Running head: GINGIVAL RECESSION TREATMENTS 1

Gingival Recession Treatments

By

Kari Burdick and Kelsey Hull

Lake Washington Institute of Technology

In partial fulfillment

of the requirements for

DHYG 324: Ethics and Jurisprudence

Agatha Stavnesli, RDH, BS, ©MS

Spring 2018
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Introduction

Periodontal health is a cornerstone of dental hygiene. A lot of the focus of preventive

treatment is geared towards preventing loss of both attached tissue and bone. However, loss of

attached tissue is common and there are multiple techniques and methods for treatment. A

subepithelial connective tissue graft (CTG) has been accepted as the gold standard treatment for

patients with recession of at least 2 mm without decay or existing restorations in the gingival

region (Chambrone, Chambrone, Chambrone, Lima, & Pustiglioni, 2008). Newer techniques,

like the Chao Pinhole Surgical Technique (PST) have been introduced and patients are intrigued

by the appeal of a less invasive treatment option. It is necessary to examine the existing research

to assess whether other treatment options like the PST are as successful as the CTG in order to

inform the patient of the pros and cons of treatments.

Recession is a very common issue among many different types of patients. While for

some it’s due to lack of proper oral hygiene care, in others it could be related to brushing too

hard and aggressively which can cause gingival distress. Regardless of why patients have

recession, the need to cover exposed root surfaces is the same. Exposed roots can increase the

risk of hypersensitivity, the chance for root caries, and future loss of alveolar bone height.

However, many patients also elect to have gingival grafting procedures done because of esthetic

concerns.

Body

The CTG is “the most commonly used and most successful root coverage procedure.”

(Pandit, Khasa, Gugnani, Malik, & Bali, 2016). This is because of the high predictability of the

procedure and the reliable results that are achieved. The process of performing a CTG involves
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utilizing a region of hard palatal tissue with at least 3.0 mm of soft tissue thickness. A flap of the

selected palatal tissue is created by making “two parallel incisions, 1.5 mm to 2.0 mm apart” and

“approximately 3.0 mm distance from the gingival margin.” (Leve, 2001) The tissues between

the two incisions are then dissected out and the epithelial layer is removed extra-orally (Leve,

2001). Once the epithelial tissue layer is removed, it is placed over the exposed root surface up

to the cementoenamel junction and “sutured through the graft and the interdental papilli.” (Leve,

2001). The patient recovery time after a CTG is roughly 2-6 weeks and includes suture removal

and post-operative evaluations.

The PST was invented by Dr. John Chao and patented as a scalpel, suture, and graft free

option to treat gingival recession. It requires making a small 2-3 mm incision to gain access to

the connective tissue, then uses papillary elevators to free the papilla around the tooth being

treated and moving a flap coronally past the CEJ of the tooth, and finally the tissue is secured in

place using a resorbable membrane (Chao, 2012). The benefits include being able to treat

multiple areas of the mouth in a single appointment, and does not require a secondary harvest

site allowing for minimal postoperative discomfort and a better esthetic result (Reddy, 2017). As

this is less invasive than a CTG, some patients may be more receptive to treating recession in the

early stages before it becomes critical. A small case study done by Dr. Reddy concluded that

PST has a success rate of “​96.7% with minimal patient discomfort and maximal esthetic

outcomes” (Reddy, 2017). A larger study was conducted by Dr. Chao and found that the success

rate for achieving 80-10% coverage of the defects (recession) was 94% for class I-II recession

sites(Chao, 2012).
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Both of the procedures have many benefits but also negatives. The CTG is incredibly

reliable and has a long record of producing optimal results. However, the procedure is fairly

invasive and requires larger incisions and a longer recovery time. Typically, it is not possible to

do the procedure on more than one area in the mouth because of the amount of epithelial tissue

needed from the hard palate. Since the PST is a graft-free procedure, it is less invasive and the

recovery time is minimal. This could make the PST a more appealing procedure to patients and

may increase the likelihood that patients elect to have grafting done when recession begins, to

halt attachment loss, instead of waiting until it is absolutely necessary. While it seems that the

PST may be a better procedure and could possibly replace the CTG as the gold standard, this

procedure is very new and the amount of research about the reliability of the procedure is

minimal.

Conclusion

Covering exposed root surfaces affected with recession can be both aesthetically pleasing

for the patient as well as functionally important for their oral health. The CTG is the gold

standard for treating gingival recession but through research new procedures are being explored

to find a less invasive method. The PST is a new procedure that has shown promise in competing

with the CTG. Patients have experienced great results without having a tissue graft and multiple

areas of the mouth can receive treatment during one appointment. While the PST could

potentially become the gold standard, it needs more positive outcomes to prove it is just as

reliable and as good of an option as CTG.

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REFERENCES:

Chambrone, D., Chambrone, L., Chambrone, L.A., Lima, L.A., Pustiglioni, F.E. (2008). Can
subepithelial connective tissue grafts be considered the gold standard procedure in the
treatment of Miller Class I and II recession-type defects? ​Journal of Dentistry, 36​(9),
659-671. Retrieved from https://doi.org/10.1016/j.jdent.2008.05.007

Chao, J.C., (2012). A novel approach to root coverage: The pinhole surgical technique.​ The
International Journal of Periodontics and Restorative Dentistry, 32​(5), 521-529.
Retrieved from pinholesurgicaltechnique.com

Gugnani, S., Pandit, N., Khasa, M., Malik, R., & Bali, D. (2016). Comparison of two techniques
of harvesting connective tissue and its effects on healing pattern at palate and recession
coverage at recipient site. ​Contemporary Clinical Dentistry,7​(1), 3.
doi:10.4103/0976-237x.177099

Leve, R. (2001). PERIODONTIC DENTISTRY: The Subepithelial Connective Tissue Graft.

Oral Health​. Retrieved June 3, 2018, from www.oralhealthgroup.com

Reddy, S. S. P. (2017). Pinhole Surgical Technique for treatment of marginal tissue recession: A
case series. ​Journal of Indian Society of Periodontology​, ​21​(6), 507–511. Retrieved from
http://doi.org/10.4103/jisp.jisp_138_17