A 58 year old female patient was referred to my office for the treatment of severe gingival recession. Her primary concern was the unaesthetic appearance of her upper teeth when she smiles. The patient suffered from gingival recession for many years and she admitted to aggressive brushing.
The initial evaluation revealed gingival recession ranging from 5 - 8 mm on teeth # 4 - 12. Some of the exposed roots were treated with large composite restorations adding additional complexity to the esthetic challenge of this patient.
Treatment Plan: The treatment was divided into three phases:
Phase I- Surgical Phase: Connective Tissue Grafts on teeth # 4 - 12
Phase II- Restorative Phase: Provisional restorations and bleaching of the mandibular teeth.
Phase III- Restorative Phase: Final restorations
Phase I- Surgical Treatment: The goal of the surgical treatment was to provide the patient with functional and esthetic periodontium which was achieved by performing a connective tissue graft procedure on teeth # 4-12. Palatal tissues were used for the grafting. The bonded restorations were removed at the time of surgery after flap reflection. All root surfaces had to be free of composite residues in order to achieve epithelial and possibly connective tissue attachment of the newly grafted tissues. Flat root surfaces were also achieved after the removal of the restorations.
Phase II- Restorative Treatment: After six weeks of healing the teeth were prepared and provisionalized by the restorative dentist. The patient was also allowed to bleach her mandibular teeth. Surgical recontouring of some of the grafted areas was performed during this phase in order to achieve maximum esthetic outcome from the initial periodontal surgery.
Phase III- Restorative Treatment: The final restorations were placed after twelve weeks of healing.
Treatment Phtographs
Above and below: Initial Presentation. Advanced gingival recession is noted on teeth # 4-12 with large bonded composite restorations.
Above: Six weeks after the connective tissue graft procedure.
Note the significant root coverage and the thickness of the gingival tissues.
Above: Twelve weeks post-operative.
Provisional restorations were placed and gingival re-contouring was completed.
Above and below: Final restorations after eighteen weeks of healing.
