilla, aiming for the preparation of a continuous tunnel in the buccal soft tissues of the recessed area and extended well into the mucosal tissues in order to gain sufficient flap mobility.
CTG was harvested from the palate and then inserted into the tunnel.Suspended sutures in 6-0 Vicryl were performed, Small parts of the CTG were left uncovered to achieve a harmonious line of the gingival margin.
Patients were instructed to avoid any mechanical trauma in the surgical sites for 2 weeks, Chlorhexidine rinses were prescribed three times per day for 2 weeks. Sutures were removed after 2 weeks.
Clinical outcomes *
Clinically we note a good root coverage, an increase of the attached gingiva and an improvement of the tissue thickness. and this results are stable until now (18 month from the surgical procedure).
