Connective Tissue Graft Wall Technique in Management of Cairo's RT2 and RT3 With Intra-bony Defects
Condition: Recession, Gingival
MeSH terms: Gingival Recession
Study type: Interventional

Summary: 
      Recession presents a day to day challenge due to the high esthetic demand of the patients.
      The prevalence, extent, and severity of recession associated with intra-bony defects due to
      periodontitis increases with age rendering the success of the root coverage procedures
      questionable due to loss of interdental papillary support. .

      Therefore, connective tissue graft wall technique in cases of Cairo's RT2 and RT3 gingival
      recession associated with intra bony defects seems promising with regard to recession depth
      reduction and radiographic bone fill.
    

Detailed description: 
      Recession is usually treated by an array of mucogingival surgical techniques. The choice of
      the procedure depends on the morphology of the recession defect. Full root coverage in RT2
      and RT3 gingival recession defects cannot always be predictably achieved due to the presence
      of bone loss. Improvement is further complicated when these recessions are associated with
      intra-bony defects as mucogingival surgical techniques are not designed to treat intra-bony
      defects. The preferred surgical modality for treatment of intrabony defects is guided tissue
      regeneration. However when considering recession defects, the amount of root coverage
      achieved by GTR may be limited with less results achieved.

      Most of the root coverage procedures have proven to be successful, however, when recession is
      associated with intrabony defect especially in cases of low height and thickness of
      keratinized tissue and GTR is performed, the treatment results were unpredictable and it was
      found that the recession might increase post-surgically, so the procedure might offer a
      limited benefit.

      Therefore, the technique introduced by Zucchelli et al. in 2014 in cases of RT2 and RT3
      gingival recession associated with intra bony defects seems promising with regard to
      recession depth reduction and radiographic bone fill. A simplified papilla preservation
      technique was performed on the defect site, a de-epithelialized free gingival graft was used
      to treat the gingival recession present and intrabony defects because it acted as a membrane,
      creating a buccal wall to the intra-bony defect from one side and on the palatal aspect since
      no flap elevation was done. The palatal connective tissue acted as a palatal wall preventing
      gingival epithelium and connective tissue from contacting the space created allowing both
      improved root coverage and bone fill. He reported interproximal probing depth reduction,
      clinical attachment gain, improvement in the papilla covering the intrabony defect regarding
      the gingival thickness and root coverage and complete bone fill was shown radiographically in
      1 year.

      This technique needs more investigations, but it seems encouraging to improve regenerative
      and esthetic parameters in the treatment of deep infrabony defects, in one surgical session.
    

Intervention name(s): De-epithelialized connective tissue graft wall
Intervention type(s): Procedure
Intervention description(s): A de-epithelialized free gingival connective tissue graft will be used to treat Cairo's recession type 2 and type 3 associated with inta-bony defects
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment