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©	2017 www.centralenglandreferrals.co.uk
KNOWLEDGE	
HUB	
Recession	Case	
by	Monica	
Campos	Gallego
This	patient	was	referred	to	
Dr.	Monica	Campos	Gallego	
by	his	GDP	due	to	a	
recession	in	his	upper	left	
canine	where	the	patient	
was	suffering	of	sensitivity.	
Look	through	the	case	and	
join	in	the	conversations	
online.	
Recession	Case	-	November	2017	
Monica	Campos	Gallego
Sharing	knowledge	and	stimulating	conversation	between	dental	professionals
INITIAL	PROBLEM
www.centralenglandreferrals.co.uk©	2017
On	examination,	the	patient	had	some	shallow	recession	but	on	the	upper	left	canine	he	had	a	Miller	class	II	of	
5mm	in	length.		He	was	also	suffering	from	bleeding	gums	and	a	large	amount	of	supra	and	subgingival	deposits	
of	tartar	were	present.
Recession	Case	-	November	2017	
Monica	Campos	Gallego
PREGRAFTING
www.centralenglandreferrals.co.uk©	2017
	Following	the	periodontal	assessment	(comprising	plaque	and	bleeding	scores,	pocket	depth,	recession	depth,	clinical	
attachment	level,	and	keratinized	gingiva	height),	Dr.	Monica	explained	the	patient	the	necessity	of	treating	the	
gingivitis	before	carrying	out	the	coverage	of	the	recession.
Recession	Case	-	November	2017	
Monica	Campos	Gallego
PREGRAFTING
www.centralenglandreferrals.co.uk©	2017
Throughout	several	appointments,	the	hygienist	removed	all	calculus	and	plaque	retentive	factors	and	provided	oral	
hygiene	instructions	to	the	patient.	As	a	result,	the	bleeding	score	dropped	from	45%	to	8%	when	Dr.	Monica	
reassessed	the	case	6	weeks	after	the	last	hygiene	appointment.		And	thus,	the	conditions	were	appropriate	to	
undertake	the	surgical	procedure.	
Recession	Case	-	November	2017	
Monica	Campos	Gallego
SURGICAL	PROCEDURE
www.centralenglandreferrals.co.uk©	2017
The	aim	of	the	root	coverage	should	be	complete	coverage	of	the	recession	defect	with	a	pleasing	colour	and	tissue	
blend	between	the	treated	area	and	adjacent	tissues,	thereby	achieving	both	biologic	and	aesthetic	success.		
Recession	Case	-	November	2017	
Monica	Campos	Gallego
SURGICAL	PROCEDURE
www.centralenglandreferrals.co.uk©	2017
In	this	case,	a	connective	tissue	graft	(CTG)	was	harvested	from	the	palate	using	the	trap	door	technique.	After	local	
anesthesia	was	induced	the	exposed	root	surfaces	were	planed	with	hand	instruments	and	burs	to	eliminate	any	
surface	irregularities.		A	modified	envelope	flap	(Zucchelli´s	technique)	was	used	(as	showed	in	the	“surgical	
procedure	plan”)	and	the	envelope	flap	was	raised	with	a	split-full-split	approach	in	the	corono-apical	direction.	
The	remaining	anatomic	interdental	papillae	were	de-epithelialized	to	create	the	connective	tissue	beds	to	which	the	
surgical	papillae	would	be	sutured.	A	sharp	dissection	into	the	vestibular	lining	mucosa	was	performed	to	eliminate	
muscle	tension	and	facilitate	the	adequate	coronal	displacement	of	the	flap.
Recession	Case	-	November	2017	
Monica	Campos	Gallego
www.centralenglandreferrals.co.uk©	2017
SURGICAL	PROCEDURE
Once	the	CTG	has	been	collected	from	the	palate	was	immediately	placed	over	the	prepared	recipient	site	and	secured	in	
place	with	Vicryl	5-0.	The	tissue	flap	was	coronally	repositioned	over	the	graft	and	secured	at	the	level	of	the	CEJ	using	
interdental	5-0	Vicryl	sutures.	
Recession	Case	-	November	2017	
Monica	Campos	Gallego
www.centralenglandreferrals.co.uk©	2017
POST	SURGERY
ONE	WEEK
TWO	WEEKS
TWO	WEEKS	
STITCHES	REMOVED
Recession	Case	-	November	2017	
Monica	Campos	Gallego
RESULT
www.centralenglandreferrals.co.uk©	2017
The	patient	was	given	postoperative	instructions	and	prescribed	antibiotics	(amoxicillin	500	mg	three	a	day	for	7	days)	
and	analgesics.		A	0.2%	chlorhexidine	spray	was	prescribed	for	the	early	healing	phase.	Sutures	were	removed	2	
weeks	after	surgery.			As	shown	in	the	picture	above,	oral	prophylaxis	was	performed	at	regular	intervals;	1,	3,	and	5	
weeks	after	suture	removal	and	every	3	months	thereafter	until	the	final	follow-up.	
ONE	MONTH
Recession	Case	-	November	2017	
Monica	Campos	Gallego
Click here to refer to CESRC or:
Call 0121 478 3770
Email info@centralenglandreferrals.co.uk
	
www.centralenglandreferrals.co.uk©	2017
Recession	Case	-	November	2017	
Monica	Campos	Gallego
Types	of	patient	to	be	referred:	
Patients	with	BPE	4,		
especially	patients	<40	years	
Persistent	pocketing		
	Advanced	bone	loss	
Crown	lengthening		
Recession	
Referrals	to		
Monica	Campos	Gallego

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Recession Case by Dr Monica Campos Gallego