*Piotr Sobiech1, Marcin Szerszeń1, 2, Julia Wiśniewska3
Application of Kazanjian’s vestibuloplasty in the prevention of gingival recession in children – a report of two cases
Wykorzystanie westibuloplastyki metodą Kazanjiana w zapobieganiu recesji dziąseł u dzieci – opis dwóch przypadków
1Department of Paediatric Dentistry, Medical University of Warsaw
Head of Department: Professor Dorota Olczak-Kowalczyk, PhD, MD
2Department of Dental Prosthetics, Medical University of Warsaw
Head of Department: Professor Elżbieta Mierzwińska-Nastalska, PhD, MD
3Students’ Research Association at the Department of Paediatric Dentistry, Medical University of Warsaw
Mentor to the Students’ Research Association: Anna Turska-Szybka, PhD, MD
Streszczenie
The period of teeth replacement and the development of stomatognathic system are characterised by intense changes in the periodontium. The position of frenulum and the width of the attached gingiva begin to stabilise, but early abnormalities may contribute to disorders in normal structure and aesthetics. Mandibular incisor gingival recessions occurring in children during this period are not uncommon. Despite the possibility of spontaneous reversal with the development of the stomatognathic system, some patients require surgical treatment. Rapid intervention is necessary to prevent periodontal abnormalities from becoming permanent and to avoid greater destruction. We describe 2 cases of young patients undergoing vestibuloplasty by the Kazanjian technique. The choice of this approach was based on the surgical protocol, which could be used in a relatively cooperative patient. Surgical procedures in children must be rapid and generate predictable and safe treatment outcomes. It is also important that convalescence after the procedure does not limit patient’s functioning and requires no extreme care from the patient. The effects are fully satisfactory in terms of both aesthetics and health.
Summary
The period of teeth replacement and the development of stomatognathic system are characterised by intense changes in the periodontium. The position of frenulum and the width of the attached gingiva begin to stabilise, but early abnormalities may contribute to disorders in normal structure and aesthetics. Mandibular incisor gingival recessions occurring in children during this period are not uncommon. Despite the possibility of spontaneous reversal with the development of the stomatognathic system, some patients require surgical treatment. Rapid intervention is necessary to prevent periodontal abnormalities from becoming permanent and to avoid greater destruction. We describe 2 cases of young patients undergoing vestibuloplasty by the Kazanjian technique. The choice of this approach was based on the surgical protocol, which could be used in a relatively cooperative patient. Surgical procedures in children must be rapid and generate predictable and safe treatment outcomes. It is also important that convalescence after the procedure does not limit patient’s functioning and requires no extreme care from the patient. The effects are fully satisfactory in terms of both aesthetics and health.
Introduction
The need for periodontal intervention in children is usually due to the common presence of dental plaque resulting from either irregular or ineffective oral hygiene. It promotes dental caries and gingivitis, which may lead to adverse periodontal changes. Although gingival recession affects about 20% of children, the actual recession may be diagnosed only after the age of 10 years due to gingival maturation (1-5).
Gingival recession – causes and management
Gingival recession in children is most often located in the region of mandibular incisors. Multiple causes of this phenomenon, such as improper tooth brushing technique (usually in highly developed countries), chronic gingivitis due to dental plaque retention, occlusal trauma, iatrogenic factors (most often due to labial tooth movement during orthodontic treatment) and, most of all, developmental factors (Geiger, Olsson and Lindhe), classified as osseous, gingival and dental, are reported by different authors (2, 4, 5). From the clinical point of view, it is important to know the cause of recession to choose the mode of treatment, especially since recessions may resolve in children after eliminating the causative factor (6, 7). However, effective plaque control in the prevention of recessions proves efficacious in children below the age of 12 years (2, 5).
Miller’s classification of gingival recession may be useful in choosing proper therapy and setting expectations after the procedure (8). There are four classes of recessions:
– class I – recession does not cross the mucogingival junction (MGJ), and there is no tissue loss in the interdental area,
– class II – recession extends to or beyond the MGJ; there is no tissue loss in the interdental area,
– class III – recession extends to or beyond the MGJ; bone or soft tissue loss in the interdental area is present,
– class IV – recession extends to or beyond the MGJ; the bone or soft tissue loss in the interdental area is severe and often associated with malpositioning of teeth.
In the first two classes, aesthetics recovery can be expected; in class III and IV, full reconstruction of lost tissues is difficult. Therefore, early prevention or treatment is of particular importance among young patients.
In the case of anatomical gingival causes, such as an abnormal insertion of the lower lip frenulum or shallow vestibule of the mouth, periodontal plastic surgery (PPS) should be considered. Positive pull test indicating the presence of the so-called pull syndrome, which accompanies these disorders, is an indication for augmentation of the attached gingiva, as in accordance with the guidelines set out at the first European Periodontology Congress. The technique described by Kazanjian in 1935 is a method of choice for vestibular deepening and correction of the insertion of the lower labial frenulum in children as it spares the periosteum. The technique involves vestibular deepening by inserting a mucosal flap, which was separated from the alveolar periosteum, apically to the mucogingival junction (3, 10).
Case report 1
A 12-year-old patient reported to the Department of Paediatric Dentistry of the Medical University of Warsaw for check-up. Intraoral examination revealed Miller class I gingival recession at teeth 31 and 41, and significantly shallowed vestibule (fig. 1). Dental plaque was observed and removed during the visit; no signs of gingivitis were found. Local ischaemia of the proper gingiva, i.e. the so-called pull syndrome, was observed when pulling the upper lip. The patient’s parent reported a history of unsuccessful lower labial frenulum correction. In the light of positive pull test, vestibuloplasty by Kazanjian technique was performed to deepen the vestibule and extend the region of proper gingiva without dissection of a full-thickness flap.
Fig. 1. Baseline – case 1
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Piśmiennictwo
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