CASE OF THE MONTH

1. CASE OF THE MONTH JANUARY 2012

2. HISTORY • 28 year-old male; medical history within normal limits. • 2- year history of periodic, progressive thermal hypersensitivity. Patient states progressive recession over the past year. • Referral to periodontist for evaluation and potential treatment.

3. CLINICAL EXAM • Teeth #9 through #11 revealed dentinal exposure, ranging from 2-4 mm. • Recession is classified Miller’s Class I • No bleeding upon probing, and probing depths were less than 3 mm. • No perceptible tooth mobility was noted. • Radiographs presented no evidence of interproximal bone loss. • No history of tobacco use.

6. TREATMENT PLAN • Discussion of current plaque control regimen. Patient currently uses “medium” stiffness toothbrush. The patient will convert to toothbrush of “soft” stiffness. • Treatment options proposed to patient: • Autogenous soft tissue • Acellular dermal matrix (ADM) • Patient selects ADM due to concern for second surgical site.

7. ADM is “sized” to fit sites

8. ADM placed into “tunnel” developed from sulci

9. The following slide shows closure of the site and coverage of the ADM via expanded polytetrafluorethylene sutures (e-PTFE). • Individual sling sutures were placed, and tied on the palatal surfaces of the respective teeth.

11. 21 months

12. 21 months

13. SUMMARY • PROBLEM • Periodic, progressive thermal hypersensitivity in areas of dentinal exposure. • TREATMENT • Use of Acellular Dermal Matrix as graft material in a root coverage procedure. • OUTCOME • 1 to 3 mm probing depths, with total root coverage, and no thermal hypersensitivity at 21 months post-surgery.