2017 Volume 59 Issue 3 Pages 161-171
Depending on the location of an impacted tooth, traction from the gingiva may be necessary in the absence of an attached gingiva. Herein, we report 2 cases with an impacted tooth and a tooth with lower labioversion for which the prevention of gingival recession and a stable attached gingiva were successfully obtained after free gingival grafting during traction as part of orthodontic treatment. Case 1 was a 17-year-old male patient who had gingivitis, an inversely impacted maxillary left central incisor, and severe crowding. During the treatment, we performed initial periodontal therapy for the gingivitis, orthodontic treatment for the impacted tooth and crowding, fenestration surgery for the crown of the impacted tooth, and free gingival grafting to obtain attached gingiva for the tooth. Gingival grafting for the impacted tooth was performed once the crown had sufficiently erupted as a result of traction from the orthodontic treatment so as to allow free gingival grafting to the labial cervical region. The inversely impacted central incisor was then appropriately arranged, and a sufficient width was obtained for the surrounding attached gingiva. Case 2 was a 16-year-old female patient who had localized periodontitis, skeletal maxillary protrusion, severe crowding of the mandibular anterior teeth, and crowding-induced gingival recession of the mandibular left central incisor. For this patient, we provided the same treatment as that used for Case 1, in the same order. The timing of the gingival grafting was particularly important. The periodontal surgical procedures were performed when leveling for the crowding of the mandibular anterior teeth had been completed. In both patients, free gingival grafting was performed to obtain keratinized gingiva during traction/guiding of the impacted and displaced teeth by orthodontic force, and gingival recession was prevented by successive orthodontic treatments. Furthermore, the gingival recession caused by the roll-separating force improved in Case 2.
