Gingival recession is the displacement of marginal gingival tissue
apical to the cemento-enamel junction with exposure of
root surface to the oral environment. The gingival recession
is found most commonly on facial and buccal surface as a
result of vigorous tooth brushing, whereas it may affect other
tooth surfaces also because of poor oral hygiene. It has
been proposed that recession is multi-factorial, with one type
being associated with anatomic factors such as bone dehiscence,
malpositioning of teeth, trauma associated with malocclusion.
Another type of recession is associated with physiological
(aging) or pathological factors (where it occurs as
part of pathogenesis of periodontal disease or smoking).
More than 50% of population has one or more sites of gingival
recession ≥ 1 mm3
. The process by which gingival recession
occurs is still unclear; however, it seems that gingival recession
probably occurs in the presence of inflammation. Tissue
destruction in plaque-induced periodontal disease in different
scenarios causes apical migration of the epithelium and destruction
of the periodontal ligament along with bone resorption.
Therefore, gingival recession may be a consequence of
this stage of disease, or it may be seen as a part of the healing
process in response to periodontal treatment. Which results
in reduction of probing depth and shrinkage of the tissue that
leads to tightening of the gingival cuff and formation of long
junctional epitelium. In studying the etiology of gingival
recession Gronman concluded that tooth malalignment and
tooth brushing are most common factors associated with gingival
recession. Sangnes and Gjermo confirmed that different
types of traumatic injuries may result in a variety of
gingival lesions.
The lateral pedicle graft was described by Grupe and Warren
in 1956. The purpose was to gain attached gingiva and to
cover areas of gingival recession, especially those on the facial
surfaces of mandibular anterior teeth. The lateral positioned
flap can be used to cover the isolated, denuded roots that have
adequate donor tissue laterally and vestibular depth. Prognosis
for Miller class I and class II is good to excellent whereas,
A 23-year old healthy female presented to the department
of periodontics, government dental college Aurangabad with
chief complaint of receding gum in the lower front teeth region.
On examination there was Miller’s class II gingival recession
in the lower left central incisor region with a recession of
6mm in depth and 2 mm in width it was due to malposition.
Trauma from occlusion with respect to the involved tooth was
ruled out clinically.Patient was motivated and educated and oral hygiene instructions
were given. Scaling and root planing was done and the
patient was periodically recalled to assess his oral hygiene
and gingival status before taking up the case for periodontal
surgery and allowing the creeping attachment for 3-4weeks.
Blood and radiographic investigation was carried out. No interproximal
bone loss was seen.
The root surface was thoroughly scaled and planned to remove
plaque, accretions and surface irregularities. Profound
analgesia was obtained using local anesthesia for the recipient
site. A no.15 scalpel blade was used to prepare the recipient
bed. The epithelium was dissected preserving the connective
tissue for the graft acceptance in the coronal-apical direction
several millimeters below the mucogingival junction. The high
frenum attachment was relieved thereafter.
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