29 July 2024

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Treatment of Gingival Recession and Root Coverage Outcomes Using Fascia Lata Allograft: A Case Report with Two Years of Follow-Up

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Mucogingival surgery is a procedure for the treatment of gingival recession, which is a shift of marginal gingival tissue to the cementoenamel junction (CEJ), exposing the surface of the root teeth. One treatment for gingival recession is the Langer and Langer bilaminar technique, which involves the use of the fascia lata (FL) membrane. This membrane is harvested from the aponeurosis of the external muscles. The purpose of this case report was to present the clinical results of a 2-year follow-up using the Langer and Langer bilaminar technique modified with FL in a patient with gingival recession.

Recessions are a shift of marginal gingival tissue to the CEJ, which exposes the surface of the root teeth. At the 2-year follow-up, the patient presented with a gingival recession in tooth 41, which resulted in complete root coverage, reaching 83.3%; the amount of keratinized tissue increased to 3 mm in each tooth, changing the gingival biotype from thin to thick and scalloped. This case report supports the use of FL as a successful alternative treatment.

Introduction

Gingival recession is the movement of marginal gingival tissue to the enamel-cement junction (CEJ) and causes exposure to the surface of the root. Gingival recession must be treated to eliminate hypersensitivity, abrasion, fracture, or root caries. Root exposure can be corrected with surgical procedures that provide predictability based on the integrity of the interdental insertion, increasing the possibility of complete root coverage, while loss of interdental insertion reduces the possibility of complete root coverage. To determine treatment and predict root coverage of gingival recession, the classification of the presence of the CEJ and the periodontal phenotype should be considered. A variety of surgical techniques are used to correct gingival recession and reduce root exposure. The type of gingival recession, presence of the CEJ, and presence of clinical periodontal symptoms determine the choice of technique. Different gum recession treatment techniques have varying success rates. Lateral displacement flaps have shown success rates ranging from 34 to 97%. The average coverage of the coronally advanced flap was 97%, and the root coverage of the semilunar coronally positioned flap ranged from 90% to 95%. On the other hand, the tunnel technique has a success rate of 82% for covering localized gingival recessions and 87% for multiple recessions. Vestibular incision subperiosteal tunnel access (VISTA) has an average root coverage of 88% for multiple recessions and a complete root coverage of 67% for multiple recessions. The success rates ranged from 11% to 53% for gingival grafts. The success rate of the subepithelial connective tissue graft technique ranged from 64.4% to 96.6%. In contrast, deepithelialized connective tissue grafts showed an average root coverage of 80.3%. A coverage of 98.4% is achieved with both connective tissue grafts and the tunnel technique. With the use of biomaterials, root coverage with acellular dermal matrix (ADM) was 94%. The xenogenic dermal matrix achieved 75.29% root coverage. Finally, the FL membrane exhibited an average coverage rate of 94.2%. The FL is used to cover roots and is characterized as viscous tissue, forming a functional three-dimensional collagen matrix that surrounds and infiltrates all body structures. The fascial system serves to protect and support muscles and internal organs.

However, its main function is to reduce friction between muscles and the mechanical force generated by the muscle and skeletal system. Comparisons between gingival recession treatments using FL versus autologous connective tissue grafts demonstrated a slight advantage for FL in covering all root surfaces compared to autologous grafts.

Comparison of the use of fascia lata membrane and autologous connective tissue graft for the coverage of gingival recessions at 6 months revealed a slight advantage in terms of the complete root coverage of the autologous graft (94.87 ± 0.14 mm) in comparison to the fascia lata membrane (94.24 ± 0.20 mm). These findings highlight the favorable clinical outcome of both transplants in the treatment of multiple GRs. Therefore, the objective of this case report was to evaluate clinical outcomes after two years of follow-up using the Langer and Langer technique modified with FL.

Authors: Fatima Liliana De Freitas Correia, Beatriz Raquel Yáñez-Ocampo, Cesar Augusto Esquivel Chirino, Daniela Carmona Ruiz, Delina Montes-Sánchez

Source: https://onlinelibrary.wiley.com/