Treatment of Gingival Fenestration with Connective Tissue Graft: A Case Report

Successful management of a large mucosal fenestration at 18-months follow-up

OBJECTIVES

Mucosal fenestrations are infrequent and often challenging to treat depending on the extent of soft and hard tissue destruction. This article presents the successful management of a relatively larger mucosal fenestration associated with complete absence of buccal bone plate in a mandibular incisor secondary to trauma-induced periapical pathosis.

CLINICAL CONSIDERATIONS

After non-surgical endodontic therapy, surgery was performed for debridement of the osseous defect, root resection/shaping, connective tissue graft (CTG) placement on the affected root surface and platelet rich fibrin (PRF) in periapical osseous defect rather than use of bone graft and/or barrier membrane. Healing was uneventful, however, a small mucosal defect remained at 2 weeks follow-up. After 3 months of primary surgery, a corrective surgery was performed utilizing an "incision-free" approach i.e. tunnel technique with CTG in contrast to the contemporary flap approach. At 18 months follow-up, complete closure of the mucosal defect with a thick gingival biotype, normal sulcus depth, and good esthetic outcome were achieved. No recurrence and any clinical signs of infection or inflammation were observed.

CONCLUSIONS

Based on the outcomes of present case, an early intervention utilizing the minimally invasive surgical therapy and autologous biomaterials may be considered a viable approach to treat such complex lesions.

CLINICAL SIGNIFICANCE

Endodontic therapy in combination with PRF and CTG appears to provide successful outcomes in treatment of a large mucosal fenestration with periapical osseous defect.

Mucogingival augmentation by connective tissue graft for the management of orthodontic-induced alveolar fenestration with soft-tissue deficiency: A multidisciplinary approach

Developing alveolar bone defects is one of the reported complications of orthodontic teeth movement especially in the region of the incisors, which may pose a risk for teeth health and their long term prognosis. In this case report, a 15-year-old female patient with an ongoing orthodontic treatment presented with labially protruded apices of lower anterior teeth and thin overlying soft tissue which caused esthetic and functional concerns. A combined periodontal-orthodontic approach was carried out starting with soft-tissue augmentation using bilaminar technique with sub-epithelial connective tissue graft and single incision access flap, followed by orthodontic repositioning of teeth. The augmented site healed uneventfully, and thick soft-tissue coverage was evident which helped the camouflage of the defect area and allowed for the recommencement of orthodontic treatment. Hence, orthodontic-induced alveolar defects with mucogingival complications can be successfully managed through a multidisciplinary approach with stable results after 1 year.

Gingival fenestration defect treated with gingivectomy and gingivoplasty: A case report with an 8-year follow-up

INTRODUCTION

Gingival fenestration (GF) is scarcely reported in the literature. We present a unique case of GF defect combined with gingivitis and altered passive eruption (APE).

CASE PRESENTATION

An 18-year-old female patient with gingivitis, APE, and GF in the mandibular left central incisor presented for periodontal treatment. The gingival lesion was successfully treated with basic periodontal therapy gingivectomy, and gingivoplasty and resulted in an excellent aesthetic long-term outcome. This case report shows its 8-year clinical follow-up.

CONCLUSION

There are no earlier reports dealing with the use of gingivoplasty for the treatment of GF, as it is not the usual therapeutic intervention for these defects. Gingivoplasty proved to be effective in treating GF. Why is this case new information? Available literature on gingival fenestration defects does not describe gingivectomy and gingivoplasty as a treatment of choice. Gingivectomy and gingivoplasty proved to be effective in treating gingival fenestration defects. What are the keys to successful management of this case? Proper diagnosis. What are the primary limitations to success in this case? Gingival fenestration has been defined when the overlying gingiva is denuded, exposing the root to the oral cavity. However, in this case report, only the crown was exposed because the patient had altered passive eruption.