Root coverage in deep recessions with apex involvement: Long-term case study

Area of Science:

• Periodontology
• Restorative Dentistry
• Oral Surgery

Background:

• Deep gingival recessions (GRs) with root apex exposure pose significant clinical challenges.
• A multidisciplinary approach is often necessary to improve tooth prognosis in such cases.
• This study focuses on seven teeth with deep GRs (≥5 mm) and exposed root apices.

Observation:

• Teeth were treated with endodontic therapy, apicoectomy, and root coverage procedures.
• Surgical techniques included the laterally positioned flap or modified double papilla flap with connective tissue grafts (CTG).
• The mean follow-up period was 3.86 years, ranging from 1 to 11 years.

Findings:

• A mean gingival recession reduction of 7.57 mm was achieved.
• Complete root coverage was observed in four of the seven cases.
• No teeth required extraction, and all demonstrated improved prognoses.

Implications:

• Root coverage surgery combined with CTG and apicoectomy is effective for severe mucogingival defects.
• This interdisciplinary approach can successfully alter tooth prognosis, offering a viable alternative to extraction.
• The findings support prioritizing mucogingival procedures as a first-line treatment for deep gum recession with apex involvement.