International Journal of Dental Sciences and Research
ISSN (Print): 2333-1135 ISSN (Online): 2333-1259 Website: Editor-in-chief: Marcos Roberto Tovani Palone
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International Journal of Dental Sciences and Research. 2018, 6(3), 53-56
DOI: 10.12691/ijdsr-6-3-1
Open AccessCase Report

The Use of Subepithelial Connective Tissue Graft for Treatment of Gingival Recession in a Snuff Dipping User (A Case Report)

Abdelrahman Magzoub1, Abubaker Mohamed2 and Nada Tawfig3,

1Department of Periodontology, School of Dentistry, Nile College, Sudan

2Masa Dental Center for Paedodontics Specialty, Khartoum, Sudan

3Department of Periodontology, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan

Pub. Date: March 24, 2018

Cite this paper:
Abdelrahman Magzoub, Abubaker Mohamed and Nada Tawfig. The Use of Subepithelial Connective Tissue Graft for Treatment of Gingival Recession in a Snuff Dipping User (A Case Report). International Journal of Dental Sciences and Research. 2018; 6(3):53-56. doi: 10.12691/ijdsr-6-3-1


Nowadays patients have become excessively concerned about esthetics. These esthetic concerns of patients have become an essential part of periodontal practice. Gingival recession is considered as one of the clinical manifestations affecting adult people with chronic periodontal disease. Smokeless tobacco (ST) use has been linked with a number of oral manifestations confined to the site of ST placement. These manifestations include mucosal lesions, gingival and periodontal effects, such as gingival recession, changes in gingival blood flow, and interproximal periodontal attachment loss. Gingival recession and attachment loss have been shown to occur in the area adjacent to where the smokeless tobacco is held. Various grafting procedures have been proposed in order to cover the area of recession and to prevent further recession by increasing the width of the attached gingiva. This paper reports a case in which a subepithelial connective tissue graft with a coronally positioned flap were used to produce a full coverage for miller class II recession.

gingival recession snuff dipping connective tissue grafts.

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[1]  Tugnait A, Clerehugh V. Gingival recession-its significance and management. J Dent. 2001; 29: 381-94.
[2]  Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003; 134: 220-5.
[3]  Albandar JM and Kingman A, “Gingival recession, Gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994,” Journal of Periodontology 1999; 70: 30-43.
[4]  Addy M, Mostafa P, Newcombe RG. Dentine hypersensitivity: the distribution of recession, sensitivity and plaque. J Dent 1987; 15: 242-8.
[5]  Gorman WJ. Prevalence and etiology of gingival recession. J Periodontol 1967; 38: 316-22.
[6]  Walsh PM, Epstein JB. The Oral Effects of Smokeless Tobacco. J Can Dent Assoc. 2000; 66: 22-5.
[7]  Idris AM, Ibrahim YE, Warnakulasuriya KA, Cooper DJ, Johnson NW, Nilsen R. Toombak use and cigarette smoking in the Sudan: estimates of prevalence in the Nile state. Prev Med. 1998; 27:597-603.
[8]  Axéll T, Mörnstad H, Sundström B. The relation of the clinical picture to the histopathology of snuff dipper’s lesions in a Swedish population. J Oral Pathol. 1976; 5: 229-236.
[9]  Frithiof L, Anneroth G, Lasson U, Sederholm C. The snuff-induced lesion. A clinical and morphological study of a Swedish material. Acta Odontol Scand. 1983; 41:53-64.
[10]  Christen AG, McDaniel RK, Doran JE. Snuff dipping and tobacco chewing in a group of Texas college athletes. Tex Dent J. 1979; 97: 6-10.
[11]  Montén U, Wennström JL, Ramberg P. Periodontal conditions in male adolescent using smokeless tobacco (moist snuff) J Clin Periodontol. 2006; 33: 863-868.
[12]  Robertson PB, Walsh M, Greene J, Ernster VL, Grady D, Hauck W. Peridontal effects associated with the use of smokeless tobacco. J Peridontol 1990; 61: 438-43.
[13]  Kardachi BJR and Clarke NG. An Etiology of Acute Necrotising Ulcerative Gingivitis: A Hypothetical Explanation, J Periodontol 1974; 45: 830-832.
[14]  Clarke NG and Carey SE. Etiology of Chronic Periodontal Disease:An Alternative Perspective, J Am Dent Assoc 1985; 110: 689-691.
[15]  Alghamdi H, Babay N, Sukumaran A. Surgical management of gingival recession:A clinical update. The Saudi Dental Journal (2009); 21: 83-94.
[16]  Hall WB. Gingival augmentation/mucogingival surgery. In: Proceedings of the World Workshop in Clinical Periodontics. Chicago: The American Academy of Periodontology; 1989: VII/l-VII/21.
[17]  Novaes Jr. AB, Grisi DC, Molina GO, Souza L.S.S., Taba Jr.M, Grisi M.F.M. Comparative 6-Month Clinical Study of a Subepithelial Connective Tissue Graft and cellular Dermal Matrix Graft for the Treatment of Gingival Recession. J Periodontol 2001; 72: 1477-1484.
[18]  Miller Jr PD. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985; 5: 8-13.
[19]  Kour A, Kumar A, Puri K, Khatri M, Bansal M, and Gupta G. Comparative evaluation of probing depth and clinical attachment level using a manual probe and Florida probe. J Indian Soc Periodontol. 2016; 20: 299-306.
[20]  Miller PD. Root coverage grafting for regeneration and esthetics. Periodontology 2000 1993; 1: 118-127.
[21]  Donaldson M, Goodchild JH. Appropriate analgesic prescribing for the general dentist. Gen Dent. 2010; 58(4): 291-7.
[22]  Hürzeler MB, Weng D. Hurzeler MB, et al. Int J Periodontics Restorative Dent. 1999; 19: 279-87.
[23]  Agudio, G., Nieri, M., Rotundo, R., Cortellini, P., Pini Prato, G. Free gingival grafts to increase keratinized tissue: a retrospective long-term evaluation (10 to 25 years) of outcomes. J. Periodontol.2008; 79: 587-594.
[24]  Langer L, Langer B. The subepithelial connective tissue graft for treatment of gingival recession. Dent Clin North Am. 1993; 37: 243-64.
[25]  Gritz ER, Baer-Weiss V, Benowitz NL, Van Vunakis H, and Jarvik ME. Plasma Nicotine and Cotinine Concentrations in Habitual Tobacco Users, Clin Pharmacol Ther 1981; 30: 201-209.
[26]  Johnson GK, Todd GL, Johnson WT, Fung YK, Dubois LM. Effects of Topical and Systemic Nicotine on Gingival Blood Flow in Dogs. J Dent Res 1991; 70: 906-909.