Page 61 - MDA MIDEC 2024 Programme Book

ORAL PRESENTATION ABSTRACTS

P019 Name of Presenter: Engku Ahmad Muzhaffar bin Engku Zainal Abidin, Pusat Pakar Pergigian
Seremban
Title of Presentation: Connective Tissue Graft with Epithelial Collar for Treating Orthodontic-
Associated Gingival Recession of Lower Incisors: Case Series

Abstract
Engku Ahmad Muzhaffar EZA 1,* , Nurul Zatil Amali I 1, Nuzul Izwan O 1, Muhammad Hadi MH 1, Rasidah A
1, Dewi Mayang Sari K 2
1 Periodontic Unit, Pusat Pakar Pergigian Seremban, Jalan Zaaba, 70100 Seremban, Negeri Sembilan,
Malaysia
2 Dental Public Health Unit, Pusat Pakar Pergigian Seremban, Jalan Zaaba, 70100 Seremban, Negeri
Sembilan, Malaysia

Introduction: Prevalence of orthodontic-associated gingival recession (GR) reported to be 10.3%, mainly
central incisors, linked to lower incisor position changes. GR impacts aesthetics, causes hypersensitivity,
and complicates plaque control. Although the coronally advanced flap (CAF) with connective tissue graft
(CTG) is the gold standard treatment, it is not always feasible. This case series highlights CTG with epithelial
collar (EC) as an alternative treatment.
Case report:
Case 1: A 25-year-old Malay male with class II division I incisor relationship on class II skeletal base was
treated with fixed orthodontic appliances and orthognathic surgery. Post-orthodontically, he presented
with Recession Type (RT)2 labial recession on 31, complicated by the absence of apical keratinised tissue
width (KTW) and shallow labial vestibule. Following non-surgical periodontal therapy (NSPT), root coverage
(RC) surgery on 31 was performed using a CTG with EC. Twelve months postoperatively, 50% RC and >5mm
of apical KTW were achieved. Subsequently, orthodontic re-treatment conducted to tip the 31 root lingually
and enhance RC surgery outcome.
Case 2: A 24-year-old Malay female with class II division I incisor relationship on class I skeletal base was
treated with fixed orthodontic appliances. Post-orthodontically, she presented with RT1 labial recession on
31-41, complicated by high frenal attachment and shallow vestibule. After NSPT, lower labial frenotomy was
performed, followed by RC surgery on 31-41 using a CTG with EC. Eighteen months postoperatively, 100%
RC, >5mm of apical KTW, and deeper vestibule were achieved. Despite the encouraging outcomes, the
presence of EC may lead to gingival colour discrepancy between the treated site and the adjacent tissue,
indicating superior aesthetic outcome with the CAF and CTG procedure.
Conclusion: CTG with EC can be an alternative to the CAF with CTG procedure, particularly in severe gingival
recession cases with minimal KTW, shallow vestibules, and in non-aesthetic regions.

Key words: Gingival recession, connective tissue graft, epithelial collar, orthodontic

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