Çoklu Diş Eti Çekilmelerinin Modifiye Tünel ve Modifiye VISTA Teknikleri ile Tedavisi: Bir Vaka Raporu

Yıl 2020, Cilt: 1 Sayı: 1, 48 - 53, 17.12.2020

Dicle Altındal , Hacer Şahin Aydınyurt

Öz

Diş eti çekilmesi (DÇ), diş eti kenarının travma, inflamasyon veya çeşitli anatomik faktörler nedeniyle mine-sement sınırına göre apikale doğru yer değiştirmesidir. Böylece tek veya birden çok dişin labial veya lingual/palatinal kök yüzeylerinin açığa çıkmasına neden olur. Periodontolojinin uzun dönem hedeflerinin arasında da bu kök yüzeyleri kapatmak yer almaktadır. DÇ dentin hassasiyeti, kök çürükleri ve oral hijyenin idame ettirilememesine neden olabildiği gibi yarattığı estetik problemler, hastayı hekime getiren nedenlerin başında yer almaktadır. Protetik ve restoratif yöntemlerle tedavi edilebilmekle beraber kabul edilebilir biyolojik sonuçlara sahip oldukları için cerrahi yöntemler DÇ için tercih edilmektedir. Cerrahi yönteme bağ dokusu grefti (BDG) ilavesinin tam kök kapamada en iyi sonucu sağlayacağı bildirilmiştir. BDG’nin kullanıldığı koronale ve laterale pozisyone flepler, çift papil flebi, semilunar flep gibi flep tasarımlarının yanında son dönemlerde papiller bütünlüğe saygı duyacak şekilde çeşitli flep tasarımları önerilmiştir. Modifiye tünel ve modifiye vestibüler insizyon subperiostal tünel erişimi (VISTA) teknikleri bunlardan ikisidir. Bu vaka raporunda bağ doku grefti ile bu iki teknik kullanılarak, hassasiyet ve estetik şikayetlerle kliniğimize başvuran hastanın maksiller bölgedeki iki taraflı çoklu DÇ’in tedavisi ve 9 aylık takibi sunulmaktadır.

Anahtar Kelimeler

Diş eti çekilmesi, bağ doku grefti, mukogingival cerrahi

Treatment of Multiple Gingival Recessions with Modified Tunnel and Modified VISTA Techniques: A Case Report

Öz

Gingival recession (GR) is the displacement to apical shift of the gingival margin respect to the enamel-cementum junction due to trauma, inflammation or various anatomical factors. Thus, it causes the labial or lingual/palatinal root surfaces of single or multiple teeth to be exposed. One of the long-term aims of periodontology is to cover these root surfaces. As GR may cause dentin sensitivity, root caries and failure to maintain oral hygiene, the aesthetic problems they create are among the main reasons that bring the patient to the physician. Although they can be treated with prosthetic and restorative methods, surgical methods are preferred for GR because they have acceptable biological results. It has been reported that the addition of the connective tissue graft (CTG) to surgical method will provide the best result to achieve complete root closure. In addition to flap designs such as coronally and laterally positioned flaps, double papillary flaps, semilunar flaps in which CTG is used, various flap designs have recently been proposed to respect papillary integrity. Modified tunnel and modified vestibular incision subperiosteal tunnel access (VISTA) techniques are two of them. In this case report, the treatment of bilateral multiple GR in the maxillary region of the patient who applied to our clinic with sensitivity and aesthetic complaints using these two techniques with CTG and 9-month follow-up is presented.

Anahtar Kelimeler

Gingival recession, connective tissue graft, mucogingival surgery

Kaynakça

• 1. Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000. 2015;68(1):333-368.
• 2. Gorman WJ. Prevalence and etiology of gingival recession. J Periodontol. 1967;38(4):316-322.
• 3. Pini Prato G, Clauser C, Tonetti MS, Cortellini P. Guided tissue regeneration in gingival recessions. Periodontol 2000. 1996;11(1):49-57.
• 4. Sullivan HC, Atkins JH. Free autogenous gingival grafts. 3. Utilization of grafts in the treatment of gingival recession. Periodontics. 1968;6(4):152-160.
• 5. Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol. 2002;29(3):178- 194.
• 6. Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol. 2014;41(15):44-62.
• 7. Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. II. Clinical results. Int J Periodontics Restorative Dent. 1994;14(4):302–315.
• 8. Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique. Int Periodontics Restorative Dent. 1994;14(4):216–227.
• 9. Zabalegui I, Sicilia A, Cambra J, Gil J, Sanz M. Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: A clinical report. Int J Periodontics Restorative Dent. 1999;19(2):199–206.
• 10. Azzi R, Etienne D, Takei H, Fenech P. Surgical thickening of the existing gingiva and reconstruction of interdental papillae around implant-supported restorations. Int J Periodontics Restorative Dent. 2002;22(1):71–77.
• 11. Azzi R, Etienne D. Recouvrement radiculaire et reconstruction papillaire par grefon conjonctif enfoui sous un lambeau vestibulaire tunnelise et tracte coronairement. J Parodontol Implantol Orale. 1998;17:71–77.
• 12. Zuhr O, Fickl S, Wachtel H, Bolz W, Hürzeler MB. Covering of gingival recession with a modified microsurgical tunnel technique: A case report. Int J Periodontics Restorative Dent. 2007;27(5):457–463.
• 13. Zadeh HH. Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet-derived growth factor BB. Int J Periodontics Restorative Dent. 2011;31(6):653-660.
• 14. Fiorellini JP, Kim DM, Ishikawa SO. Clinical features of gingivitis. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA (eds). Carranza’s Clinical Periodontology, ed 10. St Louis: Saunders. 2007:224–231.
• 15. Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(S20): S190-S198.
• 16. Santamaria MP, Neves F, Silveira CA, et al. Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions: a randomized clinical trial. J Clin Periodontol. 2017;44(5):540-547.
• 17. Thalmair T, Fickle S, Wachtel H. Coverage of Multiple Mandibular Gingival Recessions Using Tunnel Technique with Connective Tissue Graft: A Prospective Case Series. Int J Periodontics Restorative Dent. 2016;36(6):859-867.
• 18. Tözüm TF, Keçeli HG, Güncü GN; Hatipoğlu H, Sengün D. Treatment of gingival recession: comparison of two techniques of subepithelial connective tissue graft. J Periodontol. 2005;76(11):1842-1848.
• 19. Pini Prato GP, Magnani C, Chambrone L. Long-term evaluation (20 years) of the outcomes of coronally advanced flap in the treatment of single recession-type defects. J Periodontol. 2018; 89(3):265–274.
• 20. Cortellini P, Buti J, Pini Prato G, Tonetti MS. Periodontal regeneration compared with access flap surgery in human intrabony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs. J Clin Periodontol. 2017;44(1):58–66.
• 21. Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P. Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. J Clin Periodontol. 2010;37(7):644–650.