Six year follow-up of a root coverage procedure on a lower molar tooth with lateral pedicle flap
A 62-year-old female patient, presented to the dental clinic with a chief complaint of bad breath along with bleeding gums, difficulty in mastication and inability to maintain deposit free teeth in relation to the right lower back region. On clinical examination, there were local factors present and she had faulty tooth brushing practice. An isolated Miller's Class III recession defect[] was observed in relation to the mesial root of 46 []. Tooth 45 was missing and un-replaced. The edentulous space was slightly collapsed due to mesio-buccal tilting of 46. There was visible food impaction in between 46, 47 and 48. Dental caries was diagnosed distal to 46 and 47. Patient was systemically healthy without any deleterious habits.\nPhase 1 therapy consisting of thorough oral prophylaxis and root planning was performed on 46 and caries was restored. Vitality check showed a non-vital 47. Root canal treatment was done for 47. Oral hygiene practice was corrected and the patient was recalled after a month. Patient maintained a good oral hygiene. LPF was planned for the root coverage and was explained to the patient and an informed consent was obtained.\nThe gingival recession was in relation to the mesial root of 46 and was measured. The dimensions were 4 mm wide and 8 mm deep. Donor site was adjacent edentulous area in relation to 45. There was sufficient width, length and thickness of keratinized tissue present. Oral hygiene and patient maintenance was satisfactory.\nNumber 15 blade was used to make a crestal incision on the adjacent edentulous area in relation to 45 and was extended to make a crevicular incision that crossed the apical area around the gingival recession. Vertical releasing incisions were performed on both sides, one distal to the mesial root of 46 and the other distal to 44. The pedicle flap size was 1.5 times wider than the area of the recession. Vertical incisions were extended to the alveolar mucosa so that the pedicle flap could be reflected sufficiently to enable the lateral displacement without tension. A full thickness flap was then reflected sufficiently from the donor site and displaced without tension at the recipient site. Suturing was done using 4-0 non resorbable silk suture. Area was cleaned and Coe pack applied [Figures –]. Cap Amoxicillin 500 mg tid, tablet meftal forte tid and chlorhexidine mouth wash thrice daily for 5 days were prescribed. Patient was advised to have a soft diet and avoid brushing in the area of surgery. Sutures were removed after 10 days. Healing was satisfactory.\nAfter completion of the procedure, approximately 7 mm of recession attained clinical attachment gain and adequate width of attached gingiva was appreciated []. After 6 months, coverage increased to 8 mm probably due to creeping attachment []. On review the periodontium looked healthy and the maintenance was satisfactory even after the 3rd year. Hence the next phase of treatment was started.\nFollowing crown preparation, a 4-unit bridge was constructed from 44 to 47 []. Follow-up visits were scheduled 2 months post-operative and subsequently after 4, 5 and 6 years [Figures –]. Maintenance was satisfactory and the gingiva maintained the same level of attachment throughout 6 years without any clinical sign of inflammation.