Lower anteriors recession

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Posted on By Romani Nashid In Soft Tissue Enhancement

Hello mentors and colleagues,
55 yr old female with clear medical history presented with lower anterior recession in teeth # 31 and 41 (lower first centrals). She has a good width of Keratinized tissue. I recommended Pinhole Technique to treat but she wants ONLY CTG. A friend of hers had it and she is convinced that this is what she wants. She doesnt even want ACDM. Any advise as to how to proceed. I thought that Pinhole or ACDM would be better option in her case! If CTG is the way to go, should i use palatal or tuberosity? how successful will it be?
Many Thanks

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Romani; Always try to add some radiographs as well to properly evaluate. A PA would assist in a more complete evaluation. 1st, as you said, she does have an adequate zone of KT and minimal recession. this could be treated with many different options successfully. 1. do nothing 2. Restoration with composite resin NO GRAFT 3. CTG from palate 4. CTG with ACDM 5. Tunnel, VISTA or Pinhole would also be effective here. Good luck Dr. Salama


Thanks very much Dr. Salama for your feedback, really appreciate it. Please find attached the PA below. Because the recession is very minimal, I am not sure what would be the best treatment option for her. She said she cares about long term results. Can you please kindly advise which of the options you would you go with if you were treating this case? Thanks again


Why do you think the recession occurred and are you intent on treating this cause?
I would not treat this given the amount of recession is mild at best with a large amount of keratinised tissue. The chance of further recession is low
I might have more concerns with the upper right central.
I would attempt to find and treat the cause if I felt the situation was ongoing


Thanks very much for the feedback Barry. The patient is requesting treatment. I agree with you I find it mild recession with good band of keratinized gingiva. That's why I thought about Pinhole as a rather conservative approach. But when the patients asked for CTG, I was a bit hesitant to treat as I feel it is a bit aggressive treatment option in her case. As for Diagnosis, probably toothbrush abrasion as she thinks she used to brush hard in that area, but not anymore!


I would bond and restore and avoid surgery. This would provide better gingival symmetry. By the way, I do not find Pinhole to be minimally invasive...and I prefer tunnel.


Awesome! Thanks very much Dr. Salama. I am very grateful for this great platform where I get to learn from all the gurus. Regards


I’d personally recommend class V composites. Discuss brushing technique and call it a day. I would not recommend grafting 1.given that the recession is less than 3mm it’s unlikely to gain an adequate amount of coverage 2. Miller class 3/4 defect between the centrals make coverage less likely as well. Otherwise, if she still insists I’d have her see my favorite Periodontist and have fun.


Thanks Brad :)


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