Vestibular tunnel approach in restoring non-carious cervical lesion gingival recessions with combination of bioceramics and collagen matrix: A case report with a 1-year follow-up

Abstract

Introduction

Non-carious cervical lesions (NCCLs) can compromise the integrity to both hard and soft tissues of teeth. This case report introduces a novel interdisciplinary technique by utilizing bioceramics-based cement (BBC) and porcine collagen matrix (CM) to reconstruct the dentogingival complex where enamel, dentin, and soft tissues were involved.

Case presentation

A 38-year-old healthy male was referred to the periodontics department for gingival recessions teeth #27–29 and a deep (NCCL) on the facial (F) #28 involving the loss of the cementoenamel junction (CEJ). The F #28 was restored with BBC according to manufacturing instructions. Soft tissues of #27–29 were simultaneously augmented with two CM strips via a coronally advanced tunnel utilizing suspended sutures. At the 6-month follow-up, approximately 100% root coverages were obtained for #27 and 29. The F #28 gingival tissue stabilized at the anticipated level of maximum root coverage (MRC), 1 mm apical to the coronally displaced CEJ. The exposed layer of BBC, F #28, was veneered with resin-modified glass ionomer to re-establish the original position of the CEJ. At the one-year follow-up visit root coverage for #28 remained stable and probing depths remained unchanged at 2 mm F #27–29. A sectional cone beam computed tomography scan illustrated the BBC restoration remained intact and well adapted.

Conclusion

The 12-month follow-up illustrated that the BBC may be a viable restorable material while performing simultaneous gingival grafting with CM in deep NCCLs with gingival recessions.

Key points

Why is this case new information?

• A novel approach treating the deep non-carious cervical lesion with BBC and CM.

What are the keys to successful management of this case?

• The BBC placement needs to be flat.
• Secure the surgical site with non-resorbable suspensory sutures fixed by flowable composite.

What are the primary limitations to success in this case?

• The primary limitation to success is the blood moisture control which may limit the placement of collagen matrix strips via the portal entry.