CAF went wrong

44 Rating(s).


Posted on By Michel Azer In Failures

As humans we make mistakes also as humans we don’t show the failures. Today I taking advantage of being part of a very critical and constructive group like XP, I am sharing a case of mine and I am expecting guidance as to what went wrong and how to count for it next time.

Patient came in to uncover implant #12 and root coverage of #11. CAF+CTG was the technique of choice to gain access to the implant as well as gain enough mobilization of the tissues without the need to extend vertically.

Initial presentation
Implant uncovering + CAF

Another close up look


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8 Comments

Bro,
This really is the biggest advantage to this forum. So many times I shared complications and cases that I was not sure how to proceed with, and XP was always there for me.
As far as your surgical execution here, I don't think there is much to improve on. Your technique is spotless!!
But here are the three main points that come to mind.
-I have learned to stay away from situations where I am coronally advancing and apically positioning the same flap. Can be cumbersome in my hands.
-I believe this a class 3 Miller defect with slight rotation of the tooth, I don't believe complete coverage can be achieved here IMHO.
-looks like you had some Ischemia/necrosis of the flap in that area, possibly due to the pressure from suture and superimposed by plaque accumulation?

These are just my two cents. Thank you for sharing this case from which we will all learn.

Regards,
Ehab


Reply

Bob your comments always amaze me!
You are right about Miller class III defects is more challenging in the presence of some rotation of the root. I agree on the ischemia on the mesial of the flap, do you think putting a slightly loose knot would work better?


Reply

Thank you bro. Not really sure here, suture pressure Vs # of sutures Vs flap thickness. I have had this happen in cases where I did not expect it to. I would think etiology is more multifactorial. Again Micho, beautiful technique and great discussion :)

Ehab


Reply

As usual Bob :)


Reply

Michel, your technique seems to me very nice, although I would prefer a bigger CTG to achieve more vascularisation (it´s all on the root, and has blood supply only from the flap).
But I agree with Ehab that this recession can not be covered completely. If you compare CEJ on the canine and lateral incisor, they are on the same level. The canine seems to be rotated and may be elongated. In cases like this I use to draw to the restorative dentist (according to Zucchelli`s rules) where the future gingiva level is expected (after recession covering) and ask her(him) to make Class V filling to this expected margin.
Thank you for posting, great idea! Let`s hear what XPerts have to say!
Best regards
Snjezana


Reply

Snjezana,
Thank you for the feedback. Do you have the restorative dentist do the class V prior to the surgery? or does it matter at all?


Reply

Michel, yes, I have a restorative dentist to do it. It`s Zuchelli`s recommendation and it looks really better if restoration is done prior to surgery.
Attached you`ll find a case where both sides are done in tunnel technique with CTG. On the right cervical restoration were done after surgery and on the left before surgery.
Thank you for considering my input.
Best regards
Snjezana


Reply

Snjezana, you always have something to learn from thats why I like to ask you questions.

Thanks for sharing!


Reply


KLS Martin
DoWell Dental Products