Three Years Follow Up of a Combined Periodontal and Endodontic Therapy in a Patient with Severe Gingival Recession: A Case Report

Case Report

Austin J Dent. 2016; 3(2): 1036.

Three Years Follow Up of a Combined Periodontal and Endodontic Therapy in a Patient with Severe Gingival Recession: A Case Report

Akpinar KE1*, Marakoğlu I2 and Akpinar KE3

1Department of Periodontology, Cumhuriyet University, Turkey

2Department of Periodontology, Selçuk University, Turkey

3Department of Endodontic, Cumhuriyet University, Turkey

*Corresponding author: Aysun Akpinar, Department of Periodontology, Cumhuriyet University, 58140-Sivas, Turkey

Received: May 10, 2016; Accepted: June 20, 2016; Published: June 22, 2016


In this case report, the treatment of an advanced gingival recession leaving open the lower right central root tip due to trauma with combined endodontic and mucogingival techniques were presented.

After phase I periodontal treatment, endodontic treatment were performed. Gingival recession was treated with lateral sliding flap operation and the patient was taken under observation. At third week after operation, discoloration of tooth was treated with commercial bleaching kit.

After three years following, an optimal gingival health was maintained with the normal sulcus depth and the esthetic pleasure is satisfactory.

Keywords: Gingival recession; Lateral sliding flap; Apical resection


Gingival recession is defined as the displacement of the gingival margin to apical from the cementoenamel junction. It is characterized by the loss of periodontal connective tissue fibers, along with tooth cementum and alveolar bone [1,2]. Reports on prevalence range from 14 to 90 percent, depending on the population being studied [3]. The main causes of gingival recession are periodontal disease, improper oral hygiene, frenal pull, bone dehiscence, improper restorations, tooth mal position, sub gingival calculus formation and trauma. Recession of gingival tissue causes root hypersensitivity, poor esthetic appearance and cervical root caries. Gingival recession defects are typically treated by periodontal plastic surgery to correct or eliminate the deformities of the gingival mucosa [1,4,5].

To cover exposed root surfaces, various mucogingival procedures have been used successfully, including pedicle flaps, free soft tissue grafts, and guided tissue regeneration procedures. A review of the literature shows that these procedures may result in mean root coverage between 62% and 89% of the original defect [6]. Lateral sliding flap operation is one of pedicle flaps and it was developed by Gruope and Warran [7] at 1956. This technique is a microgingival surgery technique when used in the condition that there is enough donor tissue at lateral side of the operation area.

Endodontic-periodontal lesions can provide many challenges to clinicians. They are often characterized by extensive loss of periodontal attachment and alveolar bone. It seems that periodontal disease rarely jeopardizes vital functions of the pulp. In teeth with moderate break down of attachment apparatus, the pulp usually remains in proper function. Breakdown of the pulp presumably does not occur until the periodontal disease process has reached a terminal state, i.e. when bacterial plaque involves the main apical foramina [8,9].

In this case report, 3 years follow-up of endodontic-periodontal combined treatment of an advanced level gingival recession with the opening root tip, was presented.

Case Presentation

A 16-year-old Caucasian girl referred to Cumhuriyet University School of Dentistry, Department of Periodontology with complaint of localized gingival recession on the buccal aspect of tooth and discoloration of tooth. The patient was in good health with no contraindication for periodontal therapy. In the intra oral examination, it was determined that a gingival recession (Miller class II) with also denuded root point at buccal side of the teeth was due to trauma on 41(st) tooth which was exposed when she was 9 years old (Figure1). Mobility was observed (periotest value of 18) as a result of trauma. Although the calculus formation was seen in some areas, a good oral hygiene of the patient was observed. The entire dentition except traumatic teeth had normal structure and pattern.

After phase I periodontal treatment, temporary splint was made at lingual surfaces between 33(rd) and 43(rd) teeth in order to decrease the mobility. After phase I periodontal treatment, root canal treatment was started immediately with access opening and working length determined, calcium hydroxide dressing was given and patient was recalled after a week, after which obturation was done.

The bleaching agent used in this case is a 38% hydrogen peroxide power bleaching gel. Coronal debridement was established, the guttapercha in the root canal was sealed off from the pulp chamber with conventional glass ionomer cement. Opal dam was placed as a barrier for protection of the gingiva from the bleaching agent. The bleaching agent was applied extra coronally on the labial surface of the tooth and intracoronally in the prepared pulp space. The bleaching agent was applied for 15 minutes and agitated every 5 minutes to activate the agent. This was continued for two more cycles. The patient was recalled after a week. (Figure-2).