El Dentista Moderno - - Periodoncia Multidisciplinar -

Gin­gi­val re­ces­sions we­re clas­si­fied by Mi­ller ac­cor­ding to the prog­no­sis for root co­ve­ra­ge. It was con­ven­tio­nally as­su­med that the com­pro­mi­se of the in­ter­pro­xi­mal in­ser­tion le­vel (Mi­ller class III) li­mi­ted the pos­si­bi­li­ties of to­tal coating of the ex­po­sed roots. This ar­ti­cle des­cri­bes the treat­ment of a Mi­ller class III re­ces­sion in the an­te­ro-in­fe­rior area using a com­bi­na­tion of pe­rio­don­tal plas­tic sur­gery tech­ni­ques. The ex­ten­sion of the de­nu­ded ra­di­cu­lar area and the scant api­cal ke­ra­ti­ni­sed gin­gi­va on the de­fect mo­ti­va­ted the choi­ce of the tech­ni­que, which in­clu­ded a subepit­he­lial con­nec­ti­ve graft, a tun­ne­lled flap and a ro­ta­tio­nal flap for its vas­cu­lar sup­port. In the re­sults, com­ple­te root co­ve­ra­ge was ob­ser­ved in a fi­ne pe­rio­don­tium. This im­plies a pa­ra­digm shift with res­pect to the Mi­ller clas­si­fi­ca­tion and con­curs with more re­cent stu­dies in which the analy­sis of the in­ter­pro­xi­mal tis­sue would ha­ve a pre­dic­ti­ve va­lue of root co­ve­ra­ge. The con­trol of the oral bio­film, prior pe­rio­don­tal nor­ma­li­sa­tion, the mag­ni­fi­ca­tion ap­proach, the bi­la­mi­nar cha­rac­ter of the nu­tri­tio­nal con­tri­bu­tion for the con­nec­ti­ve tis­sue graft, the re­lea­se of the an­te­roin­fe­rior buc­cal fre­nu­lum, the root con­di­tio­ning with pro­teins de­ri­ved from the ena­mel ma­trix, the su­tu­re wit­hout tension of low tis­sue reac­tion, and the the­ra­peu­tic ad­he­sion of the pa­tient are fac­tors con­di­tio­ning the the­ra­peu­tic re­sult ob­tai­ned. Com­ple­te re­co­very of the fun­ction and aest­he­tics of the mu­co­gin­gi­val com­plex, when trea­ting gin­gi­val re­ces­sion with loss of in­ter­pro­xi­mal in­ser­tion, can be achie­ved by the ove­rall ap­proach of its prog­nos­tic fac­tors.

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