How to predetermine the line of root coverage (MRC) in mucogingival surgery.

In 2006 in the article “Clinical and anatomical factors limiting treatment outcomes of gingival recession: A new method to predetermine the line of root coverage” published on J Periodontol by Zucchelli G, Testori T, De Sanctis M. was presented a method to predetermine maximum root coverage level (MRC). The aim of the study was to suggest a method to predetermine the level of root coverage in non-molar teeth.



The method used to predetermine MRC was based on the biologic and clinical concept that interdental papillae act as the most coronal vascular beds to which the soft tissues covering the root exposure are anchored at the time of the surgery. The MRC was predetermined by calculating the ideal vertical dimension of the interdental papilla of the tooth with the recession defect, the height of anatomic papilla can be measured as the distance between the line connecting the line angles of adjacent teeth and the tip of the papilla.





In a healthy periodontium, at the level of non-molar teeth and in the absence of tooth rotation, the tip of the papilla coincides with the contact point with no space between them. Once the ideal papilla has been measured, this dimension is reported apically starting from the tip of both papillae mesial and distal to the tooth with the recession defect. The projections on the recession margin of these measurements allow identification of two points that are connected by a scalloped line, this line represents the line of root coverage (Fig. 2).




This approach should not be taken as a method with mathematical precision but as a technique that indicates the direction and that helps us in a decision-making process towards a predictable treatment, treatment that can be periodontal surgery, restorative associated with periodontal surgery or only restorative treatment.



Knowing in advance the MRC achievable with surgery should allow clinicians to increase the length of the clinical crown by means of a composite restoration before performing root coverage surgical procedure. Restoring the clinical crown might result in the patient’s esthetic satisfaction even when complete root coverage could not be obtained. In the presence of cervical abrasion defects associated with gingival recession, root coverage predetermination could make the restorative treatment easier. MRC could be used as a guideline for the apical preparation of the composite filling. The operative field could be adequately isolated with a rubber dam applied to that portion of the root exposure between MRC and gingival margin. The composite filling could make the surgical procedure easier to perform by restoring the profile of the clinical crown and by giving a stable and convex substrate for the coronal placement of the flap.


References:


Zucchelli G, Testori T, De Sanctis M.

Clinical and anatomical factors limiting treatment outcomes of gingival recession: A new method to predetermine the line of root coverage.

J Periodontol 2006;77:714-721.

Zucchelli G, Mele M, Stefanini M, et al.

Predetermination of root coverage.

J Periodontol. 2010;81(7):1019–1026.


Zucchelli G, Gori G, Mele M, et al.

Non-carious cervical lesions associated with gingival recessions: a decision-making process.

J Periodontol. 2011;82(12):1713–1724.


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