CDEN0110

I 15 special _ root recession I cosmeticdentistry 1_2010 minimum apical-coronal dimension of AG that was necessarytomaintainperiodontalhealth.However, subsequent clinical12–15 and experimental studies16,17 have demonstrated that there is no minimum numerical value necessary. However, for aesthetics, a uniform colour and value of AG is desirable amongst adjacent teeth.18 Some of the earliest techniques for correcting recession involved extension of the vestibule.19 The subsequent healing usually resulted in an in- crease of AG. However, within six months, as much as a 50 % relapse of the soft-tissue position was reported.20,21 Thus, these techniques did not ade- quately address recession. In order to improve aesthetics and increase KG for root coverage procedures, current periodontal surgery largely involves the use of gingival grafts. There are a multitude of surgical techniques, which can be distinguished based on the relationship be- tween the donor and recipient sites. Gingival graft procedures involve either (a) pedicle soft-tissue grafts, which maintains the pedicle blood supply, or (b) free autogenous soft-tissue grafts. Techniques involvingthelattertyperequirethecliniciantopre- pare two surgical sites: one to harvest the tissue (1) and another one to prepare the recipient site (2). In this case, the autogenous soft-tissue graft has a separate blood supply to the recipient site. Com- binations of (a) and (b) have also been reported.22–24 Thepediclesoft-tissuegraftwasfirstdescribedby Grupe and Warren in 1956.25 This involved raising a full thickness flap and laterally positioning and then suturingdonortissueintoplacefromanadjacentarea, while maintaining a pedicle blood supply. This tech- nique and others that followed were designed to in- creasethezoneofAG.Latermodificationsofthetech- nique included the double papilla flap26 —introduced by Cohen and Ross in 1968—the oblique rotational flap27 andtherotationalflap.28 Anothertypeofgingi- valmovementflapwasdescribedlaterasthecoronal- ly repositioned flap.29 This technique involves mobili- sing a full thickness flap and repositioning the tissue to the CEJ, thereby covering the exposed recession. The use of free gingival grafts was described in the 1960s by Sullivan and Atkins.30 The free auto- Fig. 1_Pre-op labial view of anterior teeth: recession on tooth #6; tooth #7 surrounded by a small adequate zone of keratinised apical tissue. Fig. 2_Flaps reflected preserve the interproximal tissue, which preserves the blood supply and prevents black triangles (unaesthetic interproximal spaces). Fig. 3_The GTR membrane was shaped and placed over the root surfaces of teeth #6 and 7. Fig. 4_Gingival tissue was coronally repositioned, covering the membranes and the roots of teeth #6 and 7, and sutured in place. Fig. 5_Post-op view: the previously recessed roots of teeth #6 and 7 are covered with attached pink, keratinised gingival tissue, with no pocket depth upon probing. Fig. 3 Fig. 4 Fig. 1 Fig. 2 Fig. 5 BEFORE AFTER

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