Diş Eti Çekilmeleri ve Güncel Yaklaşımlar
Özet
Bu bölümde diş eti çekilmeleri, etiyolojisi, sınıflandırılması, klinik değerlendirme yöntemleri ve güncel tedavi yaklaşımları kapsamlı olarak ele alınmaktadır. Diş eti çekilmeleri; periodontal hastalıklar, travmatik fırçalama, anatomik faktörler ve iatrojenik nedenler gibi çok faktörlü etiyolojik unsurların etkisiyle ortaya çıkan önemli bir klinik problemdir. Bu durum hem estetik kaygılara hem de dentin hassasiyeti ve kök çürüğü gibi fonksiyonel problemlere yol açabilmektedir. Bölümde, çekilmelerin oluşum mekanizmaları ve farklı sınıflandırma sistemleri detaylı olarak açıklanmakta; klinik ölçüm yöntemleri ve tanı kriterleri ele alınmaktadır. Ayrıca lateral kaydırılan flep, koronal kaydırılan flep, serbest diş eti grefti, subepitelyal bağ dokusu grefti ve yönlendirilmiş doku rejenerasyonu gibi güncel cerrahi tedavi yöntemleri bilimsel veriler ışığında incelenmektedir. Tedavi planlamasında bireysel hasta özelliklerinin ve defekt tipinin dikkate alınmasının önemi vurgulanmaktadır.
This chapter provides a comprehensive overview of gingival recession, including its etiology, classification, clinical assessment, and current treatment approaches. Gingival recession is a multifactorial condition associated with periodontal disease, traumatic toothbrushing, anatomical factors, and iatrogenic causes. It may lead to both esthetic concerns and functional problems such as dentin hypersensitivity and root caries. The chapter discusses the mechanisms of recession development and various classification systems, along with clinical diagnostic and measurement methods. Contemporary surgical treatment modalities, including laterally positioned flap, coronally advanced flap, free gingival graft, subepithelial connective tissue graft, and guided tissue regeneration, are evaluated based on current evidence. Emphasis is placed on individualized treatment planning according to defect characteristics and patient-specific factors to achieve predictable clinical outcomes.
Referanslar
Lang, N. P., & Lindhe, J. (Eds.). (2015). Clinical periodontology and implant dentistry, 2 Volume Set. John Wiley & Sons.
Strauss, F. J., Marruganti, C., Romandini, M., Cavalla, F., Neira, P., Jiménez, F. J., ... & Gamonal Aravena, J. (2023). Epidemiology of mid‐buccal gingival recessions according to the 2018 Classification System in South America: Results from two population‐based studies. Journal of Clinical Periodontology, 50(10), 1336-1347.
Cortellini, P., & Bissada, N. F. (2018). Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. Journal of periodontology, 89, S204-S213.
Seong, J., Bartlett, D., Newcombe, R. G., Claydon, N. C. A., Hellin, N., & West, N. X. (2018). Prevalence of gingival recession and study of associated related factors in young UK adults. Journal of dentistry, 76, 58-67.
Hall, W. B. (1977). Present status of soft tissue grafting. Journal of periodontology, 48(9), 587-597.
Tugnait, A., & Clerehugh, V. (2001). Gingival recession—its significance and management. Journal of dentistry, 29(6), 381-394.
Postnikov, M. A., Vinnik, A. V., Rakhimov, R. R., Kostionova-Ovod, I. A., & Vinnik, S. V. (2022). Etiopathogenesis of gum recession: the current aspects. Aspirantskiy Vestnik Povolzhiya, 22(4), 27-32.
Novaes, A. B., Ruben, M. P., Kon, S., Goldman, H. M., & Novaes Jr, A. B. (1975). The development of the periodontal cleft: a clinical and histopathologic study. Journal of periodontology, 46(12), 701-709.
Wang, I. C., Chan, H. L., Johnson, G. K., & Elangovan, S. (2022). Assessment of negative gingival recession: a critical component of periodontal diagnosis. Applied Sciences, 12(14), 7015.
Baghele, O. N., & Bezalwar, K. V. (2022). A study to evaluate the prevalence of teeth without clinically detectable mucogingival junction. Journal of Indian Society of Periodontology, 26(2), 162-168.
Scarfe, W. C., Farman, A. G., & Sukovic, P. (2006). Clinical applications of cone-beam computed tomography in dental practice. Journal-Canadian Dental Association, 72(1), 75.
Imber, J. C., & Kasaj, A. (2021). Treatment of gingival recession: when and how?. International dental journal, 71(3), 178-187.
Guttiganur, N., Aspalli, S., Sanikop, M. V., Desai, A., Gaddale, R., & Devanoorkar, A. (2018). Classification systems for gingival recession and suggestion of a new classification system. Indian Journal of Dental Research, 29(2), 233-237.
Cairo, F., Nieri, M., Cincinelli, S., Mervelt, J., & Pagliaro, U. (2011). The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. Journal of clinical periodontology, 38(7), 661-666.
Pini‐Prato, G. (2011). The Miller classification of gingival recession: limits and drawbacks. Journal of clinical periodontology, 38(3), 243-245.
Holtzman, L. P., Blasi, G., Rivera, E., Herrero, F., Downton, K., & Oates, T. (2021). Gingival thickness and outcome of periodontal plastic surgery procedures: a meta-regression analysis. JDR Clinical & Translational Research, 6(3), 295-310.
Dym, H., & Tagliareni, J. M. (2012). Surgical management of cosmetic mucogingival defects. Dental Clinics, 56(1), 267-279.
De Sanctis, M., & Clementini, M. (2014). Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. Journal of clinical periodontology, 41, S108-S122.
Zucchelli, G., Cesari, C., Amore, C., Montebugnoli, L., & De Sanctis, M. (2004). Laterally moved, coronally advanced flap: A modified surgical approach for isolated recession‐type defects. Journal of periodontology, 75(12), 1734-1741.
Wong, D. H. (2019). Mucogingival and periodontal plastic surgery: lateral sliding flaps. In Advances in Periodontal Surgery: A Clinical Guide to Techniques and Interdisciplinary Approaches (pp. 177-189). Cham: Springer International Publishing.
Carranza, N., & Rojas, M. A. (2019). Treatment of an advanced gingival recession involving the apex of the tooth: Periodontal plastic, endodontic surgical approach with a laterally stretched flap and a connective tissue graft. Clinical Advances in Periodontics, 9(2), 70-76.
Mathew, M. P., Pratebha, B., & Jannani, M. (2020). Frenectomy with Laterally Displaced Flap. Journal of Scientific Dentistry, 5(1), 52-55.
Pini Prato, G., & Di Gianfilippo, R. (2023). Challenges and success in periodontal plastic surgery. Journal of Clinical Periodontology, 50(12), 1572-1581.
Jahnke, P. V., Sandifer, J. B., Gher, M. E., Gray, J. L., & Richardson, A. C. (1993). Thick free gingival and connective tissue autografts for root coverage. Journal of periodontology, 64(4), 315-322.
Santana, R. B., Mattos, C. M., & Dibart, S. (2010). A clinical comparison of two flap designs for coronal advancement of the gingival margin: semilunar versus coronally advanced flap. Journal of clinical periodontology, 37(7), 651-658.
Tarnow, D. P. (1986). Semilunar coronally repositioned flap. Journal of clinical periodontology, 13(3), 182-185.7
Mavi, S. Journal of Clinical Case Studies, Reviews & Reports.
Thompson, B. K., Meyer, R., Singh, G. B., & Mitchell, W. (2000). Desensitization of exposed root surfaces using a semilunar coronally positioned flap. General Dentistry, 48(1), 68-71.
Prato, G. P., Tinti, C., Vincenzi, G., Magnani, C., Cortellini, P., & Clauser, C. (1992). Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession. Journal of periodontology, 63(11), 919-928.
Cortellini, P., Prato, G. P., DeSanctis, M., Baldo, C., & Clouser, C. (1991). Guided tissue regeneration procedure in the treatment of a bone dehiscence associated with a gingival recession: a case report. International Journal of Periodontics & Restorative Dentistry, 11(6).
Grupe, H. E., & Warren Jr, R. F. (1956). Repair of gingival defects by a sliding flap operation. The Journal of Periodontology, 27(2), 92-95.
Shetty, N. J. (2013). Double papilla repositioned flap for the treatment of isolated recession–A case report. Singapore Dental Journal, 34(1), 25-27.
Acunzo, R., Pagni, G., Fessi, S., & Rasperini, G. (2015). Modified double papillae flap technique: a new surgical approach for the treatment of isolated gingival recession defects. A case series. Int J Esthet Dent, 10, 258-68.
Harris, R. J., Miller, L. H., Harris, C. R., & Miller, R. J. (2005). A comparison of three techniques to obtain root coverage on mandibular incisors. Journal of periodontology, 76(10), 1758-1767.
Arzouman, A., Deas, D. E., Mills, M. P., Huynh‐Ba, G., Prihoda, T. J., & Mealey, B. L. (2021). Impact of different surgical protocols on dimensional changes of free soft tissue autografts: A randomized controlled trial. Journal of periodontology, 92(1), 45-53.
Zucchelli, G., Tavelli, L., McGuire, M. K., Rasperini, G., Feinberg, S. E., Wang, H. L., & Giannobile, W. V. (2020). Autogenous soft tissue grafting for periodontal and peri‐implant plastic surgical reconstruction. Journal of periodontology, 91(1), 9-16.
De Sanctis, M., & Zucchelli, G. (2007). Coronally advanced flap: A modified surgical approach for isolated recession‐type defects: Three‐year results. Journal of clinical periodontology, 34(3), 262-268.
Esfahani, N. N., Khorsand, A., & Salehimonfared, S. M. (2021). The influence of harvesting free gingival graft on self-reported pain perception: a randomized two-arm parallel clinical trial. Journal of Dental Sciences, 16(1), 410-416.
Francetti, L., Del Fabbro, M., Testori, T., & Weinstein, R. L. (2004). Periodontal microsurgery: report of 16 cases consecutively treated by the free rotated papilla autograft technique combined with the coronally advanced flap. International Journal of Periodontics & Restorative Dentistry, 24(3).
Liu, H., Liu, J., Guo, M., Chen, X., & Chen, M. (2023). Protocol: Two-stage method of free gingival graft prior to periodontal regenerative surgery for the treatment of intrabony defects with insufficient keratinised tissue width: a study protocol for an open-label randomised controlled trial. BMJ Open, 13(7).
Oh, S. L., Masri, R. M., Williams, D. A., Ji, C., & Romberg, E. (2017). Free gingival grafts for implants exhibiting lack of keratinized mucosa: a prospective controlled randomized clinical study. Journal of Clinical Periodontology, 44(2), 195-203.
Patur, B. (1977). The rotation flap for covering denuded root surfaces-a closed wound technique. Journal of periodontology, 48(1), 41-44.
Tackas, V. J. (1995, January). Root coverage techniques: a review. In The Journal of the Western Society of Periodontology/Periodontal abstracts (Vol. 43, No. 1, pp. 5-14).
Referanslar
Lang, N. P., & Lindhe, J. (Eds.). (2015). Clinical periodontology and implant dentistry, 2 Volume Set. John Wiley & Sons.
Strauss, F. J., Marruganti, C., Romandini, M., Cavalla, F., Neira, P., Jiménez, F. J., ... & Gamonal Aravena, J. (2023). Epidemiology of mid‐buccal gingival recessions according to the 2018 Classification System in South America: Results from two population‐based studies. Journal of Clinical Periodontology, 50(10), 1336-1347.
Cortellini, P., & Bissada, N. F. (2018). Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. Journal of periodontology, 89, S204-S213.
Seong, J., Bartlett, D., Newcombe, R. G., Claydon, N. C. A., Hellin, N., & West, N. X. (2018). Prevalence of gingival recession and study of associated related factors in young UK adults. Journal of dentistry, 76, 58-67.
Hall, W. B. (1977). Present status of soft tissue grafting. Journal of periodontology, 48(9), 587-597.
Tugnait, A., & Clerehugh, V. (2001). Gingival recession—its significance and management. Journal of dentistry, 29(6), 381-394.
Postnikov, M. A., Vinnik, A. V., Rakhimov, R. R., Kostionova-Ovod, I. A., & Vinnik, S. V. (2022). Etiopathogenesis of gum recession: the current aspects. Aspirantskiy Vestnik Povolzhiya, 22(4), 27-32.
Novaes, A. B., Ruben, M. P., Kon, S., Goldman, H. M., & Novaes Jr, A. B. (1975). The development of the periodontal cleft: a clinical and histopathologic study. Journal of periodontology, 46(12), 701-709.
Wang, I. C., Chan, H. L., Johnson, G. K., & Elangovan, S. (2022). Assessment of negative gingival recession: a critical component of periodontal diagnosis. Applied Sciences, 12(14), 7015.
Baghele, O. N., & Bezalwar, K. V. (2022). A study to evaluate the prevalence of teeth without clinically detectable mucogingival junction. Journal of Indian Society of Periodontology, 26(2), 162-168.
Scarfe, W. C., Farman, A. G., & Sukovic, P. (2006). Clinical applications of cone-beam computed tomography in dental practice. Journal-Canadian Dental Association, 72(1), 75.
Imber, J. C., & Kasaj, A. (2021). Treatment of gingival recession: when and how?. International dental journal, 71(3), 178-187.
Guttiganur, N., Aspalli, S., Sanikop, M. V., Desai, A., Gaddale, R., & Devanoorkar, A. (2018). Classification systems for gingival recession and suggestion of a new classification system. Indian Journal of Dental Research, 29(2), 233-237.
Cairo, F., Nieri, M., Cincinelli, S., Mervelt, J., & Pagliaro, U. (2011). The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. Journal of clinical periodontology, 38(7), 661-666.
Pini‐Prato, G. (2011). The Miller classification of gingival recession: limits and drawbacks. Journal of clinical periodontology, 38(3), 243-245.
Holtzman, L. P., Blasi, G., Rivera, E., Herrero, F., Downton, K., & Oates, T. (2021). Gingival thickness and outcome of periodontal plastic surgery procedures: a meta-regression analysis. JDR Clinical & Translational Research, 6(3), 295-310.
Dym, H., & Tagliareni, J. M. (2012). Surgical management of cosmetic mucogingival defects. Dental Clinics, 56(1), 267-279.
De Sanctis, M., & Clementini, M. (2014). Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. Journal of clinical periodontology, 41, S108-S122.
Zucchelli, G., Cesari, C., Amore, C., Montebugnoli, L., & De Sanctis, M. (2004). Laterally moved, coronally advanced flap: A modified surgical approach for isolated recession‐type defects. Journal of periodontology, 75(12), 1734-1741.
Wong, D. H. (2019). Mucogingival and periodontal plastic surgery: lateral sliding flaps. In Advances in Periodontal Surgery: A Clinical Guide to Techniques and Interdisciplinary Approaches (pp. 177-189). Cham: Springer International Publishing.
Carranza, N., & Rojas, M. A. (2019). Treatment of an advanced gingival recession involving the apex of the tooth: Periodontal plastic, endodontic surgical approach with a laterally stretched flap and a connective tissue graft. Clinical Advances in Periodontics, 9(2), 70-76.
Mathew, M. P., Pratebha, B., & Jannani, M. (2020). Frenectomy with Laterally Displaced Flap. Journal of Scientific Dentistry, 5(1), 52-55.
Pini Prato, G., & Di Gianfilippo, R. (2023). Challenges and success in periodontal plastic surgery. Journal of Clinical Periodontology, 50(12), 1572-1581.
Jahnke, P. V., Sandifer, J. B., Gher, M. E., Gray, J. L., & Richardson, A. C. (1993). Thick free gingival and connective tissue autografts for root coverage. Journal of periodontology, 64(4), 315-322.
Santana, R. B., Mattos, C. M., & Dibart, S. (2010). A clinical comparison of two flap designs for coronal advancement of the gingival margin: semilunar versus coronally advanced flap. Journal of clinical periodontology, 37(7), 651-658.
Tarnow, D. P. (1986). Semilunar coronally repositioned flap. Journal of clinical periodontology, 13(3), 182-185.7
Mavi, S. Journal of Clinical Case Studies, Reviews & Reports.
Thompson, B. K., Meyer, R., Singh, G. B., & Mitchell, W. (2000). Desensitization of exposed root surfaces using a semilunar coronally positioned flap. General Dentistry, 48(1), 68-71.
Prato, G. P., Tinti, C., Vincenzi, G., Magnani, C., Cortellini, P., & Clauser, C. (1992). Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession. Journal of periodontology, 63(11), 919-928.
Cortellini, P., Prato, G. P., DeSanctis, M., Baldo, C., & Clouser, C. (1991). Guided tissue regeneration procedure in the treatment of a bone dehiscence associated with a gingival recession: a case report. International Journal of Periodontics & Restorative Dentistry, 11(6).
Grupe, H. E., & Warren Jr, R. F. (1956). Repair of gingival defects by a sliding flap operation. The Journal of Periodontology, 27(2), 92-95.
Shetty, N. J. (2013). Double papilla repositioned flap for the treatment of isolated recession–A case report. Singapore Dental Journal, 34(1), 25-27.
Acunzo, R., Pagni, G., Fessi, S., & Rasperini, G. (2015). Modified double papillae flap technique: a new surgical approach for the treatment of isolated gingival recession defects. A case series. Int J Esthet Dent, 10, 258-68.
Harris, R. J., Miller, L. H., Harris, C. R., & Miller, R. J. (2005). A comparison of three techniques to obtain root coverage on mandibular incisors. Journal of periodontology, 76(10), 1758-1767.
Arzouman, A., Deas, D. E., Mills, M. P., Huynh‐Ba, G., Prihoda, T. J., & Mealey, B. L. (2021). Impact of different surgical protocols on dimensional changes of free soft tissue autografts: A randomized controlled trial. Journal of periodontology, 92(1), 45-53.
Zucchelli, G., Tavelli, L., McGuire, M. K., Rasperini, G., Feinberg, S. E., Wang, H. L., & Giannobile, W. V. (2020). Autogenous soft tissue grafting for periodontal and peri‐implant plastic surgical reconstruction. Journal of periodontology, 91(1), 9-16.
De Sanctis, M., & Zucchelli, G. (2007). Coronally advanced flap: A modified surgical approach for isolated recession‐type defects: Three‐year results. Journal of clinical periodontology, 34(3), 262-268.
Esfahani, N. N., Khorsand, A., & Salehimonfared, S. M. (2021). The influence of harvesting free gingival graft on self-reported pain perception: a randomized two-arm parallel clinical trial. Journal of Dental Sciences, 16(1), 410-416.
Francetti, L., Del Fabbro, M., Testori, T., & Weinstein, R. L. (2004). Periodontal microsurgery: report of 16 cases consecutively treated by the free rotated papilla autograft technique combined with the coronally advanced flap. International Journal of Periodontics & Restorative Dentistry, 24(3).
Liu, H., Liu, J., Guo, M., Chen, X., & Chen, M. (2023). Protocol: Two-stage method of free gingival graft prior to periodontal regenerative surgery for the treatment of intrabony defects with insufficient keratinised tissue width: a study protocol for an open-label randomised controlled trial. BMJ Open, 13(7).
Oh, S. L., Masri, R. M., Williams, D. A., Ji, C., & Romberg, E. (2017). Free gingival grafts for implants exhibiting lack of keratinized mucosa: a prospective controlled randomized clinical study. Journal of Clinical Periodontology, 44(2), 195-203.
Patur, B. (1977). The rotation flap for covering denuded root surfaces-a closed wound technique. Journal of periodontology, 48(1), 41-44.
Tackas, V. J. (1995, January). Root coverage techniques: a review. In The Journal of the Western Society of Periodontology/Periodontal abstracts (Vol. 43, No. 1, pp. 5-14).
