A 20 years old female presented with mobile teeth, signs of inflammation and evident malocclusion
Radiographic status and clinical analysis of a case of malocclusion at first visit and after 30 years. The initial radiographs were taken during the first visit, before the non-surgical therapy. The only anterior contacts happen between teeth 11 and 41 and 21 and 32. No signs of traumatic lesions may be seen on the radiograph, while gingivitis and gingival recession are clinically present on teeth #31 and #41. An extracoronal splint and a free gingival graft have been performed on the mandibular central incisors to improve the periodontal situation. An epithelial connective tissue graft of 1.5 mm thikness has been taken from the palatal premolar/molar area with a Bard-Parker no. 15 blade and then sutured in place with a suspended 4-0 silk suture. The wound has been protected with a Coe-Pak periodontal dressing which was removed 10 days later.
Radiographic and clinical analysis of a case of malocclusion at first visit and after 30 years. Contacts only exist between teeth #16 and #47. No signs of traumatic lesions may be seen on the radiographs.
Radiographic and clinical analysis of a case of malocclusion at first visit and after 30 years. Contact only occurs between teeth #27 and #37. No traumatic lesions may be seen on the radiographs.
These illustrations show the surgical procedure that was chosen for the treatment of this case. A free gingival graft was executed: first step was probing beyond the mucogingival junction in the area of the mandibular incisors followed by an intra-sulcular incision.
Two external bevel incisions were angled at 45 degrees. The vertical incisions were then connected by another incision at the base of the fornix, perpendicular to the bone surface.
We then proceeded to the removal of the tissue to be eliminated and gingivoplasty of the interproximal area.
Fenestration of the periosteum with the blade perpendicular to the periosteum and sling suture anchored to the periosteum.
An X-shaped suture makes the graft intimately adhere to the underlying surface; this allows, in the end, a healing with leveled gingival margins and an adequate width of attached gingiva.
Through the control of the inflammatory lesions with periodic recalls and minor surgical treatment in the lower incisors area it was possible to maintain the natural dentition for many years.
In this particular case, occlusal trauma played no significant role in tooth mobility.
Chambrone L, Chambrone D, Lima LA, Chambrone LA. Predictors of tooth loss during long-term periodontal maintenance: a systematic review of observational studies. J Clin Periodontol. 2010 Jul;37(7):675-84. Epub 2010 May 26. Review.
Glickman I, Smulow JB. Further observations on the effects of trauma from occlusion in humans. J Periodontol. 1967 Jul-Aug;38(4):280-93.
Glickman I, Smulow JB. The combined effects of inflammation and trauma from occlusion in periodontitis. Int Dent J. 1969 Sep;19(3):393-407.
Polson AM, Zander HA. Effect of periodontal trauma upon intrabony pockets. J Periodontol. 1983 Oct;54(10):586-91.
Harrel SK, Nunn ME, Hallmon WW. Is there an association between occlusion and periodontal destruction? Yes-occlusal forces can contribute to periodontal destruction. J Am Dent Assoc. 2006 Oct;137(10):1380, 1382, 1384 passim. Review.
Deas DE, Mealey BL. Is there an association between occlusion and periodontal destruction? Only in limited circumstances does occlusal force contribute to periodontal disease progression. J Am Dent Assoc. 2006 Oct;137(10):1381, 1383, 1385 passim. Review.
Waerhaug J, Hansen ER. Periodontal changes incident to prolonged occlusal overload in monkeys. Acta Odontologica Scandinavica 1966;24:91-105.