Many Class V abrasion or abfraction lesions are filled with composite resin. The results provide teeth that are no longer sensitive to cold water and prevention of the further breakdown of tooth structures. The disadvantages of the procedure include excessively long looking teeth and marginal leakage of the resin restoration. However, some class V lesions with receded buccal marginal gingiva can be treated with subepithelial connective tissue (CT) graft. Root covering CT graft can be done in most buccal recession (with little interproximal tissue loss) and some lingual recession areas. Most researches have shown CT graft to be an effective way to treat buccal marginal gingiva recession. Once the denuded root is covered with tissue, the tooth will no longer be sensitive to cold.
One must understand that not all recessions can be treated with CT graft. Miller’s classification can be used in predicting success of many recession cases. However, a simpler way to predict where the coronal margin of the grafted tissue will end up is using simple periapical radiographs. On radiographs, we usually find the interproximal bone to be within 2 mm to the CEJ if there was no periodontitis and hence no attachment loss. So if both the mesial and distal crestal bone levels are within 2 mm of the CEJ on a radiograph, 100% root coverage can routinely be achieved. In other words, the most apical point in the buccal margin of the gingiva is usually in line with the mesial and distal bone levels.
- Before Surgery
- After Surgery #22, 27
If you are considering a root coverage procedure with severe interproximal bone loss, you will see disappointing results. If your periodontist promises you that he or she can achieve 100% with such cases, he or she is either inexperienced or is only trying make some bucks at the cost of you and your patient. Most periodontist will, however, call you back and kindly remind you that such cases can not be worked on.
After the surgery, the patient will be advised not to brush and touch the surgical area for a few weeks. When the surgical area has healed completely, the probing depth of the surgical covered area is usually less than 3 mm, most of them 1 mm or less. The donor palatal site usually heals within 2-4 weeks depending on the harvesting technique. If you have a class V lesion that needs restoration, consider the root coverage procedure. The CT grafting usually provides better esthetics since the tooth will be given a natural corono-apical dimension.