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      Periosteal pedicle graft: A novel root coverage approach

      case-report

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          Abstract

          Gingival recession along with reduced width of attached gingiva and inadequate vestibular depth is a very common finding. Many techniques have been adopted in order to treat such defects and obtain predictable root coverage. Several graft procedures are used to obtain the coverage, but they have not been able to deliver predictable and satisfactory results (except connective tissue graft). Some of them also resulted in the secondary surgical site that was very uncomfortable for the patients. There was an intense need for a technique that provides not only good and predictable root coverage, but also reduces the need for secondary surgical site. Hence, this paper describes a single stage technique for increasing the width of attached gingiva and root coverage by using the periosteal pedicle graft.

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          On the repair potential of periodontal tissues.

          Alan Melcher (1976)
          Article 0 comments Cited 143 times – based on 0 reviews     Review now
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            Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases.

            Roberto Rotundo, Robert Miller, Francesco Cairo … (2009)
            Generally, esthetic outcomes following root-coverage procedures are not assessed. This article proposes a score for evaluating the esthetic outcome following root-coverage surgery. Thirty-one patients with Miller Class I and II recession defects treated with root-coverage procedures were evaluated. Esthetic outcomes were assessed using the root coverage esthetic score (RES) 6 months after surgery. This score evaluates five variables: level of the gingival margin, marginal tissue contour, soft tissue texture, mucogingival junction alignment, and gingival color. Because complete root coverage was the primary treatment goal, and the other variables were considered secondary, the value assigned for root coverage was 60% of the total score, whereas 40% was assigned to the other four variables. With regard to assessment of the final position of the gingival margin, 3 points were given for partial root coverage, and 6 points were given for complete root coverage; 0 points were assigned when the final position of the gingival margin was equal or apical to the previous recession. One point was assigned for each of the other four variables. Thus, 10 points was a perfect score. Of the 31 treated recession defects, 24 (77%) exhibited complete root coverage at 6 months. The mean amount of root coverage was 89.4% (range, 0% to 100%). The mean RES was 7.8. Five of 24 cases of complete root coverage achieved a perfect score (RES = 10). In one case, RES = 0. The RES system may be a useful tool to assess the esthetic outcome following root-coverage procedures.
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              Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study.

              L Wennström, G Zucchelli (1996)
              The aim of this study was to evaluate whether an increased thickness of the gingiva through the use of a free connective tissue graft, in conjunction with a coronally advanced flap procedure, may positively influence the treatment outcome with respect to (i) root coverage and (ii) long-term stability of the position of the soft tissue margin following treatment of recession type defects. 67 consecutive patients having a total of 103 buccally located recession type defects of at least 3 mm were included in the study. After an initial phase of prophylaxis including instructions in a tooth brushing technique giving minimal apically directed forces to the gingival margin, the recession sites were surgically covered with a coronally advanced flap alone (control sites), or coronally advanced flap combined with a free connective tissue graft taken from the palate (test sites). Clinical examinations, including assessments of oral hygiene, gingival conditions, recession depth, gingival height, probing pocket depth and probing attachment loss, were performed before and 6, 12 and 24 months after surgical treatment. The mean initial recession depth for both treatment groups was about 4.0 mm (SD 1.0) with a gingival height apical to the recession of 1.0 mm (0.5). At the re-examination performed 6 months after surgical treatment, the mean recession depth had decreased to 0.2 mm in both the test and control groups. Complete root coverage was observed at 72% of the test sites and 74% of the control teeth. At teeth treated with the combined surgical procedure, the mean gain in probing attachment amounted to 3.7 mm and the mean gingival height had increased to 3.5 mm (0.6). The corresponding figures for control teeth were 3.6 mm and 1.5 mm (0.5), respectively. At the 24-month follow-up examination, the mean root coverage amounted to 98.9% (test) and 97.1% (control). 88% of the teeth in the test group showed complete root coverage compared to 80% for teeth in the control group. It was concluded that the 2 surgical procedures resulted in similar degree of root coverage and that changes of tooth brushing habits may be of greater importance than increased gingival thickness for long-term maintenance of the surgically established position of the soft tissue margin.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Indian Soc Periodontol
                Journal ID (iso-abbrev): J Indian Soc Periodontol
                Journal ID (publisher-id): JISP
                Title: Journal of Indian Society of Periodontology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0972-124X
                ISSN (Electronic): 0975-1580
                Publication date (Print): Jan-Feb 2015
                Volume: 19
                Issue: 1
                Pages: 99-102
                Affiliations
                [1] Department of Periodontology, Narsinhbhai Patel Dental College, Visnagar, Gujarat, India
                [1 ] Private Practitioner in Mehsana, Gujarat, India
                Author notes
                Address for correspondence: Dr. Mishal Piyush Shah, B/29, Utsav Bumgalows, Near Shree Nagar Society, Mehsana, Gujarat, India. E-mail: drmishalshah@ 123456yahoo.com
                Article
                Publisher ID: JISP-19-99
                DOI: 10.4103/0972-124X.145828
                PMC ID: 4365168
                SO-VID: 7f2634da-2d73-4f94-a247-64ad5ebe049f
                Copyright © Copyright: © Journal of Indian Society of Periodontology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 April 2014
                Date accepted : 12 June 2014
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Dentistry
                Keywords: attached gingiva,periosteal fenestration,periosteal pedicle flap,single stage technique,vestibular deepening,width of attached gingival
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: attached gingiva, periosteal fenestration, periosteal pedicle flap, single stage technique, vestibular deepening, width of attached gingival

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