Parihar AS. Sub-epithelial Connective Tissue Graft. 43 Journal of Advanced Medical and Dental Sciences Research |Vol. 6|Issue 6| June 2018 Journal of Advanced Medical and Dental Sciences Research @Society of Scientific Research and Studies Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Case Report Sub-epithelial Connective Tissue Graft: A predictable method for coverage of recession associated with orthodontic treatment Anuj Singh Parihar Senior Lecturer, Department of Periodontology, RKDF Dental College & Research Centre, Bhopal - 462027, Madhya Pradesh, India ABSTRACT: Aesthetic concerns and functional abnormalities, such as dentin hypersensitivity, are often associated with gingival recession defects. Root coverage procedures aim to restore both gingival aesthetics and function in recession. There was a strong correlation between the severity and extent of gingival recessions and past orthodontic treatment, and it was suggested that orthodontic tooth movement might lead to a gingival recession. Miller’s Classes I and II recessions, in which the etiological factors are well diagnosed and eliminated, show great predictability of total coverage when the technique of subepithelial connective tissue graft is used. The purpose of this case report was to illustrate the relationship between orthodontic therapy and gingival recession and to describe the successful treatment of this case. A 25-year old girl with gingival recession and hypersensitivity in the anterior mandibular region was admitted to periodontology clinic. Treatment consisted of oral hygiene instructions, mechanical debridement, and surgical root coverage was by subepithelial connective tissue graft (SCTG). Keywords: Gingival recession, etiology, orthodontic, treatment, subepithelial connective tissue graft (SCTG) Received: 18 April 2018 Revised: 4 May 2018 Accepted: 7 May 2018 Corresponding author: Dr. Anuj Singh Parihar, Senior Lecturer, Department of Periodontology, RKDF Dental College & Research Centre, Bhopal - 462027, Madhya Pradesh, India This article may be cited as: Parihar AS. Sub-epithelial Connective Tissue Graft: A predictable method for coverage of recession associated with orthodontic treatment. J Adv Med Dent Scie Res 2018;6(6):43-45. INTRODUCTION: The etiology of gingival recession is multifactorial. Many factors play a role in recession development, i.e., excessive or inadequate teeth brushing; destructive periodontal disease; tooth malpositioning; alveolar bone dehiscence; thin and delicate marginal tissue covering a non- vascularized root surface; high muscle attachment and frenal pull; occlusal trauma; lip piercing; and iatrogenic factors related to reconstructive, periodontal, orthodontic, or prosthetics treatment (1).Among these etiologic factors, a strong correlation was found between the severity and extent of the gingival recession to past orthodontic treatment, and it was suggested that orthodontic tooth movement, especially beyond the labial or lingual alveolar plate, may lead to a gingival recession (2). Coverage of denuded roots has become one of the most challenging procedures in mucogingival periodontal surgery (1). The subepithelial connective tissue graft (SCTG) introduced by Langer and Langer in the year 1985, achieved a high success rate by combining the advantages of both free gingival and pedicle grafts. This technique has been proposed as “Gold standard”, as far as predictability and esthetics are concerned (3). CASE REPORT: A 25-year-old girl was referred by her orthodontist to the Department of Periodontology of our college for evaluation and treatment of the gingival recession associated with the mandibular left incisor. Her general health condition was good, did not take any medications, had no known allergies and was a non-smoker. Her chief complaint was concern relative to the recession associated with the lower front tooth. Clinical evaluation revealed gingival recession on the buccal surface extending 6 mm apical to the CEJ and a narrow zone of attached gingiva (Fig-1). There was no loss of papilla height on the mesial and distal aspect of the (e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805 SJIF (Impact factor) 2017= 6.261; Index Copernicus value 2016 = 76.77