Treating Gum Recession with Connective Tissue Graft and Emdogain

11/10/2023
13:04

Introduction

At Facialia.com, we specialize in advanced periodontal treatments that restore both function and aesthetics. This clinical case highlights a comprehensive approach to treating gum recession using the connective tissue graft, Emdogain, and the tunnel technique, from diagnosis through post-operative maintenance.

Patient’s Main Complaint

A 46-year-old patient visited our clinic in Valencia, Spain, presenting with:

Generalized tooth mobility
Bleeding gums and pus discharge
Bad breath
Increasing dental sensitivity, especially in teeth 2.1 and 2.2
Gum recession

Medical and Social History

Medical Background: Bruxism, depression, past COVID-19, psychosis
Habits: Nail biting, daily snus use (previously smoked 20 cigarettes/day)
Alcohol Use: Increased during depressive episodes
Allergies: Pollen
Occupation: Unemployed

Initial Clinical Assessment

Clinical and radiographic evaluations showed:

Miller Class I–IV gum recessions
Thin periodontal biotype
Pocket depth and bone loss >15%
Mobility grade 2 in multiple teeth
High plaque and bleeding indices

Phase 1: Supragingival Control and Patient Education

This stage focused on biofilm removal and motivation for behavioral change:

Professional cleaning and airflow
Instruction in effective brushing techniques (electric toothbrush recommended)
Disclosing tablets to track plaque removal
Scaling and root planing
Education on the risks of smoking and alcohol consumption

Diagnosis

Based on Miller’s classification:

Class I: Teeth 4.4, 4.5, 4.2, 1.3, 2.3, 1.4, 1.5
Class II: 3.4, 3.5
Class III: 1.1, 1.2, 2.2, 2.4, 2.6
Class IV: 4.1

Also diagnosed with bruxism and a reduced periodontium.

Phase 2: Subgingival Instrumentation

Scaling and root planing were performed with chlorhexidine irrigation. The goal was to:

Reduce probing depth to <4 mm
Decrease plaque and bleeding levels to ≤25%

Phase 3: Connective Tissue Graft Surgery

We proceeded with a connective tissue graft using the tunnel technique combined with Emdogain to enhance healing and soft tissue regeneration for the gum recession:

Local anesthesia and cleaning
Tunneling flap created from 2.1 to 2.6
Subepithelial graft harvested from palatal area (1.3 to 1.5)
Emdogain applied to recipient site
Graft stabilized with suspensory sutures

Postoperative Care and Medications

Paracetamol 500 mg three times daily (3 days)
Vitamin D supplement to support bone healing
Hyaluronic acid oral rinses to aid gingival repair

Prognosis and Reevaluation

Results included:

Reduced dental sensitivity in 2.1, 2.2, and 2.3
Increased keratinized gingiva
Composite veneer placed in 2.4 for aesthetics

However, the patient continued alcohol and snus use, requiring motivational reinforcement in the next phase.

Follow-up and Complications

Two years later, the patient returned after unsuccessful regenerative surgery in London, with persistent inflammation around tooth 1.2. We decided to wait for tissue maturation before any further surgical intervention.

Maintenance Phase

Maintaining periodontal stability is essential. The patient is now under a structured follow-up program with:

Regular hygiene checks
Periodontal charting and radiographs
Treatment adaptation if relapse occurs

Conclusion

This case illustrates how gum recession can be successfully treated using a connective tissue graft, Emdogain, and the tunnel technique. The success of this method depends not only on the surgical approach but also on patient cooperation, motivation, and long-term maintenance.

Why Choose Facialia.com for Gum Recession Treatment?

At Facialia.com, we offer expert solutions for gum recession, using evidence-based approaches like connective tissue grafting and Emdogain therapy. Whether you suffer from sensitivity, aesthetic concerns, or advanced recession, our tailored treatments can help you restore your smile and comfort.

Book your consultation today at Facialia.com and take the first step toward lasting periodontal health.