Dr Bor Jian Chen
Decision of root coverage treatment before and during orthodontic treatment. A Case report with root planing surgery video
A 34 years old female patient referred to have root coverage before orthodontic treatment.
Clinical Finding:
1. 2 mm Gingival Recession of #11, with Rotated Position, 1 mm Gingival Recession for #21
2. 6 mm Cairo RT1 Gingival Recession for #31,32
3. Anterior Deep Bite with Class II Malocclusion
Treatment Plan: Periodontal Basic Treatment first to Control Gingival Health, Consult with Orthodontist for Sequence of Root Coverage and Orthodontic Treatment
Surgical Sequence Considerations:
1. Root Coverage of #11,21 Before Orthodontic Treatment due to Rotation of #11
2. Root Coverage of #31,32 After Orthodontic Leveling of Upper Teeth, Preventing Trauma to Graft After Surgery
Surgical Root Coverage for Upper Anterior:
1. Use Vestibular Incision Subperiosteal Tunnel Access ( VISTA ) Technique with Root Planing of #11 and Subepithelial Connective Tissue Graft from Palate
2. Surgical Video: https://www.youtube.com/watch?v=ya3Dvy5aj34
Surgical Root Coverage for Lower Anterior:
1. Use Tunnel Technique with Root Planing of #31,32 and Subepithelial Connective Tissue Graft from Palate
2. Surgical Video: https://www.youtube.com/watch?v=FDRnqJhvm4g
Post Surgery Maintenance: Soft brushing after suture removal for 2-3 weeks, then regular oral hygiene practice
Conclusion: To Correct Gingival Recession Defect Before Orthodontic Treatment, Tooth Rotation and Deep Bite Trauma need to consider for Sequence of Periodontal Grafting Surgery and Orthodontic Treatment
Anterior Deep Bite
2mm Gingival Recession of #11, with Rotated Position, 1 mm Gingival Recession for #21, 2. 5 mm Cairo RT1 Gingival Recession for #31,32
6 mm Cairo RT1 Gingival Recession for #31,32
2 mm Gingival Recession of #11, with Rotated Position, 1 mm Gingival Recession for #21
Vestibular Incision Subperiosteal Tunnel Access ( VISTA ) Technique
Vestibular Incision Subperiosteal Tunnel Access ( VISTA ) Technique
Root Planing with Bur
Root Planing with Curet
De-epithelium of Subepithelial Connect Tissue Graft
Suturing
10 Days suture removal
10 Days suture removal
Two Months follow
Post surgery 5 months, Starting Orthodontic Leveling
Post surgery 8 months, During Orthodontic Leveling
8 Months After Upper Teeth Root Planing , Before Lower Teeth Root Coverage
8 Months After Upper Teeth Root Planing , Before Lower Teeth Root Coverage
Root Planing Before Root Coverage
Mini Blade Incision
Tunnel Preparation
De-epithelium of Subepithelial Connect Tissue Graft
De-epithelium of Subepithelial Connect Tissue Graft
Suturing
10 Days Before Suture Removal
10 Days After Suture Removal
One Month Follow
Six Months After Root Coverage Surgery
9 Months After Upper Root Coverage, During Orthodontic Treatment
One Year After Lower Anterior Root Coverage
After Orthodontic Treatment, 4 years after Root Coverage
After Orthodontic Treatment, 4.5 Years After Root Coverage
1.5 Years Follow after orthodontic Treatment
1.5 Years Follow after orthodontic Treatment
1.5 Years Follow after orthodontic Treatment
