Tissue Grafting and Root Coverage in Class III Gingival Recessions
Koichi Ito, DDS, MSD, PhD
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.