Coronally Positioned Flaps and Tunneling
Mucogingival deficiencies often pose both esthetic and functional problems. Untreated gingival recession has been demonstrated to progress over time, while its treatment leads to stable root coverage. A variety of therapeutic approaches have been utilized
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Coronally Positioned Flaps and Tunneling Homayoun H. Zadeh and Alfonso Gil
9.1
Introduction
Patients often present with a variety of soft tissue defects around teeth and implants that can lead to functional and esthetic problems. An array of surgical procedures has been developed to manage these soft tissue defects. The initial procedures were mainly resective in nature and aimed at correcting aberrant frenum attachments, shallow vestibules, and inadequate attached gingiva. These procedures were collectively referred to as “mucogingival surgery” [1]. In recent years, surgical procedures to deal with soft tissue deficiencies have been refined and have incorporated regenerative therapies, as well as adopted the goal of esthetic enhancement. This broadening of the range of surgical procedures leads to the introduction of “periodontal plastic surgery,” as a new term, coined by Miller [2]. Soft tissue abnormalities could be treated in a predictable manner, improving soft tissue health, function, and esthetics [3].
9.2
cope of the Problem: How Common Is Gingival S Recession?
Gingival recession is characterized by apical migration of the gingival margin from the cementoenamel junction (CEJ), with concomitant exposure of the root surface. The root exposure associated with gingival recession can have negative H. H. Zadeh (*) Laboratory for Immunoregulation and Tissue Engineering, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA e-mail: [email protected] A. Gil Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland e-mail: [email protected] © Springer Nature Switzerland AG 2020 S. Nares (ed.), Advances in Periodontal Surgery, https://doi.org/10.1007/978-3-030-12310-9_9
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esthetic sequelae, as well as predispose the site to dentinal hypersensitivity and root caries [4]. The prevalence of gingival recession can vary substantially among the specific study populations. In North America, it has been described in one epidemiological study in 78–100% of middle-aged individuals, potentially affecting 22–53% of the teeth [5]. In another study, the prevalence of 1 mm or more recession in American population aged 30 years and older was 58% and increased with age [6]. In Brazil, a more recent study showed that 89% of the adults presented with gingival recession [7]. In addition, other epidemiological studies demonstrated that adult subjects showed a prevalence of gingival recession of 51% in Norway [8] and of 68% in Finland [9]. Overall, gingival recession is a highly prevalent condition, which progressively increases with age.
9.3
Etiology
The identification of potential etiological factors in the induction of gingival recession is critical in managing those risk factors in the course of therapy. The literature has described many possible factors, though their causality has not been established. Anatomical, physiological, pathological disease-related, and mechanica
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