The patient was first submitted to initial preparation comprising scaling, root planning and oral hygiene instructions. After four weeks, the deep cervical abrasions were restored. For the restorative this site procedure, isolation was carried out using a rubber dam. Dentin and enamel were etched using 35% phosphoric acid gel for 15 and 30 seconds respectively, rinsed for 30 seconds, and the excess moisture blotted. Cavities were filled with a simplified adhesive system (Single Bond, 3M ESPE), applied according to the manufacturer��s instructions and with a microfilled resin composite (Durafill VS, Heraeus Kulzer, Armonk, NY) (Figure 2a). Ten days after the restorative procedure, the surgical procedure for coverage of the exposed roots was performed using SCTG associated with coronally advanced flap.
After antisepsis and anesthesia, an intrasulcular incision was made from tooth #14 through tooth #17 and a vertical incision was made mesially to tooth #14, followed by partial-thickness flap reflection. In tooth #13 a tunnel divulsion was performed from the vertical incision on the mesial side of tooth #14 and intrasulcular incision on tooth #13, preserving the interdental papilla (Figure 2b). The exposed root surfaces were scaled and planned. The resin composite restorations were carefully polished and smoothened using a tapered, multifluted, carbide finishing bur under abundant saline solution irrigation. Final contouring and finishing were accomplished with progressively finer grit aluminum oxide disks.
Figure 2 a) Deep cervical abrasions restored with microfilled resin composite; b) Partial thickness flap reflected from the distal of tooth #13 to the mesial of tooth #17; c) Subepithelial connective tissue graft positioned and sutured to the recipient site; d) … An autogenous connective tissue graft from the palate was obtained according to technique proposed by Bosco and Bosco.14 Using vycril 5.0 sutures the SCTG was tunneled on tooth #13 and sutured on the distal region of tooth #12. In the region of teeth #14 to #16 the SCTG was stabilized with compressive suture covering part of restored roots (Figure 2c). Therefore, the flap was advanced coronally to the SCTG, covering it completely, and secured with simple interrupted sutures and Y-shaped suspensory sutures. The vertical incision was closed with simple interrupted sutures (Figure 2d).
The surgical sites were then covered with periodontal dressing. After surgery, the patient received pain control medication (paracetamol 750 mg every 6 hours) when needed, antibiotic (amoxicillin 500 mg every 8 hours during 7 days) and chemical plaque control (0.12% chlorhexidine gluconate rinse – every 12 hours for 14 days). The periodontal dressing Carfilzomib was changed after 7 days and was removed together with the sutures the 14th postoperative day. The patient was maintained under professional supervision for oral hygiene control.