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Tissue Grafting and Root Coverage in Class III Gingival Recessions

Learning Objectives:

This video describes a novel approach to root coverage using an enamel matrix derivative in conjunction with periosteal connective tissue grafting. Upon seeing this video, the viewer should:

  • Demonstrate an enhanced understanding of autogenous gingival grafting utilizing an enamel matrix derivative for root coverage in patients with Class III gingival recession
  • Understand the mechanism of action of enamel matrix derivatives

 

Labial orthodontic tooth movement is one of the many etiological factors involved in facial gingival recession. Gingival recession may lead to aesthetic compromise, root sensitivity, and/or root caries lesions. To date, several types of periodontal plastic surgery that use soft tissue grafting and guided tissue regeneration have been reported to improve gingival recession and to enable coverage of single/multiple exposed root surfaces. Using Miller's classification system for gingival recession, Class I and II recessions may be successfully treated by a number of root coverage procedures. Nevertheless, only partial root coverage may be expected in Class III recession, and Class IV recession is not amenable to root coverage. Although Wennstršm reported success with root coverage procedures in gingival recessions, the extent to which these treatments result in new connective tissue or epithelial attachment is debatable. 

*Professor and Chairman, Department of Periodontology, Nihon University School of Dentistry, Tokyo, Japan.

Related Reading:

            1.         Steiner GG, Pearson JK, Ainamo J. Changes of the marginal periodontium as a result of labial tooth movement in monkeys. J Periodontol 1981;52(6):314-320.

            2.         Miller PD, Jr. Craddock RD. Surgical advances in the coverage of exposed roots. Curr Opin Periodontol 1996;3:103-108.

            3.         Miller PD, Jr. A classification of marginal tissue recession. Int J Periodont Rest Dent 1985;5(2):8-13.

            4.         Wennstršm JL. Mucogingival therapy. Ann Periodontol 1996;1(1):671-701.

            5.         Hammarstršm L. Enamel matrix, cementum development and regeneration. J Clin Periodontol 1997;24(19):658-668.

            6.         Gestrelius S, Andersson C, Johansson AC, et al. Formulation of enamel matrix derivative for surface coating. Kinetics and cell colonization. J Clin Periodontol 1997;24(9):678-684.

            7.         Hammarstršm L, Heijl L, Gestrelius S. Periodontal regeneration in a buccal dehiscence model in monkeys after application of enamel matrix proteins. J Clin Periodontol 1997;24(9):669-677.

            8.         Heijl L. Periodontal regeneration with enamel matrix derivative in one human experimental defect. A case report. J Clin Periodontol 1997;24(9):693-696.

            9.         Egelberg J. Gingival coverage of denuded labial root surfaces. In: Periodontics. The Scientific Way. Synopses of Clinical Studies. 3rd ed. Malmš, Sweden: Odontol Science; 1999:545-563.

            10.       Heijl L, Heden G, SvŠrdstršm G, Ostgren A. Enamel matrix derivative (EMDOGAIN") in the treatment of intrabony periodontal defects. J Clin Periodontol 1997;24(9):705-714.

            11.       Lindhe J, Karring T. Anatomy of the periodontium. In: Clinical Periodontology and Implant Dentistry. 3rd ed. Copenhagen, Denmark: Munksgaard; 1997:54.

            12.       Karring T, Nyman S, Thilander B, Magnusson I. Bone regeneration in orthodontically produced alveolar bone dehiscences. J Periodont Res 1982;17(3):309-315.

            13.       Karring T, Isidor F, Nyman S, Lindhe J. New attachment formation on teeth with a reduced but healthy periodontal ligament. J Clin Periodontol 1985;12(1):51-60.

            14.       Gestrelius S, Andersson C, Lidstršm D, et al. In vitro studies on periodontal ligament cells and enamel matrix derivative. J Clin Periodontol 1997;24(9):685-692.

            15.       Bruno JF. Connective tissue graft technique assuring wide root coverage. Int J Periodont Rest Dent 1994;14(2):127-137.

            16.       Wilson TG Jr. Periodontal Regeneration Enhanced. Clinical Applications of Enamel Matrix Proteins. Carol Stream, IL: Quintessence Publishing; 1999:42-65.

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