A Multifunctional Guide for Non-Carious Cervical Lesion Restoration and Root Coverage Using a Coronally Advanced Flap in the Treatment of Combined Lesions.

Abstract

Objectives: This case report describes a digital workflow that integrates restorative and surgical planning through the design and fabrication of a multifunctional guide to optimize outcomes in the treatment of combined lesions.

Clinical considerations: Gingival recessions frequently occur alongside non-carious cervical lesions (NCCLs), forming combined defects that complicate cementoenamel junction (CEJ) identification and treatment planning. A 40-year-old male presenting with gingival recession and NCCLs on teeth #14 and #15. A restoration was planned to reconstruct the lost CEJ using clinical reference points. A custom surgical guide was subsequently designed to replicate the planned restoration's contour and to delineate the intended incision patterns for the coronally advanced flap (CAF) procedure. The CEJ restoration was executed using composite resin, with the guide assisting in achieving precise contouring. Root coverage was then performed using a CAF combined with a connective tissue graft, with the guide facilitating accurate scalpel blade placement during flap preparation. At the one-year follow-up, complete root coverage was observed and the restoration maintained stability in terms of marginal adaptation, color, and surface integrity.

Conclusions: The use of a multifunctional digital guide can enhance the precision of both restorative and surgical procedures in the management of combined gingival recession and NCCL defects, potentially improving treatment predictability and outcomes.

Clinical significance: This case report highlights the benefits of a 3D-printed multifunctional digital guide for precise CEJ restoration and flap design in treating gingival recessions associated with NCCLs.