Published date: Apr 25 2022

Journal Title: KnE Medicine

Issue title: The International Online Seminar Series on Periodontology in conjunction with Scientific Seminar

Pages: 282-293

DOI: 10.18502/kme.v2i1.10861

Rezmelia Sarirezmelia_sari@mail.ugm.ac.idDepartment of Periodontology, Faculty of Dentistry, Gadjah Mada University, Jl. Denta Sekip No. 1, Sinduadi, Sleman, Yogyakarta, 55281, Indonesia

Disty AnggraeniStudent of Periodontics Residency Programme at Faculty of Dentistry, Gadjah Mada University, Jl. Denta Sekip No. 1, Sinduadi, Sleman, Yogyakarta, 55281, Indonesia

Background: The use of fixed orthodontic appliances can affect periodontal tissues. It can increase the risk of plaque and calculus accumulation. One of the effects on the periodontal tissue is gingival enlargement. The usual treatment for gingival enlargement is gingivectomy with an external bevel. This treatment carries a risk of gingival recession if the base of the pocket is apical to the cemento-enamel junction (CEJ).

Objective: To report the actions to be taken in case of post-gingivectomy gingival recession.

Case Report: An 18-year-old woman presented to the Dental and Oral Hospital, Universitas Gadjah Mada Prof. Soedomo, with complaints of swelling of the lower front gums, partially covering the crown of the teeth, sometimes bleeding when brushing her teeth, but no pain. The patient has been in fixed orthodontic treatment since early 2018. The treatment in this case in the form of gingivectomy gave good results which aimed to remove the gingival pocket, form a new gingival anatomy and create a new gingival margin. In addition, a new gingival margin was considered coronal with suturing and fixation on the brackets to prevent recession.

Conclusion: The risk of gingival recession after gingivectomy can occur, especially in the gingiva with a thin biotype. Coronally advance flap may be an option to position the gingival margin coronal to the CEJ to prevent gingival recession after gingivectomy procedure.

Keywords: gingival enlargement, gingivectomy, fixed orthodontic appliance, coronally advanced flap

[1] Gorbunkova A, Pagni G, Brizhak A, Farronato G, Rasperini G. Impact of orthodontic treatment on periodontal tissues: A narrative review of multidisciplinary literature. International Journal of Dentistry. 2016;2016:2-3. doi.org/10.1155/2016/4723589

[2] Zanatta FB, Ardenghi TM, Antoniazzi RP, Pinto TMP, Rösing CK. Association between gingival bleeding and gingival enlargement and oral health-related quality of life (OHRQoL) of subjects under fixed orthodontic treatment: A cross-sectional study. BMC Oral Health. 2012;12(53).

[3] Kouraki K, Bissada NF, Palomo JM, Ficara AJ. Gingival enlargement and resolution during and after orthodontic treatment. New York State Dental Journal. 2005;71(4):34-37.

[4] Eid HA, Assiri HAM, Kandyala R, Togoo RA, Turakhia VS. Gingival enlargement in different age groups during fixed orthodontic treatment. Journal of International Oral Health. 2014;6(1):1-4.

[5] Kloehn JS, Pfeifer JS. The effect of orthodontic treatment on the periodontium. Angle Orthodontist. 1974;44(2):127-134.

[6] Newman MG, Takei HH, Klokkevold PR, Carranza FA. Newman and Carranza’s clinical periodontology. 13th ed. Philadelphia: Elsevier; 2019.

[7] Cohen E. Atlas of cosmetic and reconstructive periodontal surgery. 3rd ed. Hamilton: BC Decker Inc.; 2007.

[8] Chapple I, Gilbert A. Understanding periodontal diseases: Assessment and diagnostic procedures in practice. United Kingdom: Quintessence Publishing Co. Ltd.; 2002.

[9] Reali L, Zuliani E, Gabutti L, Schonholzer C, Marone C. Poor oral hygiene enhances gingival overgrowth caused by calcineurin inhibitors. Journal of Clinical Pharmacy and Therapeutics. 2009;34(3):225-260.

[10] Somacarrera ML, Lucas M, Scully C, Barrios C. Effectiveness of periodontal treatments on cyclosporine-induced gingival overgrowth in transplant patients. British Dental Journal. 1997;183(3):89-94.

[11] Kapoor P, Sachdeva S. Topical hyaluronic acid in the management oral ulcer. Indian Journal of Dermatology. 2011;56:300-302.

[12] O’leary TJ, Drake RB, Naylor JE. The plaque control record. Journal of Periodontology. 1972;43(1):38.

[13] Gulati M, Saini A, Anand V, Govila V. Esthetic dentistry for multiple gingival recession cases: Coronally advanced flap with bracket application. Journal of Indian Society of Periodontology. 2016;20(2):207-210.

[14] Tatakis DN, Chambrone L. The effect of suturing protocols on coronally advanced flap root-coverage outcomes: A meta-analysis. Journal of Periodontology. 2015;87(2):148-155.

[15] Kirmani M, Trivedi M, Bey A, Sharma VK. Post-operative complications of periodontal surgery. International Journal of Contemporary Medical Research. 2016;3(5):1285- 1286.

[16] Susin C, Fiorini T, Lee J, de Stefano JA, Dickinson DP, Wikesjo UM. Wound healing following surgical and regenerative periodontal therapy. Journal of Periodontology. 2015;2000(68):83–98.