[Surgery]  Grafting Question

This is a 37 years old caucasian female patient. She has localized mesial root gum recessions on both 36 and 46. I have attached a picture of 36 but 46 looks the same. Both areas have probing depth of 1.5mm and KT looks to be slightly less than 3mm. I would describe the tissue biotype as thick in general but just these two areas seem to be thinned out a little. Interproximal bone level is good. about 1.5mm below CEJ.   I couldn't scan PAs so couldn't attach them.   1) I know this is a very basic question but what type of perio grafting would you recommend to a patient like this?   My understand is you cannot do root coverage with Free Gingival graft. FGG can only thicken up the tissue. So only Connective Tissue grafting can cover the exposed root surface and thicken up the tissue as well. I, therefore, recommended CTG but just wanted to ask your thoughts.   2) Also do you use PRF when you do CTG? I remember learning that FGG and CTGs are highly predictable procedures so i assume probabaly not. but just wanted to know from your experiences.   3) Last question. If FGG is to only thinken up the tissue biotype then is FGG more of a preventive procedure to decrease the chance of recession in the future?

by Mark Kwon at Thu, Jan 12, 2012 7:15 PM

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Bernard Jin Replied at Thu, Jan 12, 2012 7:38 PM


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Mark Kwon Replied at Thu, Jan 12, 2012 7:17 PM

Hi Sunny Good to hear from you as well. Yes - we all had a well deserved time to rest & reflect over the holidays.  Hope yours went well too! Yes - your understanding of CTG and FGG are generally correct.  CTG for coverage.  FGG for developing biotype. FGG can be used for root coverage if you do the FGG 1st, then at a later time perform a coronally repositioned flap for root coverage. Yes - recommend sending the periapical rad if you have a chance. Assuming bone is all okay - there are a few factors here to consider: - find out the etiology of the recession.  (the abfraction should be giving you a clue.  yes - prob. parafunction or occl. trauma). - this is a multi-rooted tooth (coronally repositioning the pocket flap will be difficult - with sling sutures).  It can be done but it will be challenging. Use of PRF will accelerate healing.  Do you need it? no.  But having it will help.  Especially in the harvest site. Placing it in the graft site will help as well but make sure you have secured the CT graft well - otherwise, having the PRF & CTG in the pocket flap could be too much and you would have a hard time suturing the flap down. So you next question would most likely be: what recommendations do i have? firstly - recommend a night guard and/or occlusal equilibration to address the etiology secondly - much of your treatment depends on your patient's expectations - if she is happy with what it looks like and simply wants it not to worsen, then it's easy.  Night guard & perform a FGG. if she wants root coverage, then you could perform a FGG, and then perform a coronally repositioned flap (with vertical releasing incisions) at a separate appointment (2 months later) to cover the root. if you are very experienced, you could do a pita-pocket flap CTG like we showed you at the course but you would have to make sure your suturing technique is perfect.  This would also apply to your releasing technique for the graft site (to adjacent teeth beyond the line angles of the adjacent teeth).  It can be done but suturing is hard (AND you're likely fighting strong musculature - like the masseter & possible platysmus & other muscle fibers). Hope that helps. My thoughts on school - i think it was probably taught to all of us - but I too probably didn't process it in my mind, then.  I didn't get a grasp of this until after I left school  :) Hope this helps ! Bernard Depends on your patient expectations: