Introduction
Apical migration of gingival margin resulting in exposure of root surfaces is known as gingival recession.1 Etiological factors for gingival recession include improper brushing technique, flossing, plaque accumulation, inflammation, periodontitis and improper occlusal contacts.2 Successful root coverage has been the main objective to maintain form, function, aesthetic and patient’s comfort. Various recession coverage techniques have been developed and modified to obtain predictable outcome.3 The main purpose of developing new techniques is to increase patient’s satisfaction of aesthetic demand. This case report aims to assess the gingival recession management with CAF with/without autologous PRF membrane.4
Case 1
Case presentation
A female patient, 48 years old, presented herself at the Seema Dental College and Hospital, Rishikesh, Uttarakhand with the problem of receding gums, aesthetic discomfort and sensitivity. A clinical examination was carried out in which multiple miller’s class I recession was identified in upper right canine and premolar tooth region. The proposed treatment was CAF along with autologous PRF membrane irt 13 14 (Figure 1). At baseline, 1st and 3rd months clinical outcome was assessed by following clinical parameters such as RD (Figure 2, Figure 4), RW (Figure 3, Figure 5), CAL, WKT.
Preparation of platelet rich fibrin (PRF)
20 ml of blood was withdrawn from vein, which lies within the cubital fossa anterior to the elbow the patient. The 10 ml of blood was stored in 2 tubes and in other 2 tubes 10 ml of saline was poured. Then, the blood sample withdrawn was centrifuged for 10 min. at 3000 rpm to obtain PRF (Choukron’s PRF). The PRF clot obtained (Figure 8) was compressed by using sterile glass slides which was then placed at the required site.5
Pre-surgical preparation
Phase I therapy (scaling and polishing) was carried out followed by revaluation.
Surgical procedure
After attaining sufficient amount of anesthesia (Lignocaine 1:80,000), scaling and root planing was done with ultrasonic instruments. An intracrevicular incision was given irt 13 14 with two releasing incision given vertically (Mesial to 13 and Distal to 14) (Figure 6). Then, the Mucoperiosteal flap was elevated to the mucogingival junction (Figure 7) for free coronal displacement of the flap. Then, Granulation tissue was removed and obtained PRF membrane was placed irt 13 14. To cover the defect completely, flap was coronally advanced and secured at its advanced position with interrupted sling suture using 3-0 black braided silk sutures (Figure 9).
Case 2
Case presentation
A male patient, 27 years old came to the department of periodontics at the Seema Dental College and Hospital, Rishikesh, Uttarakhand with the chief complaint of receding gums and dentinal hypersensitivity. On clinical examination, multiple miller’s class I recession in upper right lateral, canine and premolar tooth region (Figure 11). The proposed treatment was coronally advanced flap irt 12 13 14 & 15. At baseline, 1st and 3rd month clinical outcome was assessed by following parameters such as RD (Figure 12, Figure 14), RW (Figure 13, Figure 15), CAL, WKT.
Pre-surgical preparation
Phase I therapy (scaling and polishing) was carried out followed by revaluation.
Surgical procedure
After attaining adequate anesthesia (Lignocaine 1:80,000), an intracrevicular incision was given irt 12 13 14 and 15 along with two vertical releasing incision (Figure 16 ; Trapezoidal Flap). Mucoperiosteal flap was elevated to the mucogingival junction (Figure 17). Then, the flap was Coronally advanced and secured at its advanced position with interrupted sling suture using 3-0 black braided silk sutures (Figure 18).
Both patients were advised not to brush at surgical site and to use 0.12% chlorhexidine gluconate mouthwash for 15 days. Use of icepacks was recommended immediately after surgery, intermittently for every two hours. Systemic antibiotics (Amoxicillin 500 mg, TDS for five days) along with analgesics were prescribed.
Results
There was reduction in the RW, RD and gain in CAL, WKT at 1st and 3rd month from baseline following treatment in both the patient. But better result was seen in CAF with PRF (Figure 10, Figure 20).
Discussion
Gingival recession affects vast population, shown by the fact that these patients often report with pain, dentinal hypersensitivity and aesthetic discomfort.6 Before initiating any therapy for gingival recession, cause of the problem must be addressed. Once the etiology is identified, we may proceed for the treatment to arrest or reverse the receding gingiva. The present case report aimed at treatment of miller’s class I gingival recession with CAF with/without PRF. There was decrease in RW and RH and gain in CAL and WKT at 1st and 3rd month postoperatively from baseline. Various benefits of this technique are colour and contour match with the surrounding tissue, no additional surgical site required and improved aesthetics.7 Acc. to Kumar AP et al. in 2011 the use of PRF may be an effective and non-invasive way of managing receding gingiva as compared to autogenous graft. Optimal aesthetic results with excellent soft tissue contour and texture were observed.8 Contraindicating to this Aroca S et al in 2009, CAF is an effective treatment option for Miller’s Class I or II recession defects. The addition of a PRF membrane resulted in lesser root coverage but gain in GTH at 6 months was seen compared to conventional therapy.9 Eren G et al. in 2014 also added that receding gums could be successfully treated with CAF with PRF as well as CAF with SCTG with no statistical significant difference between treatment groups.10 Acc. to Thamaraiselvan M et al. in 2015 addition of PRF to CAF provide no added advantage in terms of root coverage except for an increase in GTH.11
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