Tatiana Frederico de Almeida; Maria Cristina Teixeira Cangussu

Clinical Case

Clinical Efficacy of Double Gingival Grafting Technique for the Treatment of Gingival Recession

Mohamed A Maksoud¹* and Alaa Ahmed²

¹Harvard University School of Dental Medicine, Boston, Ma, USA

²Private Practice Boston, Ma, USA

Corresponding Author

Received Date: March 07, 2023; Published Date: March 20, 2023

Abstract

Autogenous gingival grafts are considered the “gold standard” for the treatment of inadequate keratinized gingiva and recession. Recently with the introduction of Amniotic Membranes for the same procedure it has shown promising results due to the abundance of growth factors. The amnion Chorion membrane with the trophoblast layer was also used intra-orally in guided bone regeneration and demonstrated expedited healing when used on top of augmented extraction sockets. In this report adult patient was selected with moderate recession and inadequate keratinized gingiva and the treatment consist of the use of Amnion Chorion plus Trophoblast in addition to acellular dermal matrix in a stackable manner within a coronally advanced flap. The clinical results was adequate gain of keratinized gingiva and root coverage in addition to bulkiness.

Keywords:Gingiva; Recession; Allograft

Materials and Methods

An adult patient was selected with moderate to severe recession of the mandibular anterior teeth ( Miller Class III) [1]. The patient had a past history of orthodontic treatment. Scaling and root planning rendered on a previous visit and on the day of the surgery an intrasulcular full thickness mucoperiosteal flap was carried out. This was followed by conditioning of the root surface utilizing EDTA ( 17% ethylenediaminetetraacetic acid solution) for approximately 30 seconds followed by vigorous rinsing. First an Amnion/Chorion membrane with Trophoblast (ACMT)* was applied to the root surface followed by the Acellular Dermal matrix (ADM)** with the epithelial side against the ACMT. Suturing was accomplished using PTFE (Polytetrafluoroethylene) sutures after undermining the flap to allow suturing without tension. Postoperative instructions were given in addition to ice pack together with a prescription of Amoxicillin 500mg three times a day for one week and Motrin 800mg for discomfort. The patient presented for follow up and suture removal visit after two weeks that demonstrated good healing with no complications and scheduled for additional follow up visits in four , six and eight weeks. The follow up visits showed uneventful healing with a gain in the keratinized tissue and root coverage.

Results

The healing was evaluated clinically that showed gain of the keratinized tissue in both dimensions vertically and horizontally in addition to root coverage as well.

*AmnioExcite , Salvin Dental, 3450 Latrobe Dr, Charlotte, NC 28211.

**OraCell, Salvin Dental, 3450 Latrobe Dr, Charlotte, NC 28211.

Discussion

ACM ( Amnion Chorion membrane) has demonstrated expedited healing over augmented extraction socket as reported by the author [2] due to its abundance of growth factors. Additionally with the inclusion of the trophoblast layer in the membrane ACMT, the membrane succeeded in protecting the bone mass of the augmented extraction socket in addition to developing a noticeable keratinized tissue on top [3]. The ADM on the other had was extensively used over the years in periodontal root overage with a predictable outcome [4, 5] in a coronally positioned flap. The aim of this double grafted technique reported was to demonstrate the benefits of adding growth factors from the ACMT to the commonly used ADM for periodontal root coverage.

Summary

The ADM plus ACMT used for root coverage demonstrated a viable procedure for periodontal root coverage in addition to enhancing the zone of keratinized tissue. Although role of the growth factors could not be demonstrated clinically a comparative split mouth or histological study will be needed to compare between ADM alone or ADM plus ACMT in achieving keratinized tissue in periodontal root coverage (Figures 1-7).

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Acknowledgement

None.

Conflict of Interest

No conflict of interest.

References

Miller PD Jr (1985) A classification of marginal tissue recession. Int J Periodontics Restorative Dent 5(2): 8-13.
Maksoud MA, Guze KA (2018) Tissue Expansion of Dental Extraction Sockets using Dehydrated Human Amnion/Chorion Membrane, Case Series. Clinical Advances in Periodontics 8(3): 111-114.
Maksoud MA (2021) Amnion-Chorion membrane with the trophoblast layer in augmented posterior extraction sockets, a case report with histological study. Journal Dental Oral Health 8: 203.
Achauer BM, VanderKam VM, Celikoz B (1998) Augmentation of facial soft-tissue defects with alloderm dermal graft. Ann Plast Surg 41: 503-507.
Harris RJ (1998) Root coverage with a connective tissue with partial thickness double pedicle graft and an acellular dermal matrix graft: a clinical and histological evaluation of a case report. J Periodontol 69: 1305-1311.

Article Details

Citation

Mohamed A Maksoud* and Alaa Ahmed. Clinical Efficacy of Double Gingival Grafting Technique for the Treatment of Gingival Recession. On J Dent & Oral Health. 6(5): 2023. OJDOH.MS.ID.000649.

Abbreviations

Gingival grafts, Recession, Root planning, Good healing, Amnion chorion membrane, Periodontal root, Keratinized tissue, ADM alone, Mandibular anterior teeth, Keratinized gingiva.