No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Minimally Invasive Treatment of Mandibular Anterior Lingual Defects by Vestibular Incision Subperiosteal Tunnel Access (VISTA Technique) and Connective Tissue Graft: A Case Report
Clinical Advances in Periodontics
Abstract
Introduction: Treatment of recession defects on the lingual surface of mandibular anterior teeth is challenging owing to site‐specific anatomic features of this region. Surgical approaches based on use of subepithelial connective tissue grafts (SCTGs) are considered the “gold standard” for treatment of multiple recession defects. To the best of the authors’ knowledge, this is believed to be the first case report of an attempt to correct lingual recession by SCTG with the minimally invasive vestibular incision subperiosteal tunnel access technique.
Case Presentation: A non‐smoking 55‐year‐old male patient presented with hypersensitivity in his mandibular anterior teeth in August 2016. Multiple lingual recession defects were treated by placing a SCTG harvested from the palate underneath the subperiosteal tunnel using a midline access incision. Six months after treatment, a significant increase of root coverage (88.17%), gain in gingival thickness (1.29 mm), and width of keratinized gingiva (1.41 mm) led to a promising outcome and high patient satisfaction.
Conclusion: A minimally invasive surgical technique has been presented that can restore the functional properties of lingual gingiva of the mandibular anterior teeth by repairing gingival defects and reestablishing integrity of the zone of keratinized gingiva.
... Zucchelli et al 11 propose a surgical approach based on the use of a CTG placed below a coronally advanced flap (CAF) to treat gingival recessions associated with deep probing depth and bone loss. A case report describing a minimally invasive treatment of mandibular lingual defects by vestibular incision, subperiosteal tunnel access, and CTG was proposed by Vijay et al. 21 A more recent case report 22 describes the use of a partially deepithelialized FGG to treat an isolated mandibular premolar lingual recession after orthodontic therapy. This study presents the treatments and long-term outcomes of three clinical cases of multiple lingual recessions. ...
... Only a few case reports describing treatments of lingual recessions have been published and are available in the literature. 11,[19][20][21][22] Lacking controlled studies on the treatment of lingual recessions, the AAP Consensus report 25 concludes that root coverage is possible, but evidence on predictability is insufficient. ...
Treatment of gingival recession defects on the lingual surface of mandibular anterior teeth is a challenge for the periodontist because of the region's unique anatomical features. Although there are no esthetic issues, lingual recessions should be considered seriously, especially on mandibular incisors, because they are frequently associated with periodontitis and dental hypersensitivity. The treatments and the long-term outcomes (5 years) of three clinical cases of multiple lingual recessions are presented. The tunnel technique associated with subepithelial connective tissue graft was chosen. The postoperative period was almost uneventful in all treated cases, and the 1-year outcomes were successful. Great recession reduction, up to complete root coverage, was seen, as were significant increases of both the apicocoronal amount and thickness of keratinized tissue. At the 5-year follow-up, the tissues were stable; only a slight apical shift of the gingival margin was noted in one case. The modification of the periodontal phenotype following the tunnel technique with the subepithelial connective tissue graft allowed the patients to maintain good plaque control.
... Furthermore, i-PRF also reduced the inflammatory condition created by lipopolsacharrides and maintained a supportive regenerative ability for stimulation of odontoblastic differentiation and reparative dentin in hDPCs. Bennardo et al [48] conducted a split mouth randomized controlled trial to compare the efficacy of i-PRF and triamcinolone acetonide (TA) injective therapies in patients with symptomatic oral lichen planus (OLP). The results obtained with i-PRF are similar to those obtained with TA. ...
Background:
Collagen membrane and platelet-rich fibrin (PRF) have emerged as vital biomaterials in the field of periodontal regeneration. Minimally invasive techniques are being preferred by most periodontists, as it is patient compliant with fewer post-surgical complications as compared to conventional surgical techniques. Thus, in this study we have evaluated the effect of injectable PRF (i-PRF) with collagen membrane compared with collagen membrane alone using vestibular incision subperiosteal tunnel access (VISTA) technique for gingival recession coverage.
Aim:
To compare the efficacy of VISTA using collagen membrane with collagen membrane soaked in injectable PRF for gingival recession coverage.
Methods:
A split mouth randomized controlled clinical trial was designed;13 subjects having at least 2 teeth indicated for recession coverage were enrolled in this study. The sites were randomly assigned to control group (VISTA using collagen membrane alone) and the test group (VISTA using collagen membrane with i-PRF). The clinical parameters assessed were pocket depth, recession depth (RD), recession width (RW), relative attachment level, keratinised tissue width (KTW), keratinised tissue thickness (KTT), and percentage root coverage.
Results:
RD showed a statistically significant difference between the test group at 3 mo (0.5 ± 0.513) and 6 mo (0.9 ± 0.641) and the control group at 3 mo (0.95 ± 0.51) and 6 mo (1.5 ± 0.571), with P values of 0.008 and 0.04, respectively. RW also showed a statistically significant difference between the test group at 3 mo (1 ± 1.026) and 6 mo (1.65 ± 1.04) and the control group at 3 mo (1.85 ± 0.875) and 6 mo (2.25 ± 0.759), with P values of 0.008 and 0.001, respectively. Results for KTW showed statistically significant results between the test group at 1 mo (2.85 ± 0.489), 3 mo (3.5 ± 0.513), and 6 mo (3.4 ± 0.598) and the control group at 1 mo (2.45 ± 0.605), 3 mo (2.9 ± 0.447), and 6 mo (2.75 ± 0.444), with P values of 0.04, 0.004, and 0.003, respectively. Results for KTT also showed statistically significant results between test group at 1 mo (2.69 ± 0.233), 3 mo (2.53 ± 0.212), and 6 mo (2.46 ± 0.252) and the control group at 1 mo (2.12 ± 0.193), 3 mo (2.02 ± 0.18), and 6 mo (1.91 ± 0.166), with P values of 0.001, 0.001, and 0.001, respectively. The test group showed 91.6%, 81.6%, and 67% root coverage at 1 mo, 3 mo, and 6 mo, while the control group showed 82.3%, 66.4%, and 53.95% of root coverage at 1 mo, 3 mo, and 6 mo, respectively.
Conclusion:
The use of minimally invasive VISTA technique along with collagen membrane and injectable form of platelet-rich fibrin can be successfully used as a treatment method for multiple or isolated gingival recessions of Miller's class-I and class-II defects.
... Further, it should be noted that all the clinical studies on tunnel technique for root coverage in multiple teeth are based on buccal recession defects classified as Miller class I, II and III. Evidence for the treatment of multiple lingual GRs is scarce and only limited to case reports (Wilcko et al., 2005;Assis et al., 2017;Vijay et al., 2017;Alves et al., 2019). To the best of author's knowledge, this is the first case series to report on the treatment of multiple lingual RT1 and RT2 defects in mandibular incisors with MCAT + CTG. ...
Aim: Evidence for the treatment of lingual recession defects is scarce. The aim of this case series was to investigate the clinical efficacy of modified coronally advanced tunnel (MCAT) technique in combination with connective tissue graft (CTG) for the treatment of multiple lingual gingival recessions.
Materials and methods: Six patients with a total of 20 adjacent RT1 and RT2 lingual recession defects in mandibular incisors were treated with MCAT + CTG. Clinical pa- rameters were recorded at baseline and 6 months. Patient-centred outcomes (dentinal hypersensitivity and postoperative pain) were also assessed.
Results: Postoperative course of healing was uneventful in all patients. At 6 months, significant recession depth reduction (2.45 ± 0.51 mm), keratinized tissue width gain (1.10 ± 0.55 mm) and increase in gingival thickness (0.91 ± 0.34 mm) were observed. Mean root coverage was 79.35% and complete root coverage was achieved in 40% of treated recession defects. All patients reported a significant reduction in dentinal hypersensitivity at the end of the study period.
Conclusion: Tunnel technique in combination with CTG is a safe and predictable approach for root coverage in multiple lingual recessions in mandibular incisors. However, further studies of longer duration in large number of patients are needed to support these findings.
... Vijay et al. performed minimally invasive vestibular incision subperiosteal tunnel access technique + SCTG which is a single incision technique to treat multiple lingual recession defects. [12] They reported an increase of 88.17%, root coverage, and sufficient gain in gingival thickness and WKG after 6 months. Recently, Abhyankar et al. modified and eliminated any vertical incision on the lingual surface and performed laterally closed tunnel technique on the lingual surface with SCTG on an isolated mandibular incisor root, and they achieved satisfactory results. ...
Gingival recession on the lingual aspect of teeth may cause dentinal hypersensitivity problems in patients. Treatment of such recessions is not a regular procedure owing to its anatomical restraints, difficulty in isolation as well as lack of esthetic importance. The present case describes the use of connective tissue graft (CTG) in the treatment of isolated lingual recession on mandibular lateral incisor using minimally invasive tunneling technique. Six-month posttreatment follow-up showed a root coverage of 3.5 mm with enhanced width of keratinized tissue. This report encourages the application of CTG along with tunneling technique in the treatment of lingual recession to achieve root coverage as well as alleviate patient's dentinal hypersensitivity issues.
Presence of adequate dimensions of keratinized/attached gingiva (KT/AG) and gingival thickness (GT) is considered necessary to maintain optimal periodontal health and long-term stability of gingival margin. Gingival phenotype modification therapies to increase these two dimensions (GT and KT/AG) on the buccal aspect of teeth have been widely reported, but the literature on lingual gingival augmentation is scarce. The purpose of this paper is to report the outcomes of a case treated with an envelope flap combined with a hybrid soft tissue autograft (subepithelial connective tissue graft with an epithelial collar) for phenotype modification of gingiva lingual to mandibular incisors presenting with thin gingiva (<1 mm) and lack of AG in tooth # 31 and 42. At 12 months follow-up, a substantial gain in KT, AG and GT along with partial root coverage was achieved.
This paper aims to create a "bridge" between research and practice by developing a practical, extensive, and clinically relevant study that translates evidence-based findings on soft tissue root coverage (RC) of recession-type defects to daily clinical practice.
This review is prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused questions. A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE and EMBASE databases up to and including June 2013. Systematic reviews (SRs), randomized clinical trials, controlled clinical trials, case series, and case reports evaluating recession areas that were treated by means of RC procedures were considered eligible for inclusion through the three parts of the study (part I, an overview of the base of SRs; part II, an alternative random-effects meta-analyses on mean percentage of RC and sites exhibiting complete RC; and part III, an SR of non-randomized trials exploring other conditions not extensively evaluated by previous SRs). Data on Class I, II, III, and IV recessions, type of histologic attachment achieved with treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions, tooth type and location, long-term effectiveness outcomes, unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes were assessed as well.
Of the 2,456 potentially eligible trials, 234 were included. Data on Class I, II, III, and IV gingival recessions, histologic attachment achieved after treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions/biomodification, tooth type and location, long-term effectiveness outcomes and unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes (i.e., esthetic, visual analog scale, complications, hypersensitivity, patients perceptions) were assessed. Subepithelial connective tissue (CT)-based procedures and coronally advanced flap plus acellular dermal matrix grafts, enamel matrix derivative, or collagen matrix led to the best improvements of recession depth, clinical attachment level (CAL) gain, and keratinized tissue (KT). Some conditions, such as smoking and use of magnification, may affect RC outcomes.
All RC procedures can provide significant reduction in recession depth and CAL gain for Miller Class I and II recession-type defects. Subepithelial CT graft-based procedures provided the best outcomes for clinical practice because of their superior percentages of mean and complete RC, as well as significant increase of KT.
Background:
Management of gingival recession defects, a common periodontal condition, using root coverage procedures is an important aspect of periodontal regenerative therapy. The goal of the periodontal soft tissue root coverage procedures group was to develop a consensus report based on the accompanying systematic review of root coverage procedures, including priorities for future research and identification of the best evidence available to manage different clinical scenarios.
Methods:
The group reviewed and discussed the accompanying systematic review, which covered treatment of single-tooth recession defects, multiple-tooth recession defects, and additional focused questions on relevant clinical topics. The consensus group members submitted additional material for consideration by the group in advance and at the time of the meeting. The group also identified priorities for future research.
Results:
All reviewed root coverage procedures provide significant reduction in recession depth, especially for Miller Class I and II recession defects. Subepithelial connective tissue graft (SCTG) procedures provide the best root coverage outcomes. Acellular dermal matrix graft (ADMG) or enamel matrix derivative (EMD) in conjunction with a coronally advanced flap (CAF) can serve as alternatives to autogenous donor tissue. Additional research is needed to do the following: 1) assess the treatment outcomes for multiple-tooth recession defects, oral sites other than maxillary canine and premolar teeth, and Miller Class III and IV defects; 2) assess the role of patient- and site-specific factors on procedure outcomes; and 3) obtain evidence on patient-reported outcomes.
Conclusions:
Predictable root coverage is possible for single-tooth and multiple-tooth recession defects, with SCTG procedures providing the best root coverage outcomes. Alternatives to SCTG are supported by evidence of varying strength. Additional research is needed on treatment outcomes for specific oral sites. Clinical Recommendation: For Miller Class I and II single-tooth recession defects, SCTG procedures provide the best outcomes, whereas ADMG or EMD in conjunction with CAF may be used as an alternative.
The purpose of this literature review was to investigate the topography of endosseous blood vessels supplying the anterior mandible to prevent complications both during and after oral surgical procedures.
A comprehensive literature search of MEDLINE-PubMed was performed independently for articles describing the anatomical findings of endosseous blood vessels in the anterior part of the mandible. From about 31 related studies, 14 papers were selected based on specific selection criteria. These studies were related to radiologic findings and cadaver studies.
There is significant debate concerning the blood vessels supplying the anterior part of the mandible. Hence, in the literature reviewed, no clear consensus was established. There are no reports of severe endosseous bleeding from the mandible during surgical procedures in the symphysis. Based on computed tomographic images, some papers presented an exact intraosseous path of the canals, as well as frequent blood vessel anastomosis in this region. Dissection studies confirmed the presence of sublingual blood vessels penetrating into the bone.
The potential risk of bleeding upon perforation of vessels within the bone needs to be evaluated to avoid such complications. The management of intraoperative surgical problems is of significance.
An array of therapeutic options are available for treatment of gingival recession defects, though many of these are better suited for treatment of isolated defects. Some of the limitations of current techniques include the need for harvesting of autogenous donor tissues and their associated morbidity, as well as scar formation at the recipient site resulting from surface incisions. Moreover, muscle pull during healing often leads to incomplete root coverage or relapse of the recession. The current case reports introduce a novel, minimally invasive approach applicable for both isolated recession defects as well as multiple contiguous defects in the maxillary anterior region. Access to the surgical site is obtained by means of an approach referred to as vestibular incision subperiosteal tunnel access (VISTA). This entails making an access incision in the maxillary anterior frenum, followed by elevation of a subperiosteal tunnel. VISTA allows for both access as well as an opportunity to coronally reposition the gingival margins of all involved teeth. In this approach, recombinant human platelet-derived growth factor BB saturated onto a matrix of beta-tricalcium phosphate is introduced using VISTA over root dehiscences to enhance periodontal healing. A novel method of stabilization of the gingival margins is also introduced, referred to as coronally anchored suturing, designed to maintain the coronal positioning during healing. The current report describes the technique and two clinical case documentations for treatment of Miller Class I and II defects, demonstrating stable, long-term outcomes. Although VISTA has been applied in other regions, its application is most advantageous in the esthetic zone.
Three case reports are presented that demonstrate the use of full-thickness flap/subepithelial connective tissue grafting for root coverage on the lingual surfaces of the mandibular anterior teeth. This is accomplished using an envelope full-thickness flap technique with intramarrow penetrations at the recipient site. Miller Class I, II, and III gingival recession defects and gingival perforation defects were treated. Complete root coverage was achieved in two Miller Class I gingival recession defects, in one Miller Class II gingival recession defect, and in two gingival perforation defects in areas that exhibited no radiographic evidence of bone loss. Partial root coverage was achieved in two Miller Class III gingival recession defects in an area that exhibited radiographic evidence of bone loss. Although the majority of the exposed root surface was covered in these two Miller Class III defects, about 1 mm of root surface remained exposed, which seemed to closely correspond to the amount of bone loss that was noted radiographically. A grafting technique has been presented that can be used to restore the functional properties of the lingual gingiva of the mandibular anterior teeth by repairing gingival defects and re-establishing the continuity and integrity of the zone of keratinized gingiva. Our clinical impression is that this has made it easier for the three patients presented in this report to maintain the lingual surfaces of the mandibular anterior teeth with routine oral hygiene measures.
The present case report describes the application of the connective tissue graft wall (CTGW) technique for the treatment of deep lingual gingival recessions associated with probing pockets and bone loss. Two deep lingual gingival recessions affecting the mandibular central incisors associated with severe lingual attachment and bone loss were treated. The surgical technique comprised a connective tissue graft (CTG) placed below a trapezoidal-type coronally advanced flap (CAF) acting as a lingual soft tissue wall of the infrabony defect. One year after the surgery, clinically significant root coverage, an increase in lingual keratinized tissue (KT) height and thickness, and clinical attachment level gain were achieved in both treated teeth. This case report encourages the application of the CTGW technique to improve both root coverage and regenerative parameters in lingual gingival recessions associated with severe attachment and bone loss.
Recession on the lingual aspect of mandibular incisors may occur in patients with history of tongue piercing and other factitious traumatic habits. Treatment of these areas is challenging due to the site-specific anatomical features of the region. This case report presents a novel approach for a specific type of mandibular lingual defect caused by tongue piercing. A nonresorbable titanium-reinforced barrier membrane combined with an allograft and enamel matrix derivatives was used to promote regeneration of periodontal attachment. Reentry surgery for membrane removal was performed at 8 weeks. The time from initial surgery to final follow-up was 18 months.
To clarify variations of vascular distribution around the mandibular anterior tooth lingual region, an area in which vascular injuries have often been reported during dental implant surgery. The reasons for such injuries in this region are discussed from an anatomical perspective.
Anatomical dissections were performed on 100 sides of 50 cadavers used for anatomy education. Ten sides of 5 cadavers were injected intravascularly with methyl methacrylate, and penetration of the mandible was closely evaluated.
In the mandibular anterior tooth lingual region, both the sublingual and submental arteries showed various distribution patterns. Distal branches basically penetrated the bone.
In the mandibular anterior tooth lingual region, the sublingual and submental arteries traveled from the vicinity of the mylohyoid muscle attachment along the bone surface in an anterosuperior direction. Many of these blood vessels penetrated the alveolar mucosa in the anterior tooth region, and many distal branches of the vessels also finally penetrated the bone. This seems to explain why many vascular injuries are encountered around the mandibular anterior tooth lingual region during implant surgery.
Periodontal sites of shallow initial probing depth often seem to lose probing attachment following various types of periodontal therapy, including nonsurgical therapy. The susceptibility to this treatment-associated probing attachment loss may conceivably be related to gingival architecture as well as to the inflammatory status of the tissues. This study was designed to study the relationship of buccolingual gingival thickness and bleeding on probing in shallow buccal sites (less than or equal to 3.5 mm probing depth) to loss of probing attachment following nonsurgical therapy. 3 months following treatment consisting of oral hygiene instruction and supra- and subgingival debridement, thin (less than or equal to 1.5 mm), initially non-bleeding sites displayed a mean loss of probing attachment of 0.3 mm. Thick (greater than or equal to 2.0 mm), non-bleeding sites displayed a less noticeable mean loss of probing attachment, whereas bleeding sites of both categories of gingival thickness showed a tendency towards gains in probing attachment levels. It may be concluded that the mean loss in probing attachment levels, commonly seen for shallow sites post-therapy, may be primarily due to the changes in shallow, thin healthy areas.
The inferior dental artery suffers from a marked collagenosis of its wall some 15 years before arterial disease usually appears in the remainder of the carotid arterial tree. It is suggested that this is due to abnormal stress factors being exerted within the wall and as a result, from middle age onwards, the blood supply to the mandible is mainly from the subperiosteal plexus of vessels. The clinical significance of this is discussed in relation to surgery, the treatment of fractures and radiotherapy to the jaws.
Alterations in the mucogingival complex will occur during orthodontic tooth movement, but these are independent of the apico-coronal width (height) of the gingiva. The integrity of the periodontium can be maintained during orthodontic therapy also in areas that have only a minimal zone of gingiva. In terms of changes in the position of the soft tissue margin and in gingival dimensions, the important factors to consider are the direction of the tooth movement and the bucco-lingual thickness of the gingiva. Lingual tooth movement will result in an increased bucco-lingual thickness of the tissue at the facial aspect of the tooth which results in coronal migration of the soft tissue margin (decreased clinical crown height). Facial tooth movement, on the other hand, will result in a reduced bucco-lingual tissue thickness and thereby a reduced height of the free gingival portion and an increased clinical crown height. The risk for development of recession type defects in conjunction with orthodontic tooth movement is present only if the tooth has been moved out of the alveolar bone housing, ie, when an alveolar bone dehiscence has been created.
This paper describes the prevalence and severity of gingival recession in Tanzanian adults covering the age range from 20 to 64 years. In addition, it attempts to assess the relationship between the degree of gingival recession and the presence and amount of calculus. In the 20-34 years age group recession occurred in > or = 32% of the buccal, > or = 25% of the lingual, and > or = 13% of the approximal surfaces. These %s increased to > or = 64%, > or = 52%, and > or = 48%, respectively, in the 45-64 years age group. In the 20-34 years age group, lingual surfaces of mandibular incisors and canines followed by buccal surfaces of these teeth were the sites most severely affected with gingival recession. With increasing age, all sites became gradually more severely affected, particularly the buccal and lingual surfaces of the maxillary first molar. The lingual surfaces of mandibular incisors exhibited on an average 1.3 mm, 2.4 mm and 3.2 mm recession in the 20-34 years, 35-44 years and 45-64 years age group, respectively. Most of the correlation coefficients between gingival recession and calculus at the individual tooth surface in three age groups were statistically significant. The highest correlation coefficients (0.50-0.67) were found in the youngest (20-34 years) age group at the lingual surfaces of the mandibular incisors, canine and first premolar and at the buccal surfaces of the mandibular incisors. Based on these findings, the working hypothesis is advanced that longstanding calculus is an important determinant in the onset of gingival recession at sites exhibiting pronounced recession at a young age in populations deprived of prophylactic dental care.
This article describes a new and simplified surgical approach to harvest subepithelial connective tissue grafts from the palate. For this procedure, only a single incision parallel to the gingival margin is used to access the donor site for graft preparation and harvesting. Grafts of variable size and thickness can be obtained. Since no band of epithelium is removed with the connective tissue graft the palatal donor site can heal with primary intention. No stents or hemostatic agents are necessary to cover the donor area postoperatively, and suturing can be reduced to a minimum. The harvesting technique is illustrated step by step, and the clinical application of connective tissue grafts harvested with the proposed method is demonstrated with the coverage of a gingival recession.
Gingival recession in its localized or generalized form is an undesirable condition resulting in root exposure. The result often is not esthetic and may lead to sensitivity and root caries. Exposed root surfaces also are prone to abrasion. The purpose of this article is to describe the prevalence, etiology and factors associated with gingival recession.
The authors reviewed cross-sectional epidemiologic studies of gingival recession and found that they correlated the prevalence of recession to trauma, sex, malpositioned teeth, inflammation and tobacco consumption. The recent surveys they reviewed revealed that 88 percent of people 65 years of age and older and 50 percent of people 18 to 64 years of age have one or more sites with recession. The presence and extent of gingival recession also increased with age.
More than 50 percent of the population has one or more sites with gingival recession of 1 mm or more. The prevalence of gingival recession was found in patients with both good and poor oral hygiene. It has been proposed that recession is multifactorial, with one type being associated with anatomical factors and another type with physiological or pathological factors. Recession has been found more frequently on buccal surfaces than on other aspects of the teeth.
Dentists should be knowledgeable about the etiology, prevalence and associating factors of gingival recession, as well as treatment options, so that appropriate treatment modalities can be offered to patients. Treatments for gingival recession include gingival grafting, guided tissue regeneration and orthodontic therapy. Such treatments typically result in esthetic improvement, elimination of sensitivity and a decreased risk of developing root caries.
In the previous decade, a notable increase in body adornment through tattooing and piercing has been a cause for concern among both dental and medical professionals. The author reports on the clinical consequences of wearing oral jewelry, specifically periodontal injury that requires surgical intervention. She also presents a general literature review of dental and medical consequences of wearing oral jewelry.
A 20-year-old woman with a tongue piercing had severe periodontal recession in lingual aspect of the mandibular incisal area proximal to the location of the oral jewelry. The author used a connective tissue graft to correct the defect via root coverage and an addition to the gingival width.
Wearing intraoral jewelry can lead to the development of severe mucogingival defects and necessitates careful and comprehensive periodontal evaluations on a regular basis to monitor attachment loss and damage to dental structures. Patients must be educated about these risks through counseling, patient information brochures and individual case documentation.