Periodontal plastic surgery for cases with fixed "hygienic" lingual retainer: Case study

The fixed "hygienic" lingual retainer (FHLiR)'s design is consistently observed as a contributing factor to plaque accumulation, possible minor undesired tooth movement, resulting in buccal bone loss, and gingival recession (GR). This case study aimed to describe the clinical outcomes of a combined periodontal treatment and periodontal plastic surgical approach for the treatment of GR in patients using FHLiR.

This case study involves three systemically healthy, non-smoking patients with localized GRs (RT1 and/or RT2) in the mandibular central incisors associated with FHLiR. The proposed treatment included replacement of the FHLiR with a straight retainer, periodontal therapy, and surgical root coverage procedures. Subepithelial connective tissue grafts (sCTG), tunnel techniques, microsurgical approaches, and adjunctive biomaterials were employed according to case-specific needs. All surgeries were performed by a single experienced periodontist, with follow-up up to 12 months.

Clinical outcomes consistently improved gingival thickness, root coverage, and periodontal tissue stability. Patients expressed satisfaction or high satisfaction, even in cases requiring two procedures.

This case study illustrates the clinical outcomes of a combined basic periodontal and periodontal plastic surgical approach for the treatment of RT1/RT2 GRs in mandibular incisors associated with FHLiR, suggesting its potential to achieve functional and esthetic rehabilitation in this clinical context.

Association of fixed "hygienic" lingual retainers (FHLiR) with gingival recession (GR): FHLiR, particularly those with curved or looped designs, may be a contributing factor for plaque accumulation, minor tooth movements, and buccal bone loss, leading to localized GR (RT1/RT2) in mandibular incisors. Comprehensive treatment approach: Management included replacing the FHLiR with a straight retainer, performing basic periodontal therapy, and applying periodontal plastic surgery(s) - mainly subepithelial connective tissue grafts with coronally advanced flap (using tunnel and microsurgical techniques) - with or without biomaterials, tailored to each patient's needs. Consistent clinical improvement: Across three cases, patients showed notable gains in gingival thickness, root coverage, and periodontal stability, with high satisfaction levels - even in cases requiring multiple surgical interventions.

This study aimed to describe the clinical outcomes of a combined periodontal treatment and periodontal plastic surgical approach for the treatment of gingival recession (GR) in patients using a fixed "hygienic" lingual retainer (FHLiR). It is bonded to the lingual (back) surface of the lower front teeth after orthodontic treatment. While these retainers are meant to keep teeth straight/aligned, their design often makes them challenging to clean and may reduce passivity. Over time, poor hygiene and possible minor movements might contribute to undesirable tooth shifts, bone loss, and, most notably, GR on the outer/facial tooth surfaces. This report details the treatment of three healthy patients who developed localized GR around their lower front teeth, possibly associated with FHLiR. The treatment involved removing the problematic retainer and replacing it with a simpler, straight design, followed by specialized gingival (periodontal plastic) surgery, using techniques such as connective tissue grafts to cover the exposed roots. The results showed consistent improvement in gingival thickness and successful root coverage. The study concludes that combining basic periodontal therapy with specific surgical procedures for the treatment of GRs in mandibular incisors associated with FHLiR is a practical approach for restoring both the function and appearance of the gingival tissue.