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Innovations in Periodontics
Clinical and Anatomical Factors Limiting Treatment
Outcomes of Gingival Recession: A New Method to
Predetermine the Line of Root Coverage
G. Zucchelli,* T. Testori, and M. De Sanctis
714
doi: 10.1902/jop.2006.050038
Figure 1.
A) A canine with deep gingival recession and shallow root abrasion.
A line (arrow) can be hardly recognized separating the enamel from
the coronally exposed dentin. This line is too flat to be considered the
anatomic CEJ, which has disappeared due to the abrasion defect. B)
After the root coverage surgical procedure, the abrasion line (arrow)
is more evident than before the surgery due to chlorhexidine
pigmentation of the exposed (non-coverable) coronal dentin. The
patient may consider the end result as a failure of the surgical
procedure which, conversely, achieved good root coverage.
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Figure 3.
Clinical CEJ predetermination in a tooth with loss of height of one papilla. In a canine with a deep
gingival recession, there is a loss of the distal papilla, whereas the mesial papilla completely filled the
interdental space up to the contact point. A) The ideal dimension (x) of the interdental papilla is
measured as the distance between the projection (gray line) of the mesial line angle and the contact
point. This dimension coincides with the height of the mesial anatomic papilla. B) The ideal dimension
(x) is reported apically starting from the tip of both mesial and distal anatomic papillae. Projections
(gray lines) on the recession margin of these measurements permit the identification of two points
(green dots) that are connected by the line of root coverage (red line). Note that the mesial point
coincides with the mesial line angle of the tooth, whereas the distal point is displaced more apically than
the distal line angle. C) The coverable area (screened area) differs in the mesial aspect with respect to
the distal aspect of the exposed root. At the distal aspect of the buccal surface, it is not possible to
cover the exposed root up to the anatomic CEJ, whereas complete root coverage is achieved at the
mesial aspect. D) Clinical healing 2 months after the root coverage surgical procedure. The distal aspect
of the buccal root surface is already exposed. The clinical root coverage differs in the mesial and distal
aspects of the exposed root surface as predetermined before the surgery.
Figure 4.
Clinical CEJ predetermination in a rotated tooth. A) A rotated canine with gingival recession. The
anatomic CEJ is easily recognizable, and both mesial and distal papillae fill the interdental spaces up
to the contact point. Thus, there is no loss of papillae height. Nevertheless, due to tooth
rotation, the topographic relationship between the anatomic CEJ and the interdental papillae changes:
at the mesial aspect of the buccal surface, the CEJ moves closer to the tip of the papilla, whereas at the
distal aspect it moves further away. The situation in which the CEJ moves closer to the tip of anatomic
papilla configures a condition of loss of papilla height. B) In a rotated tooth, the contact points with
adjacent teeth are not correct, and thus the ideal vertical dimension of the papilla (x) cannot be
measured at the tooth with recession but is measured at the homologous contralateral canine. The
ideal dimension of the papilla is measured as the distance between the mesial line angle and the
contact point. C) This dimension (x) is reported apically starting from the tip of both the anatomic
papillae of the rotated tooth with gingival recession. Projections of these measurements (gray lines)
allow the identification of two points (green dots) along the recession margin that are connected
by the scalloped line of root coverage (red line). The coverable (with soft tissues) area (screened area)
is less than the root exposure. D) Clinical healing 2 months after the root coverage surgical procedure.
The mesial aspect of the buccal root surface is already exposed. The clinical root coverage differs in the
mesial and distal aspects of the exposed root surface as predetermined before the surgery. Note that
chlorhexidine pigmentation makes the portion of the root surface that is non-coverable with soft tissues
even more evident and unesthetic because of tooth rotation.
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CONCLUSIONS
Within the limits of the present study, the predetermination of the clinical CEJ might be used as
follows: 1) evaluating root coverage outcomes of a
given surgical procedure when the anatomic referring parameter (CEJ) is lacking; 2) improving
esthetic outcomes of gingival recessions; and 3)
combining restorative/periodontal treatment of a
cervical abrasion associated with gingival recession.
Clinical studies are needed to confirm and improve the validity of the presented method to predetermine the level/line of root coverage and to test its
clinical applications.
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