Different Surgical Methods of Gingival Recession

Different Surgical Methods of Gingival Recession

 

Various techniques are used to increase the width of attached gingiva:

• Gingival augmentation apical to area of recession
  • Free epithelial autograft
  • Free connective tissue autograft
  • Apically positioned flap
  • Fenestration
  • Vestibular extension
• Gingival augmentation coronal to recession or root coverage
  • Free epithelial autograft
  • Free connective tissue autograft
  • Pedicle autografts
    • Rotational, i.e. lateral pedicle flap and double papilla flap
    • Advanced, i.e. coronally displaced flap and semilunar flap
  • Subepithelial connective tissue graft
  • Subpedicle connective tissue
  • Pouch and tunnel technique
  • Envelope technique
  • Guided tissue regeneration technique
• Widening of attached keratinized gingiva either apical or coronal to area of recession which is accomplish by various techniques
  • Free gingival autograft
  • Free connective tissue autograft
  • Apically positioned flap

Subepithelial Connective Tissue Graft

Proposed by “Langer and Langer” in 1985.

Different Surgical Methods of Gingival Recession Indications

• Where esthetic is of prime concern.
• For covering multiple denuded roots.
• In the absence of sufficient width of attached gingiva in the adjacent areas.

Different Surgical Methods of Gingival Recession Connective Tissue Graft Advantages

• High degree of cosmetic enhancement
• One step procedure
• Minimal palatal trauma
• Increased graft vascularity

Different Surgical Methods of Gingival Recession Connective Tissue Graft Disadvantages

• High degree of technical skills required
• Complicated suturing.

Different Surgical Methods of Gingival Recession Connective Tissue Graft Technique

• Step 1—Incisions and flap reflection: Raise a partial thickness flap with a horizontal incision 2 mm away from the tip of the papilla and two vertical incisions 1-2 mm away from the gingival margin of the adjoining teeth. These incisions should extend at least one half to one tooth wider mesiodistally than the area of gingival recession. Extend the flap to the mucobuccal fold without perforations that could affect the blood supply.
• Step 2—Scaling and planning: Thoroughly scale and plan the root surface, reducing any prominence of the root surface.
• Step 3—Obtaining the graft: From the palate, obtain connective tissue graft by means of a horizontal incision 5-6 mm from the gingival margin of molars and premolars. The connective tissue is carefully obtained and all adipose and glandular tissues are removed. The donor site is sutured after the graft is removed.
• Step 4—Transferring the graft: Place the connective tissue on the denuded root. Suture it with resorbable sutures to the periosteum. Good stability of the graft must be attained with adequate sutures.
• Step 5—Suturing: Cover the graft with the outer portion of the partial thickness flap and suture it interdentally. At least one-half to two-thirds of the connective tissue graft must be covered by the flap for the exposed portion to survive over the denuded root.
• Step 6—Covering the graft: Cover the grafted site with dry aluminum foil and periodontal dressing. After 7 days, the dressing and sutures are removed.