Gum Drop Technique - root coverage procedure using A- PRF and I- PRF

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Posted on By Delia Tuttle In Periodontics

Gum Drop Technique- - Minimal Invasive root coverage procedure involving biological factors and stem cells
LESS INVASIVE procedure, GUM DROP TECHNIQUE is a modified Vista tunneling method for root coverage using biological factors (A-PRF / I-PRF) and stem cells. This is a PAPILLA friendly technique !! No more releasing incisions, invasive flaps and iatrogenic black triangles ! Thrive with biology !

Before - front view
After- front view

Right view before
Right view after


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26 Comments

Very nice case, Delia;
What was the cause of the gingival recession? My guess is that there is impingement on the envelop of function.
Regards,
gerald


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Thank you dear Gerald, my patient is a heavy tooth brusher and a bruxer. He is basketball player. The recession progressed in the past year. Delia


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Hi Delia; Patients with the level of gingival recession all look the same..the mandible is locked in. Look at the bicuspids, they are all inclined palatally which narrows the arch. This patient has no choice but to clench. The incisal wear confirms the constricted arch diagnosis This is probably an ortho case. Best regards, gerald


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I can't agree more dear Gerald !! Constricted envelope of function. Patient refused unfortunately treatment until I mentioned the progression of recession. Also he lost a lots of enamel as well possible due acidic drinks and aggressive brushing ( sports players drink a lot of Gathorade). He is not interested in Ortho .. but he is wearing a night guard .... Thank you so much


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Delia; Welcome to Dentalxp Forum. No denying the success of the outcome here. Well done. Can you add a few representative images of the technique? Also, how far out have you followed these cases? What percentage relapse? Gerald you are quite right here regarding the potential occlusal issues that may require correction or management. regards Maurice


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Thank you D.Maurice for the warm welcoming.I am working on my technique for the past 2 years but I have well documented cases for 10 months now. I performed the procedure on 53 sites documented with good results.We need 2 mm keratinized tissue to be able to perform this procedure. The plasma exudate brings in more than 150 growth factors especially FGF and VEGF. I am using these factors in the same concept as Emdogain. The vascularization is key for success for any grafting procedure. Gum drop is a pedicle flap and I am improving on top of it the vascularization by the growth factors and by the managment of the pressure from the flap using an apical suture. I am following Pino Prato's concept from the literature regarding the coronal replacement of the flap in regards to CEJ. The fibrin is a recipient for growth factors and I-PRF will release thousands of stem cells into the area.The fibrin glue will get a gelatin effect of the A-prf membranes and sutures will stabilized it in place. I am excited to share more cases with Dental Xp members.Thank you for your kind remarks Dr.MAURICE


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Nice result Delia, always if you´ve take control of the etiologic factors that were responsable for those recessions.

Have more pictures of the technique?

Congrats and thanks to share this technique with us
Warm regards


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Delia that is an awesome result!

what strikes me is that apart from the root coverage it appears that the soft tissue has increased in thickness as well!

Yiannis


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Thank you Dr. Yiannis!! It's all about the pink :) I love soft tissue management !!! I am excited about your VIP system as well !!! Warm regards !


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Thank you Marcelo !! I have thousands of pictures :) yes , I addressed the factors


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Delia congratulations on a very nice case and results with your approach. I agree with Geralds point of view, I think in this type of cases Orthodontic therapy would aloud a better control of the etiologic factors and be on a safer side for the future maintenance of the surgical results. Sometimes patients don't want to go for Orthodontic therapy, and we end up doing occlusal guards on them with a strict maintenance protocol.
Another point of discussion here would be the aid of performing a soft tissue graft and increase the Biotype. Certainly it would be better to have a thicker biotype to maintain the case on the safe side.
Congratulations on a very nice case and initial results,
Thanks for sharing
Regards
Manuel


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Thank you Dr. Manuel !!! I agree with you ! Definitely the biotype is changing !!! I love the texture and the color of the tissue. I am excited to share with you more cases. Thank you for your interest ! Delia


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Gum drop treatment is the process of treating gum recession using biological factors and stem cells. It is considered as a cosmetic procedure and they are not performed on most of the occasions. Most of them perform this procedure in order to improve the smile, and also as a part of periodontal procedures. Almost all the dentists can perform this procedure and are gaining popularity these days.


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Great result Delia. Well done. I assume the technique is full thickness flap and then the PRF in to the hole. How does this differ to Chows pin hole technique besides the use of PRF rather than Collagen membranes. Well done on the result its brilliant to say the least


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Thank you Dr. Howie!!!! It is a full subperisteal flap indeed from the mucosa. I am working only with A-PRF, I like the natural biological approach. The A- prf tubes are without additives and the natural healing process is not disturbed. I follow the CAF benefits combined with scientific literature on A- Prf. PDGF( Platelet derived growth factor) plays an important role on my technique due highly properties of angiogenesis and by recruiting more cells to the surgical field. Adding the growth factors and sutures to my procedures makes the technique successful. Thank you again for your comments !


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Delia, beautiful results, with this minimally invasive technique . The PRF helps a lot.
The only thing I would add to this excelent case for this patient that does not want ortho and have worn out part of the teeht, is to do a minimal composite re-establishment oclusion , to the incisal edges and the canine to develop again a anterior guidance and hopefully a group guidance in the lateral excursions..
This will protect oclusion and help to maintain for long term the results.
Felicitaciones!


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Agree dr. Mariano ! Thank you so much !!!


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Delia, congratulations. Nice outcome! Please tell us your suture technique aplied here. Is like Hürzelers contact point pulling down suture? Do you use VISTA instruments or different, specific ones?
Would you recomend CTGs or Alloderm when less KG is present?
Regards and wellcome to the Forum
Jorge


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Wow. I definitely look forward to trying it in my dental practice. I see that you also eliminated the sutures used in VISTA technique, but I have some questions:
1. What postop instructions do you give to the patients?
2. Does the flap stabilize so well without sutures? Have you ever encountered premature relapses in the first days/weeks after this procedure?
3.Can you, please, tell us more about the instruments you are using and where from can they be purchased?

Thank you, you`re great as always.
Ps: Greetings from Romania :)


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Thank you Dr. Silvio! Thank you ! I am using sutures to follow principles of Pino Prato... without sutures is really not predictable. Post op are the same after any gum grafting procedure. I will be teaching this course in Romania, Bucharest September 23rd, 2017 I will be happy to see you. Delia


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Hello Delia,
Can you give me info for this course- where can i сигн уп.
Thank you!!!


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That sounds great! Hope you'll post on facebook more details about the event when the time comes!


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Hi Delia!! Fantastic case!! Thank you so much for sharing it with us!
I share the same question of Howie, is there any diference between your approach and Chao's pin hole technique?(besides the A-PRF).
How long did you already follow up cases treated with this approach?
big kiss
Bernardo


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Nice to hear from you Dr. Bernardo. I have been working on biological factors for 4 years now, I love it and I found a great formula that works for root coverage. I am very fortunate to work closely with my mentor Dr. Joseph Choukroun. Documented cases I have now for almost 1 year. I am still collecting data. Very good results !!!! It is the future !!! Never took Dr. Chao's course so I can't compare. My technique is Vista modified using solo biological factors. I use tunnel instruments and I created just one instrument to achieve perfect holes. I am teaching now this course at my office for almost 8 months with hands in and live surgeries . Check out www.gumdroptechnique.com.


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A case of Millers class I and class II multiple gingival recession in the maxillary anterior region extending from 13 to 23 was reported to the Department of Periodontics, The Oxford Dental College and Hospital, Bangalore. At the initial visit, thorough scaling and root planing was performed, patient was put on strict oral hygiene maintenance and recalled after 1-week. The VISTA approach began with a vestibular access incision in the midline of the maxillary frenum [Figure 3], which provided access to the entire anterior maxilla [Figure 4]. Subperiosteal tunnel was created by passing the incision through the periosteum and inserting a periosteal elevator between the periosteum and bone through the vestibular access incision. To mobilize gingival margins and facilitate coronal repositioning, the tunnel was extended at least one or two teeth beyond the teeth requiring root coverage. In order to achieve a low-tension coronal repositioning of the gingiva, the tunnel was sufficiently elevated beyond the mucogingival junction as well as through the gingival sulci of the teeth being augmented. Subperiosteal tunnel extension was carried out interproximally also below each papilla without making any surface incisions. Freshly prepared platelet-rich fibrin (PRF) membrane was then trimmed to fit the dimensions of the recipient site and the width was adjusted to extend at least 3-4 mm beyond the bony dehiscence's overlying the root surfaces. The PRF membrane was then carefully inserted into the subperiosteal tunnel and repositioned below the gingival margin of each tooth. The membrane and mucogingival complex were then advanced coronally and stabilized in the new position with a coronally anchored suturing technique. Direct interrupted sutures at approximately 2-3 mm apical to the gingival margin of each tooth were placed using 3-0 silk suture. Sutures were tied, and the knots positioned at the mid coronal point of each tooth and stabilized at that position by placing composite stops. Periodontal dressing was placed to cover the surgical site. Patient was prescribed analgesics and was put on strict oral hygiene maintenance. Suture removal was done after 10 days. After 6 months of follow-up, it was noticed that 91% of root coverage was achieved. You can visit at https://www.dentistanyc.com/


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Delia. Great result and technique! I expanded my use of modified tunnel and other minimally invasive techniques for many Periodontal and implant applications. Congrats. Warm regards. Chuck


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