What to do?

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Posted on By Barry Rimmer In Periodontics

I present a 28 yr old non smoker male with a thin periodontal phenotype, his father is a dentist. There is no relevant medical history. OH is excellent accept for some quick build up of tartar on lower anteriors.
My plan is to coronally reposition a flap ala Zuchelli around ul123 ur3. I will be using PRF/PRGF only below flap. However the patient has asked why not all the upper arch even though there is no or very limited recession elsewhere. What would you do if this is your son? Would anyone take cacti prior to treatment to assess bone levels on buccal aspect?

Frontal view
right side view

left side view
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At 28 with this kind of recession I would probably recommend a soft tissue allograft along with the coronally advanced flap. We know caf's can relapse up to 60% at 2 years postop...growth factors are great and will speed up wound healing and minimize inflammation but likely will not thicken the gingival phenotype / biotype. Tissue grafting will and make the gingival more resistant to future recession. These look like mainly miller 1 defects so root coverage is very predictable. Tissue >1.1mm thick associated with 100% root coverage so I would go ahead and add some while u have the flap ready to advance. Also, possible etiology of traumatic brushing with thin biotype, he has to understand that condition can relapse if tb trauma is not stopped. Just my $0.02, nice case and photos!


KLS Martin