Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.
Clin Adv Periodontics. 2023 Mar;13(1):62-66. doi: 10.1002/cap.10224. Epub 2022 Dec 29.
Several surgical approaches have been described for the management of deep adjacent gingival recessions (GRs) in the lower anterior sextant with contrasting clinical outcomes. A modified surgical technique is presented, which consists of a double laterally moved and coronally advanced flaps in combination with a connective tissue graft (CTG) and enamel matrix derivatives (EMDs).
A 42-year-old systemically healthy female presented with dentin hypersensitivity and discomfort while brushing on two adjacent Cairo recession Type 2 of 7-mm depth with a narrow band of keratinized tissue in the lower incisors. The root coverage procedure was performed using a double laterally rotated and coronally advanced flap combined with a CTG harvested from the lateral palate and EMD. At 1-year follow-up, 85% of both of the roots were covered and 6 mm of keratinized tissue width was gained.
The presented technique is a predictable procedure for treating adjacent and deep GRs in the anterior sextant whenever keratinized tissue lateral to the gingival defects is available.
Why is this case new information? To the best of our knowledge, this is the first case report in the literature using a double laterally moved and coronally advanced flap combined with EMD and CTG for adjacent deep recessions. What are the keys to successful management of this case? Flap design, handling of the bilateral pedicles, and suture technique are the most important factors to obtain a predictable root coverage. What are the primary limitations to success in this case? Lack of keratinized tissue lateral to the recession defects, flap tension, and interproximal attachment loss are the main limitations to succeed with this technique.
已经有几种手术方法被描述用于处理下颌前牙区邻面深型牙龈退缩（GR），但临床结果却大相径庭。本文提出了一种改良的手术技术，包括两个侧向旋转并冠向推进的瓣，结合结缔组织移植物（CTG）和釉基质衍生物（EMD）。
一位 42 岁的女性患者，因两颗相邻的开罗 2 型退缩（深度为 7mm，角化组织带窄）在前牙区出现牙本质敏感和刷牙不适而就诊。使用两个侧向旋转并冠向推进的瓣，结合取自侧腭部的 CTG 和 EMD 进行根覆盖术。在 1 年的随访中，85%的根面被覆盖，获得了 6mm 的角化组织宽度。
当牙龈缺损侧有角化组织时，该技术是一种治疗前牙区邻面和深型 GR 的可预测方法。
为什么这是一个新的病例？据我们所知，这是文献中首例报道使用双侧侧向旋转并冠向推进瓣联合 EMD 和 CTG 治疗相邻深型退缩的病例。成功治疗这个病例的关键是什么？瓣设计、双侧蒂的处理和缝合技术是获得可预测根覆盖的最重要因素。这个病例成功的主要限制是什么？退缩缺陷侧缺乏角化组织、瓣张力和邻面附着丧失是该技术成功的主要限制。
