Cases reported "Gingival Recession"

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1/46. guided tissue regeneration procedure applied to the treatment of endodontic-periodontal disease: analysis of a case.

    The clinical condition of a patient with chronic adult-type periodontal disease, as well as gingival recession reaching the tooth apex on a mandibular lateral incisor, is discussed. Because the use of conventional techniques would have resulted in tooth loss, the guided tissue regeneration procedure was applied, with successful results.
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2/46. Simultaneous team approach of a crown-lengthening procedure and an operative restoration: technique and long-term effect.

    Traditionally, crown-lengthening procedures to expose subgingival caries for operative restorative work are carried out in a two-stage approach. A disadvantage of this procedure is that the gingival margin associated with the treated tooth moves apically; this may create an esthetic problem. Resin-modified glass-ionomer cement has been demonstrated to have good biocompatibility with dental hard and soft tissues. Surgical and restorative procedures were combined at the same appointment in an effort to achieve a restoration with minimal change in the gingival margin. Four patients have been treated with this one-stage team approach and followed for 8 to 13 months. The clinical results demonstrated this team approach procedure is excellent for the dentition when esthetics is a consideration.
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3/46. Adverse effects associated with a bioabsorbable guided tissue regeneration device in the treatment of human gingival recession defects. A clinicopathologic case report.

    This clinicopathologic case report documents an adverse effect associated with the use of a polylactic acid-based barrier in the treatment of human gingival recession defects. A total of 27 consecutively treated patients, in whom guided tissue regeneration with a polylactic acid barrier was used to correct gingival recession defects, were evaluated. This adverse effect consisted of a midradicular-apical swelling, generally asymptomatic, with no apparent predilection for gender, age, tooth type or location (maxilla/mandible), or surgical procedure. It was observed in 14 of 27 (52%) patients and 22 of 41 (54%) defects. The swelling decreased in size over time and in most cases, it completely resolved within 12 months postsurgery. Histopathologic evaluation of a 14-week specimen indicated characteristics (multinucleated giant cells, foamy macrophages) consistent with a foreign body reaction. These findings suggest that patients undergoing GTR procedures with synthetic absorbable devices for the treatment of gingival recession defects should be advised of the possible occurrence of such an adverse effect.
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4/46. Esthetic restoration of a single-tooth dental implant using a subepithelial connective tissue graft: a case report with 3-year follow-up.

    This case report describes the use of a subepithelial connective tissue graft to restore the gingival papillae and augment ridge soft tissues adjacent to a dental implant. The patient was referred for periodontic and prosthodontic evaluation after the placement of an implant--with the implant head 6.5 mm below the adjacent cementoenamel junction--in an area of inadequate bone volume with deficient interproximal papillae and ridge soft tissues. The resulting esthetic defect was restored by means of a combined technique that used a subepithelial connective tissue graft and an emergence profile-contoured crown. A 3-year clinical follow-up with complete regeneration of the gingival papillae is described.
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5/46. Human histologic evaluation of root coverage obtained with a connective tissue with partial thickness double pedicle graft. A case report.

    The use of a connective tissue graft combined with a pedicle graft has been proven an effective method to achieve root coverage. However, little is known about the histologic results in humans. A connective tissue with partial thickness double pedicle graft was performed on 2 teeth scheduled for extraction for prosthetic reasons. The procedures were clinically successful (100% and 83.3% root coverage). At 6 months postoperative, the teeth were extracted with conservative block sections and analyzed histologically. Two different healing patterns were seen. The first was characterized by a long junctional epithelial attachment that extended well beyond the original gingival margin and occasionally almost to the original bone level with minimal connective tissue adjacent to the tooth. The other pattern was a short junctional epithelium that stopped at the previously exposed root surface. In this pattern, there was predominately connective tissue adjacent to the tooth with some isolated areas of epithelium. No new bone or cementum was seen in any section. The use of a technique that combines a connective tissue graft with a pedicle graft can produce root coverage and a successful clinical result. However, the histological evaluation of this case report revealed that true regeneration was not seen in this study, only repair.
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6/46. Successful root coverage: a human histologic evaluation of a case.

    connective tissue grafts combined with pedicle grafts (subepithelial grafts) have been shown to be effective in obtaining root coverage. Unfortunately, little is known about the histology of the results in humans. This is a case report of a tooth with a recession defect that was treated with a subepithelial graft. Complete root coverage was obtained. However, at 5 months postoperative the tooth had to be extracted because of a vertical root fracture. With the patient's permission, a small collar of tissue was removed with the tooth. The sample was processed and evaluated histologically. The results revealed areas of regeneration, with new bone, cementum, and connective tissue attachment coronal to the original gingival margin. No bone grafts or guided tissue regeneration membranes were used. This case report confirms that regeneration is possible with subepithelial grafts.
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7/46. gingival recession treatment using a bilayer collagen membrane.

    Traditional periodontal plastic surgery techniques for the management of gingival recession have typically used soft tissue grafts to obtain defect coverage with great clinical success. Clinicians using guided tissue regeneration (GTR) techniques are also enjoying significant success in periodontal plastic surgery procedures. GTR therapy utilizing bioabsorbable membranes offers the advantages of preventing a donor site surgery and a second surgical procedure for barrier removal. A new bioabsorbable bilayer collagen membrane that readily adapts to bone and tooth surfaces by a gel formation of collagen fibers and blood may be stabilized without sutures prior to soft tissue closure. This bioabsorbable membrane has been shown to be effective in guided bone regeneration procedures and in treating periodontal defects. This case demonstrates the treatment of gingival recession with a novel collagen bilayer membrane.
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8/46. Restoring esthetics and anterior guidance in worn anterior teeth. A conservative multidisciplinary approach.

    BACKGROUND: Developments in adhesive dentistry have given the dental profession new restorative materials and technology to restore esthetics and function to the worn anterior dentition. This article illustrates, through a clinical case study, the clinical requirements for restoring esthetic harmony and functional stability to the worn anterior dentition. CASE DESCRIPTION: The author presents the case of a 24-year-old man who sought esthetic dental treatment because he was unhappy with the appearance of his maxillary anterior teeth. The review of his dental history revealed that he ground his teeth at night. The author performed a complete evaluation of the causes of the patient's bruxism and created a diagnostic preview to, among other things, develop the relationship between the condylar and anterior guidance and to establish the esthetic requirements for the final restorations. Treatment included periodontal recontouring, tooth preparation and placement of temporary and then permanent restorations; the patient also was given an occlusal guard to protect the restorations against future bruxing. CLINICAL IMPLICATIONS: Whatever the cause of occlusal instability, it is important that the restorative dentist be able to recognize its signs--such as tooth hypermobility, tooth wear, periodontal breakdown, occlusal dimpling, stress fractures, exostosis, muscle enlargement and loss of posterior disclusion. When restoring the worn dentition, the clinician should bear in mind the five P's: proper planning prevents poor performance.
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9/46. histology of a human biopsy section following the placement of a subepithelial connective tissue graft.

    This case report histologically examines the type of attachment that can occur after root coverage of a long-standing facial recession defect on a maxillary premolar with a subepithelial connective tissue graft. Histologic findings suggest that various types of tissue attachment, including periodontal regeneration, may occur over a recession defect after placement of a subepithelial connective tissue graft. In the present case, it was noteworthy that after 1 year the greatest area of exposed root surface was covered by a connective tissue attachment (adhesion), which had remained intact during orthodontic movement and distal drifting of the tooth.
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10/46. Clinical and histologic evaluation of human gingival recession treated with a subepithelial connective tissue graft and enamel matrix derivative (Emdogain): a case report.

    A mandibular canine with significant gingival recession was selected for a pilot study to measure the attachment modalities resulting from mucogingival surgery. The tooth had 6 mm of recession as measured from the cementoenamel junction to the gingival margin, minimal pocketing, and no keratinized gingiva. The treatment regimen consisted of a subepithelial connective tissue graft (SCTG) plus Emdogain applied to the root surface. The tooth was extracted en bloc 6 months after surgery and processed histologically in a buccolingual plane. The tooth demonstrated a 2-mm gain of attachment and a 3-mm gain in keratinized tissue. The histologic study evidenced the migration of the junctional epithelium 1.2 mm apical to the sulcus. New cementum, evidence of newly formed woven bone, and connective tissue fibers anchored in the new cementum were evident.
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