Surgical correction of gingival recessions associated with radicular carious lesions
The authors presented clinical cases in which radicular caries and gingival recessions are surgically treated for root coverage.
Case 1 showed a partial-thickness semilunar flap raised and moved coronally on a maxillary central and lateral incisor. The flap was held without sutures. The results showed near complete root coverage. Case 2 showed a carious lesion on a mandibular central incisor. The caries were removed, the root was planed, and a restoration was placed. A connective tissue (CT) graft was obtained from the palate and placed beneath a partial-thickness flap. The partial-thickness flap was positioned coronally over the graft with sutures. Complete root coverage was achieved. Case 3 was a carious mesiobuccal root of a maxillary first molar. Treatment consisted of removal of caries, restoration, root planing and a CT graft placed under a double papillae partial-thickness flap. Case 4 involved a mandibular canine. The root caries were removed, creating a concavity on the root surface. A nonresorbable membrane was positioned under a full- thickness flap. At four weeks the membrane was removed and the new tissue formation was observed. Case 5 was a maxillary canine and utilized the same techniques as Case 4 except that a titanium-supported nonresorbable membrane was used over a composite restoration. Case 6 was a mandibular canine and utilized the same techniques as Case 5 except that a polyglactin knitted mesh was used.
Root preparations included the flattening of the root convexity to reduce the avascular portion of the recipient site. Removal of diseased cementum is sufficient to allow attachment. Traditional restorative materials did not alter the conventional surgical approach, and their use has not affected the postoperative success of root coverage. [C.S.]
Urbani G., G. Lombardo, M. Castellarin, E. Santi, and T. Abitbol, Compendium, 17:330, 1996