牙龈衰退定义为牙龈上皮的顶迁移，导致根表面暴露。有许多用于治疗牙龈衰退的手术程序，主要目标是通过软组织增强覆盖裸露的牙齿表面。为根覆盖而执行的手术技术具有自己的优势和局限性。用于管理牙龈经济衰退的手术技术是决定结果的结果和长期结果的主要因素。治疗孤立的牙龈衰退的最常见手术技术是横向椎弓根移植物，根覆盖率最高的手术技术是结缔组织移植物。该病例报告涉及与横向椎弓根和结缔组织移植物的孤立牙龈衰退的管理。该过程的结果非常出色，具有完全的根覆盖范围。

The apical migration of the gingival epithelium leading to the exposure of the root surface is termed as Gingival Recession. The gingival recession has various etiological factors and the treatment of gingival recession should eliminate the etiological factors followed by achieving the root coverage. Gingival recession may lead to plaque and calculus accumulation, loss of aesthetics, root caries, abrasion of the root surfaces and hypersensitivity. There are many surgical procedures which has been used in management of gingival recessions and technique has their own advantages and limitations. Grupe and Warren described the Lateral Sliding Flap [1]. Presence of adequate amount of soft tissue and the underlying bone at the donor site makes the prognosis of lateral sliding flap good. The major disadvantage of the lateral sliding flap is the formation of gingival defects on the donor tooth. Sullivan and Atkins described the possibility of attaining root coverage by using free grafts at the site of gingival recessions [2,3]. They described that placement of the graft over the recession site causes some amount of “Bridging” because the survival of a portion of a graft is enhanced by the circulation from the vascular bed of the recipient site. In addition to Bridging, Creeping attachment by the coronal migration of the gingival epithelium occurs. The narrowness of the defects and the presence of interdental bone coronal to the buccal bone favours the coronal migration of the free gingival margin. Langer and Langer reported increase of 2 to 6mm of root coverage by placement of sub-epithelial connective tissue graft. It comprised of free connective tissue graft placed underneath a split thickness flap without making any attempt to completely cover the exposed connective tissue. This case report highlights the management of a isolated gingival recession using lateral pedicle and connective tissue graft. The post operative results were good achieving 100 percent root coverage without any post operative complications.

一名30岁的女性患者向牙周病部报告，主要抱怨过去2个月降低前牙齿牙齿区域的牙龈。该患者以前没有病史和牙科史。在考试中，米勒的II级经济衰退在41中引起了（图1）。患者的前庭深度不足。患者接受了初始I期治疗，然后使用940 nm二极管激光器进行前庭成形术，并在门控脉冲模式下进行1W的功率设置（图2）。四个星期后，对患者进行了召唤（图3）。

根覆盖程序

4周后召回患者，并评估牙龈参数。预先测量了大约1mm（图4），大约6mm（图5）的衰退高度（图5）和大约3mm的衰退宽度（图6）的参数。使用横向椎弓根移植物与结缔组织移植物结合进行根覆盖。从患者获得同意后，用木质素麻醉了手术区域（1：2,00,000）。从相邻的牙齿42反射侧椎弓根移植物（图7）。结缔组织移植是从pa骨表面获得的，相对于25和26，将移植的位点用3-0丝缝线缝合（图8）。将收获的移植物放在裸露的根表面上（图9），并将侧椎弓根移植放在结缔组织移植物上，并用5-0 vicryl独立缝合线固定（图10）。COE-PAK牙周敷料是通过将铝箔放在手术部位上给出的（图11）。1周后，对患者进行了召回（图12）。手术后三个月显示了100％的根覆盖率（图13）。

当使用自体结缔组织移植物时，角质性组织的牙龈衰退和增益较大[4,5]。用于治疗经济衰退部位的手术技术取决于包括该部位解剖结构的各种因素，相邻角化组织的宽度和高度，衰退缺陷的大小，前庭深度以及Frenum的存在。牙龈衰退可能是由于许多病因原因引起的。在治疗计划期间，消除缺陷的因子应优先。在此案例中，单个孤立的衰退是由于前庭深度造成的。因此，在根覆盖过程之前，进行了前庭成形术。关于使用各种技术获得的根覆盖率百分比的研究导致结缔组织移植物以及冠状动脉的成功率最高的成功率约为88％至98％[6,7]。在当前情况下，角质牙龈不足以获得冠状动脉瓣，并且在相邻的牙齿中有足够的附着的牙龈，因此与结缔组织移植物结合进行了侧向椎弓根。横向椎弓根移植物提供足够的根覆盖范围，并在底部保留血液供应时在血管根表面上生存。结缔组织移植物可确保附着的牙龈的厚度。 The outcome of the surgical technique after 3 months showed good results with complete root coverage.

This case report gives a combined technique of covering the denuded root surfaces using subepithelial connective tissue graft and lateral pedicle graft. The graft survives over the denuded root surface as the vascular supply is maintained from the base of the pedicle graft and ensures complete root coverage. The major disadvantage of this technique is that it requires autogenous graft from a secondary donor site which may affect the patient compliance during the surgical procedure. In order to evaluate the efficiency of this combined technique more sample size should be included for the study. Thus combination of lateral pedicle graft and subepithelial connective tissue graft serves as a good technique for the management of isolated gingival recessions.

1. Nelson SW. The subpedicle connective tissue graft. A bilaminar reconstructive procedure for the coverage of denuded root surfaces. J Periodontol. 1987; 58: 95-102. PubMed:https://www.ncbi.nlm.nih.gov/pubmed/3546673
2. Langer B，Langer L.根覆盖的上皮下结缔组织移植技术。J Pencenontol。1985;56：715-720。PubMed：https://www.ncbi.nlm.nih.gov/pubmed/3866056
3. Guinard EA, Caffesse RG. Treatment of localized gingival recessions: Part I. Lateral sliding flap. J Periodontol. 1978; 49: 351-356. PubMed:https://www.ncbi.nlm.nih.gov/pubmed/279662
4. Oates TW，Robinson M，Gunsolley JC。治疗牙龈衰退的手术疗法。系统评价。安·周刊。2003;8：303-320。PubMed：https://www.ncbi.nlm.nih.gov/pubmed/14971258
5. Prato GP，Tinti C，Vincenzi G，Magnani C，Cortellini P等。在人类颊牙龈衰退的治疗中，引导组织再生与粘膜手术。J Pencenontol。1992;63：919-928。PubMed：https://www.ncbi.nlm.nih.gov/pubmed/1453307
6. Zucchelli G，Cesari C，Amore C，Montebugnoli L，de Sanctis M.横向移动，冠状动脉瓣：一种用于孤立衰退型缺陷的改良手术方法。J Pencenontol。2004;75：1734-1741。PubMed：https://www.ncbi.nlm.nih.gov/pubmed/15732880
7. Kassab MM，Cohen RE。牙龈衰退的治疗。J Am Dent Assoc。2002;133：1499-1506。PubMed：https://www.ncbi.nlm.nih.gov/pubmed/12462693