Periodontal plastic surgery associated with orthodontic movement for root coverage in a case of gingival recession of a buccally positioned tooth

Perio - Cases
2017-07-06

In case of stabilized recessions orthodontic treatment, it is possible to at least partly repair periodontal damage and to create the anatomical conditions for spontaneous coronal migration of the attachement and the periodontal tissue or to improve the outcome of  surgical therapy.

Effective movements to achieve this result includes bodily movement and lingual root torque.

A 27 years old female patient, non-diabetic and non-smoker, presented with severe gingival recession of a lower incisor, complaining about esthetics e sensitivity.

She was also very concerned about losing her tooth.

Fig. 1

Img. 1 – Illustration of recession classification proposed by Sullivan and Atkins. The purpose of the orthodontic therapy involving tooth repositioning inside the envelope of the bone is to entirely modify the recession or reduce it in order to facilitate an optimal response to surgical therapy.

Fig. 2

Img. 2 – Repositioning of a buccally displaced tooth inside the envelope of the bone by means of orthodontic therapy and surgery. The initial case immediately after the professional hygiene session. In the picture on the right, repositioning of 31 inside the envelope of the bone.

Fig. 3

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Fig. 4

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Fig. 5

Img. 5 – Probing of the area at the end of orthodontic treatment. Then the surgical treatment of the area by means of a bilaminar procedure with a connective tissue graft beneath a flap.

Fig. 6

Img. 6 – The flap is sutured with suspended stitches and the use of cyanoacrylate.

Fig. 7

Img. 7 – Comparison between before surgery and healing after 2 years, shows good fading of gingival margins, root coverage, and normal probing depth.

Fig. 8

Img. 8 – Radiographic examination shows repositioning of the toot in a buccolingual direction as well as in a mesiodistal direction.

 

The combined ortho-periodontal therapeutical approach may give optimal esthetics and functional results eliminating the risk of losing malpositioned and periodontally involved teeth.