Surgical Repair of Lingual Recession Defects Associated With Tongue Piercing

Case Study

A 25 year old Caucasian male was referred for localized severe mucogingival deformities in the mandibular central incisor teeth with localized periodontal abscess on the right central incisor . He was healthy, did not smoke and had no contraindications to treatment. 

The patient reported to wear the plastic tongue ring for 5 years and decided to discontinue wearing it approximately 1.5 years ago. His chief complaint was related to his concern of being told by his general dentist to remove the tongue ring because of the worsening of the gingival recession and periodontal abscess localized on the right central incisor.

The examination revealed deep and narrow Miller Class III defects in the mandibular central incisor teeth. Pre clinical probing depths on the midlingual aspect was 5mm on left central and 10mm on right central, gingival recession of 5mm and 5mm respectively, clinical attachment level of 10mm and 15 mm respectively. Width of keratinized tissue was 2mm and 1mm respectively. Bleeding on probing was more pronounced on right central incisor with remaining subgingival calculus detected with  explorer. Grade I mobility was diagnosed on both mandibular central incisor teeth.

Pretreatment radiograph shows the crest of the alveolar bone to be 3mm from the level of the interproximal cementoenamel junction and with interproximal vertical bone defects on right central incisor. A widened PDL and apical radiolucency was diagnosed as well on right central incisor.

 An initial therapy consisted of oral hygiene instruction with meticulous plaque control, permanent removal of device, scaling and root planing followed by selective occlusal equilibration. An endodontic consult was performed. The pulpal and periapical diagnosis of the right central incisor was found to be normal. Due to the severe interproximal attachment loss observed on both right and left central incisor teeth, it was recommended to perform regenerative therapy over the roots to correct first the osseous defect with a second procedure being a connective tissue graft to correct the recession and augment the attached gingival.