Dr Chih-Chung Hsu
Titile :
Interdisciplinary Therapy for Severe Gingival Recession with EMD application on Root Coverage Procedure in Esthetic zone.
Initial status:
A 24y/o university student visited our clinic due to traffic accident three months ago. The chief complaint of the patient is to seek for esthetic and functional reconstruction. After the emergency management on the day of accident, tooth 11, 21, and 23 were splinted for 4 weeks. While the patient came back for treatment, extreme gingival recession of 21 23 was noted. The pulp vitality of 21 and 23 was negative, yet there was no mobility recorded. After 6 months preliminary treatment (endodontic and provisional prosthesis), we decided to preserve tooth 21, 23, and process Two Stage root coverage surgery combined with CTG and EMD to restore esthetics.
Diagnosis:
tooth 12 porcelain fracture
tooth 11 25 Crown fracture & caries
tooth 21 23 alveolar bone fracture
tooth 12 11 21 23 lat. luxation
tooth 22 avulsion
tooth 13 residual root
tooth 16, 46 2nd caries
3/4 root size of Class II gingival recession of tooth 23
Gingival / lip laceration
Treatment Procedure:
[if !supportLists]1. [endif]Emergency treatment with Non-rigid splinting of tooth 11, 21, 23, 24 (4 weeks)
[if !supportLists]2. [endif]Preliminary phase of treatment (Periodontic / Endodontic / Provisional treatment)(6 months)
[if !supportLists]3. [endif]1st stage Root Coverage combined CTG with EMD application
[if !supportLists]4. [endif]Tooth 13 Extraction and ridge preservation
[if !supportLists]5. [endif]2nd stage Root Coverage and 22 Implant placement with Ti-mesh bone augmentation (combined CTG with EMD application for 21 23 root coverage)
[if !supportLists]6. [endif]Implant 13 placement with GBR
[if !supportLists]7. [endif]2nd stage of implant surgery and adjust gingival line with provisionals.
[if !supportLists]8. [endif]Final prosthesis impression and delivery
CONCLUSIONS:
Current data has showed us that compared to CAF alone for root coverage, using EMD additionally can (1) have better mean coverage rate and long-term stability. (2) EMD has positive effect on regeneration of periodontal attachment. (3) It is not only helpful to gain keratinized tissue, but also, most of all, (4) it promotes angiogenesis, accelerates early wound healing and reduce post-surgical discomforts.
Because of the additional benefits from EMD. We have more treatment strategies facing gingival recession.
The use of coronally advanced flap and CTG is suitable for most of the situation.
However, as the individual blood supply system compromised (ex. extreme area of exposing root surface, which the CTG can not be covered by adjacent soft tissue), the additional application of EMD to enhance early angiogenesis may be the key factor for surgery to success.
It’s Not a Perfect Case, yet an interesting one to discuss the boundary of extracting or preserving teeth to achieve esthetic and functional results.
