Management of severe gingival recession using a double papilla connective tissue graft: A 2-year follow-up case study.

IF 0.9 Q3 DENTISTRY, ORAL SURGERY & MEDICINE
Yu-Chang Wu, Oscar Duran-Garnica, Hsun-Liang Chan, Dimitris N Tatakis
{"title":"Management of severe gingival recession using a double papilla connective tissue graft: A 2-year follow-up case study.","authors":"Yu-Chang Wu, Oscar Duran-Garnica, Hsun-Liang Chan, Dimitris N Tatakis","doi":"10.1002/cap.10368","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This case study presents the treatment of a 7 mm deep and 5 mm wide RT1 gingival recession on the mandibular left canine in a 30-year-old systemically and periodontally healthy female, with the defect being associated with a self-injurious habit.</p><p><strong>Methods: </strong>Following counseling, self-injurious habit cessation, and oral hygiene reinforcement, a double papilla flap (DPF) plus subepithelial connective tissue graft (SCTG) procedure (DPF+SCTG) was performed. After de-epithelialization of the gingival margin, horizontal and vertical incisions were made, and a partial-thickness DPF was elevated. The SCTG was placed at the cementoenamel junction level and covered by the DPF.</p><p><strong>Results: </strong>Nearly complete root coverage was achieved, with recession depth reduced to 1 mm and keratinized tissue width increased from 1 mm to 6 mm. Ultrasound imaging confirmed successful graft integration and thick gingiva. At 2-year follow-up, creeping attachment was observed after the patient discontinued the self-injurious habit, despite a prior recurrence that had caused additional trauma. The successful surgical outcome resulted in patient satisfaction, plaque control improvement, and prevention of further recession, benefiting the ongoing orthodontic treatment.</p><p><strong>Conclusions: </strong>DPF+SCTG is an effective approach for treating an isolated deep and wide RT1 recession, providing long-term benefits, particularly when combined with behavior modification in patients with self-injurious habits.</p><p><strong>Key points: </strong>Technique choice and patient behavior management: The combination of double papilla flap and subepithelial connective tissue graft effectively achieved significant root coverage and increased keratinized tissue width in a patient with self-injurious habit. However, patient behavior management was crucial in preventing recurrence. Long-term stability and creeping attachment: Despite a relapse due to the patient's habit, the thickened gingiva facilitated natural healing through creeping attachment, reinforcing the importance of both surgical intervention and behavioral modifications in maintaining long-term stability. Ultrasound for non-invasive monitoring: Ultrasound imaging confirmed successful graft integration and determined tissue thickness, highlighting its potential as a non-invasive periodontal healing monitoring tool.</p><p><strong>Plain language summary: </strong>Gum recession is a common condition where the gum tissue pulls away from the teeth, exposing the roots and making them more prone to damage. This report describes the treatment of a 30-year-old woman who had severe gum recession on her lower left canine tooth, caused by her long-term habit of scratching the gums with her fingernail. To restore the lost tissue and protect the tooth, a double papilla flap (a surgical technique that moves nearby tissue) along with a connective tissue graft (transplanted tissue from the roof of the mouth) was used. Over 2 years, the recession was reduced by almost 90%, and the tissue over the tooth became healthier and stronger. Although her habit caused some recession to return, the thickened tissue allowed for natural healing once she controlled her habit again. This case highlights how proper surgical technique selection and execution, combined with patient behavior changes, can successfully treat severe gum recession. It also demonstrates how ultrasound imaging can be used as a non-invasive tool to monitor soft tissue healing over time.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9000,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Advances in Periodontics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1002/cap.10368","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
引用次数: 0

Abstract

Background: This case study presents the treatment of a 7 mm deep and 5 mm wide RT1 gingival recession on the mandibular left canine in a 30-year-old systemically and periodontally healthy female, with the defect being associated with a self-injurious habit.

Methods: Following counseling, self-injurious habit cessation, and oral hygiene reinforcement, a double papilla flap (DPF) plus subepithelial connective tissue graft (SCTG) procedure (DPF+SCTG) was performed. After de-epithelialization of the gingival margin, horizontal and vertical incisions were made, and a partial-thickness DPF was elevated. The SCTG was placed at the cementoenamel junction level and covered by the DPF.

Results: Nearly complete root coverage was achieved, with recession depth reduced to 1 mm and keratinized tissue width increased from 1 mm to 6 mm. Ultrasound imaging confirmed successful graft integration and thick gingiva. At 2-year follow-up, creeping attachment was observed after the patient discontinued the self-injurious habit, despite a prior recurrence that had caused additional trauma. The successful surgical outcome resulted in patient satisfaction, plaque control improvement, and prevention of further recession, benefiting the ongoing orthodontic treatment.

Conclusions: DPF+SCTG is an effective approach for treating an isolated deep and wide RT1 recession, providing long-term benefits, particularly when combined with behavior modification in patients with self-injurious habits.

Key points: Technique choice and patient behavior management: The combination of double papilla flap and subepithelial connective tissue graft effectively achieved significant root coverage and increased keratinized tissue width in a patient with self-injurious habit. However, patient behavior management was crucial in preventing recurrence. Long-term stability and creeping attachment: Despite a relapse due to the patient's habit, the thickened gingiva facilitated natural healing through creeping attachment, reinforcing the importance of both surgical intervention and behavioral modifications in maintaining long-term stability. Ultrasound for non-invasive monitoring: Ultrasound imaging confirmed successful graft integration and determined tissue thickness, highlighting its potential as a non-invasive periodontal healing monitoring tool.

Plain language summary: Gum recession is a common condition where the gum tissue pulls away from the teeth, exposing the roots and making them more prone to damage. This report describes the treatment of a 30-year-old woman who had severe gum recession on her lower left canine tooth, caused by her long-term habit of scratching the gums with her fingernail. To restore the lost tissue and protect the tooth, a double papilla flap (a surgical technique that moves nearby tissue) along with a connective tissue graft (transplanted tissue from the roof of the mouth) was used. Over 2 years, the recession was reduced by almost 90%, and the tissue over the tooth became healthier and stronger. Although her habit caused some recession to return, the thickened tissue allowed for natural healing once she controlled her habit again. This case highlights how proper surgical technique selection and execution, combined with patient behavior changes, can successfully treat severe gum recession. It also demonstrates how ultrasound imaging can be used as a non-invasive tool to monitor soft tissue healing over time.

使用双乳头结缔组织移植物治疗严重牙龈萎缩:2年随访病例研究。
背景:本病例研究报告了一名30岁全身和牙周健康的女性下颌左犬牙7毫米深5毫米宽RT1牙龈退缩的治疗,该缺陷与自残习惯有关。方法:采用双乳头瓣(DPF) +上皮下结缔组织移植物(SCTG)手术(DPF+SCTG),经心理咨询,戒除自残习惯,加强口腔卫生。在牙龈边缘去上皮化后,做水平和垂直切口,提升部分厚度的DPF。SCTG被放置在牙髓-牙釉质连接处,并被DPF覆盖。结果:实现了近乎完全的根覆盖,退行深度减少到1mm,角化组织宽度从1mm增加到6mm。超声检查证实植牙融合成功,牙龈较厚。在2年的随访中,在患者停止自残习惯后观察到爬行依恋,尽管之前的复发造成了额外的创伤。成功的手术结果使患者满意,菌斑控制改善,防止进一步衰退,有利于正在进行的正畸治疗。结论:DPF+SCTG是治疗孤立的深度和广泛RT1衰退的有效方法,提供了长期的益处,特别是当与有自残习惯的患者的行为改变相结合时。重点:技术选择与患者行为管理:双乳头瓣联合上皮下结缔组织移植物对有自残习惯的患者有效实现了显著的根覆盖,增加了角化组织宽度。然而,患者行为管理是预防复发的关键。长期稳定性和爬行附着:尽管由于患者的习惯而复发,但增厚的牙龈通过爬行附着促进了自然愈合,这加强了手术干预和行为改变在维持长期稳定性方面的重要性。超声用于无创监测:超声成像证实移植物成功整合并确定组织厚度,突出其作为无创牙周愈合监测工具的潜力。简单的语言总结:牙龈萎缩是一种常见的情况,牙龈组织从牙齿上脱落,露出牙根,使它们更容易受到损伤。本报告描述了一名30岁妇女的治疗方法,她的左下犬牙有严重的牙龈萎缩,这是由于她长期用指甲刮牙龈的习惯造成的。为了恢复失去的组织并保护牙齿,使用了双乳头瓣(一种移动附近组织的外科技术)和结缔组织移植物(从口腔上颚移植的组织)。在两年多的时间里,衰退减少了近90%,牙齿上的组织变得更健康、更强壮。虽然她的习惯导致了一些衰退,但一旦她再次控制了她的习惯,增厚的组织就会自然愈合。这个病例强调了正确的手术技术选择和执行,结合患者行为的改变,可以成功地治疗严重的牙龈萎缩。它还展示了超声成像如何作为一种非侵入性工具来监测软组织的愈合情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Clinical Advances in Periodontics
Clinical Advances in Periodontics DENTISTRY, ORAL SURGERY & MEDICINE-
CiteScore
1.60
自引率
0.00%
发文量
40
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信