Gingival Recession Therapy with a Completely Customized Lingual Appliance and Periodontal Surgery

Schmid, Jonas Q.; Ehmke, Benjamin; Hohoff, Ariane

Zusammenfassung

Aim: Long term retention with bonded retainers is a common procedure but can cause different unwanted tooth movements (the so called “wire syndrome” (Charavet et al., 2022)), such as a torque difference between two adjacent incisors (X-effect, (Kucera and Marek, 2016)). This can be accompanied by a gingival recession and require complicated secondary treatment. This case report adds to the literature on the root coverage on a lower incisor with orthodontic torque correction alone using a completely customized lingual appliance (CCLA) and a connective tissue graft afterwards. Subjects and Methods: A 20-year-old female patient was referred with a retainer X-effect and severe gingival recession on tooth 31. Alio loco soft tissue augmentation has been carried out previously without success. A CCLA with an extra torque of 13° on the affected tooth and 8° on the neighbouring central incisor was used for torque correction. Root coverage with a connective tissue graft was performed after debonding. Measurement of gingival recession depth and width was carried out on intraoral scans before treatment (T0), after orthodontic torque correction (T1) and after soft tissue augmentation (T2). Results: Treatment time with the CCLA was 14 months. Gingival recession depth was reduced from 3.8 mm (T0) to 2.5 mm (T1) by orthodontic torque correction alone and further reduced to 0.1 mm after healing of the connective tissue graft (T2). The width of gingival recession decreased from 2.2 mm (T0) to 1.3 mm (T1) and to zero at (T2). Conclusion: Orthodontic torque correction with a completely customized lingual appliance significantly reduced gingival recession depth and width on a lower central incisor and improved the prognosis of the subsequent root coverage with a connective tissue graft. Orthodontic torque correction and connective tissue grafting achieved a complete coverage of the gingival recession in this case.