PMC6374862_01
Patient #1: tooth UL1 presents an anaesthetic discoloration, cervical abrasion, thin gingival biotype, and free gingival margin discrepancy compared to the contralateral tooth.
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fig1
Moreover, UL1 has been previously endodontically treated with an esthetical defect due to discoloration and radicular abrasion, having a buccal gingival margin almost 3 mm more apical than the contralateral (REC 3 mm), a 3 mm PD and showing a medium biotype (Figure 1).
Patient #2: a buccal gingival recession of more than 2 mm is noticed in correspondence with UL3.
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fig2
REC was 4 mm, PD was 2 mm, and a gingival biotype was detailed as a medium (Figure 2).
PMC6374862_02
Central incisor was endodontically treated, restored with a composite post, and prosthetically prepared with a vertical finishing line.
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fig3
The tooth had vertical preparation, and temporary crown margins were adapted at first at the free gingival margin position (Figures 3 and 4).
Temporary crown was delivered, and its cervical margin was located at the free gingival baseline position.
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fig4
The tooth had vertical preparation, and temporary crown margins were adapted at first at the free gingival margin position (Figures 3 and 4).
Temporary crown margin was 2 mm shortened.
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The temporary crown buccal margin was 2 mm shortened, and the gingival epithelial components (sulcus and the upper part of the junctional epithelium) were gently disephitelized with a diamond flame bur (120-micron granulometry) and the root surface exposed to the oral environment planed and smoothed with manual curettes and washed with saline solution (Figures 5 and 6).
With diamond bur sulcus, junctional epithelium was gently removed, thus creating an induced inflammation.
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fig6
The temporary crown buccal margin was 2 mm shortened, and the gingival epithelial components (sulcus and the upper part of the junctional epithelium) were gently disephitelized with a diamond flame bur (120-micron granulometry) and the root surface exposed to the oral environment planed and smoothed with manual curettes and washed with saline solution (Figures 5 and 6).
After 6 weeks, free gingival margin appeared thicker and an initial creeping can be noticed.
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fig7
After 6 months, the gingival margin reached the temporary crown (Figure 7).
Temporary crown cervical margin was reshaped, mirroring the contralateral, and "stimulation" was performed again.
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fig8
Her buccal margin was shortened and aligned to the contralateral CEJ level, and the gingival margin was stimulated as before with the same postop chemical plaque control (Figure 8).
10 month picture: central incisors free gingival margin was at the same level; creeping occurred on UL1, with the thickening of the biotype.
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fig9
Impressions were taken and a zirconia-ceramic definitive crown was cemented to the tooth (Figure 9).
A definitive zirconia-ceramic crown was cemented (note the scalloped gingival architecture without scars or color mismatching). Control at 24 months of follow-up.
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fig10
Results were stable at the 2-year follow-up (Figures 10 and 15).
PMC6374862_03
Radicular exposed surface was manually cleaned, and gingival epithelial components adjacent to the tooth were gently removed with a diamond bur.
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fig11
Using the same previous reported protocol, dental sulcus and coronal portion of the junctional epithelium were disephitelized with a diamond flame bur (120-micron granulometry), and the radicular surface was planed and smoothed with a manual curette (Figures 11 and 12).
Marginal bleeding occurred with blood clot formation and stabilization.
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fig12
Using the same previous reported protocol, dental sulcus and coronal portion of the junctional epithelium were disephitelized with a diamond flame bur (120-micron granulometry), and the radicular surface was planed and smoothed with a manual curette (Figures 11 and 12).
Gingival margin was thicker and again stimulated with the same protocol (4 weeks of follow-up).
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fig13
In this second appointment, after local anaesthesia, the gingival margin was again stimulated as described before (Figure 13).
Complete root coverage was achieved by means of an induced creeping attachment at 6 months of follow-up; no scars and no tissue blending could be appreciated.
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fig14
After 6 months, root coverage was reached, with a thick gingival margin and no pathological probing or inflammation (Figure 14).
PMC6374862_04
A definitive zirconia-ceramic crown was cemented (note the scalloped gingival architecture without scars or color mismatching). Control at 24 months of follow-up.
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fig10
Results were stable at the 2-year follow-up (Figures 10 and 15).
Stability of the root coverage on UL3 after 24 months.
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fig15
Results were stable at the 2-year follow-up (Figures 10 and 15).