فرحناز فرخی نیا

The relation between periodontitis and cardiovascular diseases has been of interest inrecent years. Cardiovascular diseases in the developed countries account for 50% of themortality rate and are the principal causes of death. Periodontitis, one of the mostcommon diseases of human, is an infectious condition that can result in inflammatorydestruction of the peridontal ligament and alveolar bone. Periodontitis and atherosclerosishave complex etiologies like genetics and gender, and they potentially share many riskfactors, the most significant of which may be smoking. A number of studies have shown asignificant relationship between periodontitis and cardiovascular diseases, but the needfor further studies of new definitions of relationship between them especially in womenseems to be demanded

Gingival recession or apical migration of gingival margin, is a commonperiodontal lesion. A number of methods have been used to treat Miller's Class I & IIgingival recessions with a notable success in root coverage. Howevers in the treatment ofMiller's Class III & IV gingival recessions, a predictable method has not been presented.It seems that the application of connective tissue grafts combined with various kinds ofpedicle flaps may bring about satisfying results. In this study, a combination of palatalfree connective tissue graft and a special kind of coronally positioned flap was used totreat Miller's Class III & IV gingival recessions. Eight patients including 6 females and 2 males with a total number of 28 anterior affected teeth with an average age of 35 years old were included in this study. The depths of recessions were between 0.8 and 5.6 mm (with an average depth of 3.2 mm). The following parameters were measured before and 1,3 and 6 months after the procedure: probing pocket depth, the depth of gingival recession from C.E.J and stent, width of attached gingiva, clinical attachment level (CAL) and root sensitivity. In the surgical procedure, a coronally positioned flap was done with the first incision MGJ and continued with an apically directed partial thickness incision up to 5 mm. Then, it was followed by a second incision, which dissected the periosteum from the bone at the bottom of the buccal vestibule. Consequently, an intracervicular incision ran around the affected teeth, and the flap complex was pushed coronally. Prepared free connective tissue graft was placed beneath the flap on interdental areas and denuded root surfaces, and then it was sutured to the superficial flap. The apical end of the flap was sutured to the depth of vestibule. The results showed an average of 1.21-mm root coverage on the distobuccal side of the teeth. The amount of root coverage on midbuccal, mesiobuccal, mesial papilla and distal papillaes were 1.74, 1.25, 1.17and 0.93 mm respectively. The increase of CAL on mesiobuccal and midbuccal sides was significant with p<0.001. The width of keratinized gingiva remained unchanged but the width of attached gingiva increased considerably, from 4.5 mm at the baseline to 8.27 mm after the procedure. The surgical procedure can be used successfully for papilla reconstructionand root coverage in Calss III and IV gingival recessions.