* denotes required field

Your Name: *

FIRST NAME

LAST NAME

Gender: *

MaleFemale

Personal Email: *

This will be your username

Password: *

Display Name: *

This will be what others see in social areas of the site.

Address: *

STREET ADDRESS (LINE 1) *

STREET ADDRESS (LINE 2)

CITY *

STATE *

ZIP *

Phone Number:

School/University: *

Graduation Date: *

Date of Birth: *

ASDA Membership No:

I agree to the Terms of Service and Privacy Policy *

ABOUT SSL CERTIFICATES

Validation Link

Verification Link

Enter University Email Address:

Username

Password

Forgot Password

Forgot Your Password?

To reset your password, enter the email address
you use to sign in to your THE NEXT DDS account.

Enter Email Address:

Hi returning User! please login with Facebook credentials where Facebook Username is same as THENEXTDDS Username.

Username

Password

Case Name:	Date:	Contributor:	Rating:

« Previous

Case

Clinical Photos

Illustrations / Diagrams

Frenectomy via Soft Tissue Laser

Adolescent Patient Requiring Frenectomy - Laser technology has allowed clinicians to improve the level of dental care they provide to their patie...

Adolescent Patient Requiring Frenectomy - Laser technology has allowed clinicians to improve the level of dental care they provide to their patients. The soft tissue laser can be used in daily practice for precise soft tissue applications, providing rapid healing of the patient and increasing revenu...

Adolescent Patient Requiring Frenectomy<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative view of adolescent patient who requires frenectomy.</span>

Figure 1 - Preoperative view of adolescent patient who requires frenectomy.

Adolescent Patient Requiring Frenectomy<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Use of the soft tissue laser improves hemostasis and enhances healing postoperatively.</span>

Figure 2 - Use of the soft tissue laser improves hemostasis and enhances healing postoperatively.

Adolescent Patient Requiring Frenectomy<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Performing a frenectomy with an 810 nm diode laser is less invasive to the tissue as well as the patient.</span>

Figure 3 - Performing a frenectomy with an 810 nm diode laser is less invasive to the tissue as well as the patient.

Adolescent Patient Requiring Frenectomy<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Note the enhanced tissue response at 1 week postoperatively achieved through the frenectomy performed with the 810 nm diode laser.</span>

Figure 4 - Note the enhanced tissue response at 1 week postoperatively achieved through the frenectomy performed with the 810 nm diode...

Figure 4 - Note the enhanced tissue response at 1 week postoperatively achieved through the frenectomy performed with the 810 nm diode laser.

Soft Tissue Contouring

Recontouring of Gingival Height via the Soft Tissue Laser - Critical to a natural, esthetic smile is a harmonious soft tissue architecture. The e...

Recontouring of Gingival Height via the Soft Tissue Laser - Critical to a natural, esthetic smile is a harmonious soft tissue architecture. The evolution of advanced technology offers every clinician the opportunity to significantly improve the health, design, and overall appearance of the soft tiss...

Recontouring of Gingival Height via the Soft Tissue Laser<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative view of lateral incisor with unesthetic gingival height that compromises the patient’s smile.</span>

Figure 1 - Preoperative view of lateral incisor with unesthetic gingival height that compromises the patient’s smile.

Recontouring of Gingival Height via the Soft Tissue Laser<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Bone sounding is performed to assess the biologic width and evaluate the potential of soft tissue recontouring.</span>

Figure 2 - Bone sounding is performed to assess the biologic width and evaluate the potential of soft tissue recontouring.

Recontouring of Gingival Height via the Soft Tissue Laser<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Based on evaluation of the biological criteria, an 810 nm diode laser will be used to reestablish the position of the gingiva on the incisor.</span>

Figure 3 - Based on evaluation of the biological criteria, an 810 nm diode laser will be used to reestablish the position of the gingiv...

Figure 3 - Based on evaluation of the biological criteria, an 810 nm diode laser will be used to reestablish the position of the gingiva on the incisor.

Recontouring of Gingival Height via the Soft Tissue Laser<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Image of lateral incisor following contouring with the soft tissue laser.</span>

Figure 4 - Image of lateral incisor following contouring with the soft tissue laser.

Laser assisted gingival tissue procedures in aesthetic dentistry - Laser assisted gingival tissue procedures in aesthetic dentistry

Laser assisted gingival tissue procedures in aesthetic dentistry - Laser assisted gingival tissue procedures in aesthetic dentistry Contributed by Ernesto A. Lee, DMD on 7/13/2012

Laser assisted gingival tissue procedures in aesthetic dentistry<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Diode lasers provide unsurpassed operator control, allowing for precise tracing of a pre-established incision design.</span>

Figure 1 - Diode lasers provide unsurpassed operator control, allowing for precise tracing of a pre-established incision design.

Laser assisted gingival tissue procedures in aesthetic dentistry<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Gingival excision is achieved in layers with excellent hemostasis and a clean surgical field.</span>

Figure 2 - Gingival excision is achieved in layers with excellent hemostasis and a clean surgical field.

Laser assisted gingival tissue procedures in aesthetic dentistry<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> The diode laser may be utilized to perform a bloodless external bevel gingivectomy, facilitating the immediate placement of provisional restorations.</span>

Figure 3 - The diode laser may be utilized to perform a bloodless external bevel gingivectomy, facilitating the immediate placement of...

Figure 3 - The diode laser may be utilized to perform a bloodless external bevel gingivectomy, facilitating the immediate placement of provisional restorations.

Laser assisted gingival tissue procedures in aesthetic dentistry<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Postoperative appearance two weeks following laser assisted aesthetic crown lengthening with immediate provisionalization.</span>

Figure 4 - Postoperative appearance two weeks following laser assisted aesthetic crown lengthening with immediate provisionalization.

Laser assisted gingival tissue procedures in aesthetic dentistry<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Preoperative view of abutments prior to definitive impressions. Please not inflamed tissues and presence of bleeding.</span>

Figure 5 - Preoperative view of abutments prior to definitive impressions. Please not inflamed tissues and presence of bleeding.

Laser assisted gingival tissue procedures in aesthetic dentistry<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Gingival troughing with the diode laser exposes finish lines while providing excellent hemostasis. Heat transfer to the alveolar crest must be carefully monitored.</span>

Figure 6 - Gingival troughing with the diode laser exposes finish lines while providing excellent hemostasis. Heat transfer to the alve...

Figure 6 - Gingival troughing with the diode laser exposes finish lines while providing excellent hemostasis. Heat transfer to the alveolar crest must be carefully monitored.

Laser assisted gingival tissue procedures in aesthetic dentistry<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> Access to preparation margins coupled with adequate moisture control results in consistently successful impression taking.</span>

Figure 7 - Access to preparation margins coupled with adequate moisture control results in consistently successful impression taking.

Suturing Techniques for Periodontal Treatment

Flap sutures for guided tissue regeneration - The flaps are coronally repositioned and sutured to complete coverage. Use a non-resorbable or slow...

Flap sutures for guided tissue regeneration - The flaps are coronally repositioned and sutured to complete coverage. Use a non-resorbable or slowly resorbing suture since it must maintain its function for 2-4 weeks. A modified mattress suture is recommended to facilitate coronal repositioning of and...

Flap sutures for guided tissue regeneration<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Start buccally, and run the suture through the papillae with a conventional vertical mattress suture. Then, run the suture through the papillae in a lingual-buccal direction.</span>

Figure 1 - Start buccally, and run the suture through the papillae with a conventional vertical mattress suture. Then, run the suture t...

Figure 1 - Start buccally, and run the suture through the papillae with a conventional vertical mattress suture. Then, run the suture through the papillae in a lingual-buccal direction.

Flap sutures for guided tissue regeneration<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Run the suture back again, coronally to the papillae, through the loop of the suture on the lingual aspect.</span>

Figure 2 - Run the suture back again, coronally to the papillae, through the loop of the suture on the lingual aspect.

Flap sutures for guided tissue regeneration<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Return the suture back to the buccal side coronally to the papillae.</span>

Figure 3 - Return the suture back to the buccal side coronally to the papillae.

Flap sutures for guided tissue regeneration<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Tighten the flaps and make the knot.</span>

Figure 4 - Tighten the flaps and make the knot.

Subluxation of Mandibular Incisors Due to Trauma

Subluxation Injury to the Mandibular Incisors - Subluxation Injury to the Mandibular Incisors

Subluxation Injury to the Mandibular Incisors - Subluxation Injury to the Mandibular Incisors Contributed by Jean-Paul Schatz, DMD on 3/27/2012

Subluxation Injury to the Mandibular Incisors<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Subluxation of mandibular incisors, which is associated with other trauma.</span>

Figure 1 - Subluxation of mandibular incisors, which is associated with other trauma.

Total Luxation of Teeth Following Traumatic Injury

Loss of Tooth #9 Caused by Trauma - Loss of Tooth #9 Caused by Trauma

Loss of Tooth #9 Caused by Trauma - Loss of Tooth #9 Caused by Trauma Contributed by Jean-Paul Schatz, DMD on 3/27/2012

Loss of Tooth #9 Caused by Trauma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative facial view exhibits traumatic loss of tooth #9(21).</span>

Figure 1 - Preoperative facial view exhibits traumatic loss of tooth #9(21).

Loss of Tooth #9 Caused by Trauma<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Facial view of the reimplanted exarticulated incisor upon enamel etching.</span>

Figure 2 - Facial view of the reimplanted exarticulated incisor upon enamel etching.

Loss of Tooth #9 Caused by Trauma<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> The affected central incisor is splinted for 1 week with an orthodontic appliance.</span>

Figure 3 - The affected central incisor is splinted for 1 week with an orthodontic appliance.

Loss of Tooth #9 Caused by Trauma<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Three-month postoperative radiograph of the treated central incisor.</span>

Figure 4 - Three-month postoperative radiograph of the treated central incisor.

Extrusive Luxation of Teeth Attributed to Trauma

Extrusive Luxation of Teeth #9 and #10 Due to Trauma - Extrusive Luxation of Teeth #9 and #10 Due to Trauma

Extrusive Luxation of Teeth #9 and #10 Due to Trauma - Extrusive Luxation of Teeth #9 and #10 Due to Trauma Contributed by Jean-Paul Schatz, DMD on 3/27/2012

Extrusive Luxation of Teeth #9 and #10 Due to Trauma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative facial view demonstrates extrusive luxation of teeth #9(21) and #10(22).</span>

Figure 1 - Preoperative facial view demonstrates extrusive luxation of teeth #9(21) and #10(22).

Extrusive Luxation of Teeth #9 and #10 Due to Trauma<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Orthodontic appliances were utilized to splint the maxillary incisors prior to repositioning.</span>

Figure 2 - Orthodontic appliances were utilized to splint the maxillary incisors prior to repositioning.

Extrusive Luxation of Teeth #9 and #10 Due to Trauma<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> The traumatized maxillary incisors were positioned for a period of 2 weeks.</span>

Figure 3 - The traumatized maxillary incisors were positioned for a period of 2 weeks.

Lateral Luxation of Teeth as Caused by Trauma

Lateral Luxation and Fracture of the Alveolar Plate - Lateral Luxation and Fracture of the Alveolar Plate

Lateral Luxation and Fracture of the Alveolar Plate - Lateral Luxation and Fracture of the Alveolar Plate Contributed by Jean-Paul Schatz, DMD on 3/27/2012

$Lateral Luxation and Fracture of the Alveolar Plate Figure 1. Preoperative view exhibits the extent of lateral luxation and fracture of the alveolar plate.$ Figure 1 - Preoperative view exhibits the extent of lateral luxation and fracture of the alveolar plate.

Figure 1 - Preoperative view exhibits the extent of lateral luxation and fracture of the alveolar plate.

Lateral Luxation and Fracture of the Alveolar Plate<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Facial view of the affected site following stabilization with periodontology surgery.</span>

Figure 2 - Facial view of the affected site following stabilization with periodontology surgery.

Lateral Luxation and Fracture of the Alveolar Plate<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> The maxillary dentition were splinted with orthodontic appliances for a 6-week period.</span>

Figure 3 - The maxillary dentition were splinted with orthodontic appliances for a 6-week period.

Lateral Luxation and Fracture of the Alveolar Plate<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> One-month radiographic view of the maxillary dentition.</span>

Figure 4 - One-month radiographic view of the maxillary dentition.

Lateral Luxation and Fracture of the Alveolar Plate<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Postoperative facial view of the maxillary incisors 4.4 years post-trauma.</span>

Figure 5 - Postoperative facial view of the maxillary incisors 4.4 years post-trauma.

Lateral Luxation and Fracture of the Alveolar Plate<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Radiographic appearance of the maxillary arch 4.4 years following trauma. Note the complete pulp obliteration of the luxated teeth.</span>

Figure 6 - Radiographic appearance of the maxillary arch 4.4 years following trauma. Note the complete pulp obliteration of the luxated...

Figure 6 - Radiographic appearance of the maxillary arch 4.4 years following trauma. Note the complete pulp obliteration of the luxated teeth.

Intrusive Luxation of Teeth as Caused by Trauma

Intrusive Luxation of Tooth #8 and Subsequent Re-Eruption - Intrusive Luxation of Tooth #8 and Subsequent Re-Eruption

Intrusive Luxation of Tooth #8 and Subsequent Re-Eruption - Intrusive Luxation of Tooth #8 and Subsequent Re-Eruption Contributed by Jean-Paul Schatz, DMD on 3/27/2012

Intrusive Luxation of Tooth #8 and Subsequent Re-Eruption<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Facial view demonstrates traumatic intrusion of tooth #8(11) preoperatively.</span>

Figure 1 - Facial view demonstrates traumatic intrusion of tooth #8(11) preoperatively.

Intrusive Luxation of Tooth #8 and Subsequent Re-Eruption<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Facial view of complete spontaneous re-eruption at 6 months post-trauma</span>

Figure 2 - Facial view of complete spontaneous re-eruption at 6 months post-trauma

Intrusive Luxation of Tooth #8 and Subsequent Re-Eruption<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> 3A. Preoperative radiographic view of intruded tooth #8(11). 3B. Radiographic view exhibits arrested of root formation following trauma.</span>

Figure 3 - 3A. Preoperative radiographic view of intruded tooth #8(11). 3B. Radiographic view exhibits arrested of root formation follo...

Figure 3 - 3A. Preoperative radiographic view of intruded tooth #8(11). 3B. Radiographic view exhibits arrested of root formation following trauma.

Implant Restoration of the Vertically Deficient Anterior Maxilla

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla - Single-Unit Implant-Supported Restoration in the Vertica...

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla - Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla Contributed by Adilson S. Torreao, DDS on 4/5/2012

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative radiograph demonstrates external radicular resorption in tooth #8(11) due to previous endodontic treatment.</span>

Figure 1 - Preoperative radiograph demonstrates external radicular resorption in tooth #8(11) due to previous endodontic treatment.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Clinical examination of the patient revealed the compromised aesthetic appearance of the maxillary right central and lateral incisors. Severe gingival and incisal misalignment were also evident.</span>

Figure 2 - Clinical examination of the patient revealed the compromised aesthetic appearance of the maxillary right central and lateral...

Figure 2 - Clinical examination of the patient revealed the compromised aesthetic appearance of the maxillary right central and lateral incisors. Severe gingival and incisal misalignment were also evident.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Although orthodontic therapy could have been used to correct this situation, this modality was declined by the patient, who selected treatment with an implant-supported restoration and was subsequently prepared for a simultaneous bone and soft tissue augmentation.</span>

Figure 3 - Although orthodontic therapy could have been used to correct this situation, this modality was declined by the patient, who...

Figure 3 - Although orthodontic therapy could have been used to correct this situation, this modality was declined by the patient, who selected treatment with an implant-supported restoration and was subsequently prepared for a simultaneous bone and soft tissue augmentation.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> The right central incisor was extracted as atraumatically as possible following flap elevation, the alveolus was cleansed, and an implant was immediately placed in the site of tooth #8(11) while respecting 3-dimensional considerations for proper orientation (ie, buccolingual, mesiodistal, apicocoronal)</span>

Figure 4 - The right central incisor was extracted as atraumatically as possible following flap elevation, the alveolus was cleansed, a...

Figure 4 - The right central incisor was extracted as atraumatically as possible following flap elevation, the alveolus was cleansed, and an implant was immediately placed in the site of tooth #8(11) while respecting 3-dimensional considerations for proper orientation (ie, buccolingual, mesiodistal, apicocoronal)

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> A buccal fenestration of 6mm and a vertical discrepancy between the bone crest and the implant of 3 mm were observed. This vertical deficiency between the implant and bone had to be resolved using a bone graft and membrane in order to avoid the resorption of the vestibular bone junction, which could have compromised the appearance of the definitive restoration. </span>

Figure 5 - A buccal fenestration of 6mm and a vertical discrepancy between the bone crest and the implant of 3 mm were observed. This v...

Figure 5 - A buccal fenestration of 6mm and a vertical discrepancy between the bone crest and the implant of 3 mm were observed. This vertical deficiency between the implant and bone had to be resolved using a bone graft and membrane in order to avoid the resorption of the vestibular bone junction, which could have compromised the appearance of the definitive restoration.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Due to its improved vascularization and remodeling capabilities, fresh autogenous bone was harvested from the retromolar region with a 6mm trephine bur to promote osteogenesis at the site of extraction.</span>

Figure 6 - Due to its improved vascularization and remodeling capabilities, fresh autogenous bone was harvested from the retromolar reg...

Figure 6 - Due to its improved vascularization and remodeling capabilities, fresh autogenous bone was harvested from the retromolar region with a 6mm trephine bur to promote osteogenesis at the site of extraction.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> The bone was ground into particulate and placed in direct contact with the implant; the graft was also placed over the buccal region to reconstruct the facial bone contour.</span>

Figure 7 - The bone was ground into particulate and placed in direct contact with the implant; the graft was also placed over the bucca...

Figure 7 - The bone was ground into particulate and placed in direct contact with the implant; the graft was also placed over the buccal region to reconstruct the facial bone contour.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> An e-PTFE membrane was placed over the graft site and stabilized with 3 titanium minitacks to protect the graft site and promote vascularization. </span>

Figure 8 - An e-PTFE membrane was placed over the graft site and stabilized with 3 titanium minitacks to protect the graft site and pro...

Figure 8 - An e-PTFE membrane was placed over the graft site and stabilized with 3 titanium minitacks to protect the graft site and promote vascularization.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> A connective tissue graft was also performed to prepare the soft tissue for the initial prosthetic treatment. Following the placement of the graft, the periosteal flap was released, positioned in a coronal fashion, and closed with mattress sutures.</span>

Figure 9 - A connective tissue graft was also performed to prepare the soft tissue for the initial prosthetic treatment. Following the...

Figure 9 - A connective tissue graft was also performed to prepare the soft tissue for the initial prosthetic treatment. Following the placement of the graft, the periosteal flap was released, positioned in a coronal fashion, and closed with mattress sutures.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> A postoperative antibiotic regimen that included analgesics and 0.12% chlorhexidine was prescribed to prevent infection and maintain proper hygiene during the healing period. Fifteen days postsurgery, the sutures were removed, and a bonded provisional crown restoration was placed.</span>

Figure 10 - A postoperative antibiotic regimen that included analgesics and 0.12% chlorhexidine was prescribed to prevent infection and...

Figure 10 - A postoperative antibiotic regimen that included analgesics and 0.12% chlorhexidine was prescribed to prevent infection and maintain proper hygiene during the healing period. Fifteen days postsurgery, the sutures were removed, and a bonded provisional crown restoration was placed.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> Following a 6-month period of healing in which no complications were observed, the second surgical phase was initiated.</span>

Figure 11 - Following a 6-month period of healing in which no complications were observed, the second surgical phase was initiated.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 12. <span style='font-size: 16px; font-weight: normal'> Vertical releasing incisions were carefully performed to preserve the papilla while removing the nonresorbable membrane.</span>

Figure 12 - Vertical releasing incisions were carefully performed to preserve the papilla while removing the nonresorbable membrane.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 13. <span style='font-size: 16px; font-weight: normal'> Once the membrane had been removed, it was possible to assess the horizontal bone growth along the vestibular bone junction as well as the vertical bone growth in the mesial and distal aspects.</span>

Figure 13 - Once the membrane had been removed, it was possible to assess the horizontal bone growth along the vestibular bone junction...

Figure 13 - Once the membrane had been removed, it was possible to assess the horizontal bone growth along the vestibular bone junction as well as the vertical bone growth in the mesial and distal aspects.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 14. <span style='font-size: 16px; font-weight: normal'> As a result of the regeneration process, bone papilla had been formed. This newly regenerated osseous contour would serve as the underlying support for the soft tissue in the subsequent restorative phase.</span>

Figure 14 - As a result of the regeneration process, bone papilla had been formed. This newly regenerated osseous contour would serve a...

Figure 14 - As a result of the regeneration process, bone papilla had been formed. This newly regenerated osseous contour would serve as the underlying support for the soft tissue in the subsequent restorative phase.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 15. <span style='font-size: 16px; font-weight: normal'> Since large abutments could have caused soft-tissue recession, short, narrow healing abutments were selected to promote improved tissue maturation during the provisionalization period.</span>

Figure 15 - Since large abutments could have caused soft-tissue recession, short, narrow healing abutments were selected to promote imp...

Figure 15 - Since large abutments could have caused soft-tissue recession, short, narrow healing abutments were selected to promote improved tissue maturation during the provisionalization period.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 16. <span style='font-size: 16px; font-weight: normal'> The mucogingival junction was repositioned and carefully sutured during flap closure. Two types of sutures were utilized to prevent gaps, minimize tissue scarring, and ensure proper healing.</span>

Figure 16 - The mucogingival junction was repositioned and carefully sutured during flap closure. Two types of sutures were utilized to...

Figure 16 - The mucogingival junction was repositioned and carefully sutured during flap closure. Two types of sutures were utilized to prevent gaps, minimize tissue scarring, and ensure proper healing.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 17. <span style='font-size: 16px; font-weight: normal'> Two months following completion of the second-stage surgical procedure, the soft tissues had healed around the abutments, and the provisionalization phase was initiated. </span>

Figure 17 - Two months following completion of the second-stage surgical procedure, the soft tissues had healed around the abutments, a...

Figure 17 - Two months following completion of the second-stage surgical procedure, the soft tissues had healed around the abutments, and the provisionalization phase was initiated.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 18. <span style='font-size: 16px; font-weight: normal'> The tissues were then conditioned with two acrylic provisional crown restorations that wer econnected to the implant and the adjacent right lateral incisor.</span>

Figure 18 - The tissues were then conditioned with two acrylic provisional crown restorations that wer econnected to the implant and th...

Figure 18 - The tissues were then conditioned with two acrylic provisional crown restorations that wer econnected to the implant and the adjacent right lateral incisor.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 19. <span style='font-size: 16px; font-weight: normal'> At 15-day intervals, the provisional restorations were removedto permit additional contouring. The successive addition of acrylic material to the restorations was used to facilitate the formation of the interdental papillae and proper contour of the concave gingival architecture through blanching of the soft tissues.</span>

Figure 19 - At 15-day intervals, the provisional restorations were removedto permit additional contouring. The successive addition of a...

Figure 19 - At 15-day intervals, the provisional restorations were removedto permit additional contouring. The successive addition of acrylic material to the restorations was used to facilitate the formation of the interdental papillae and proper contour of the concave gingival architecture through blanching of the soft tissues.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 20. <span style='font-size: 16px; font-weight: normal'> The condition of the maxillary soft tissue was subsequently evaluated at the conclusion of the provisionalization stage. </span>

Figure 20 - The condition of the maxillary soft tissue was subsequently evaluated at the conclusion of the provisionalization stage.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 21. <span style='font-size: 16px; font-weight: normal'> Once minor tissue molding had been performed, a set of polyvinylsiloxane impressions were taken and forwarded to the laboratory to permit the fabrication of models and the definitive ceramic full-coverage crown restoration.</span>

Figure 21 - Once minor tissue molding had been performed, a set of polyvinylsiloxane impressions were taken and forwarded to the labora...

Figure 21 - Once minor tissue molding had been performed, a set of polyvinylsiloxane impressions were taken and forwarded to the laboratory to permit the fabrication of models and the definitive ceramic full-coverage crown restoration.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 22. <span style='font-size: 16px; font-weight: normal'> Porcelain material was applied to a ceramic abutment that corresponded to the actual intraoral environment in order to fabricate a restoration that would achieve the biomechanical and aesthetic objectives that had been established preoperatively.</span>

Figure 22 - Porcelain material was applied to a ceramic abutment that corresponded to the actual intraoral environment in order to fabr...

Figure 22 - Porcelain material was applied to a ceramic abutment that corresponded to the actual intraoral environment in order to fabricate a restoration that would achieve the biomechanical and aesthetic objectives that had been established preoperatively.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 23. <span style='font-size: 16px; font-weight: normal'> The definitive porcelain crown restoration was returned to the clinician and connected to the implant with an occlusal set screw to permit evaluation of contact points, occlusion, and contour.</span>

Figure 23 - The definitive porcelain crown restoration was returned to the clinician and connected to the implant with an occlusal set...

Figure 23 - The definitive porcelain crown restoration was returned to the clinician and connected to the implant with an occlusal set screw to permit evaluation of contact points, occlusion, and contour.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 24. <span style='font-size: 16px; font-weight: normal'> Due to its ability to match the implant-supported crown, a full-coverage ceramic crown restoration was seated on the right lateral incisor tooth.</span>

Figure 24 - Due to its ability to match the implant-supported crown, a full-coverage ceramic crown restoration was seated on the right...

Figure 24 - Due to its ability to match the implant-supported crown, a full-coverage ceramic crown restoration was seated on the right lateral incisor tooth.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 25. <span style='font-size: 16px; font-weight: normal'> The optical characteristics (eg, color, luster, translucency) of the restorations achieved the aesthetic requisites of the patient. These results demonstrate that when the supporting hard and soft tissues are properly reconstructed, implant therapy is an effective means of single-tooth replacement.</span>

Figure 25 - The optical characteristics (eg, color, luster, translucency) of the restorations achieved the aesthetic requisites of the...

Figure 25 - The optical characteristics (eg, color, luster, translucency) of the restorations achieved the aesthetic requisites of the patient. These results demonstrate that when the supporting hard and soft tissues are properly reconstructed, implant therapy is an effective means of single-tooth replacement.

Single-Unit Implant-Supported Restoration in the Vertically Deficient Anterior Maxilla<br/> Figure 26. <span style='font-size: 16px; font-weight: normal'> Postoperative radiograph of implant supported crown restoration. Bone regeneration and fit of the abutment are evident.</span>

Figure 26 - Postoperative radiograph of implant supported crown restoration. Bone regeneration and fit of the abutment are evident.

Surgical Crown Lengthening Procedures

Aesthetic Considerations for Surgical Crown Lengthening - Recent patient interest in aesthetic treatment has resulted in the development of advan...

Aesthetic Considerations for Surgical Crown Lengthening - Recent patient interest in aesthetic treatment has resulted in the development of advanced surgical and restorative procedures that are capable of conservatively addressing such objectives. While numerous materials and techniques have been de...

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative facial view of the maxillary anterior dentition. The lip line displays the entire tooth crown and gingival tissue. Extensive incisal wear is apparent.</span>

Figure 1 - Preoperative facial view of the maxillary anterior dentition. The lip line displays the entire tooth crown and gingival tiss...

Figure 1 - Preoperative facial view of the maxillary anterior dentition. The lip line displays the entire tooth crown and gingival tissue. Extensive incisal wear is apparent.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Facial view of the entire dentition. The patients bruxism has resulted in short clinical crowns that will require crown lengthening prior to full-mouth restoration.</span>

Figure 2 - Facial view of the entire dentition. The patient's bruxism has resulted in short clinical crowns that will require crown len...

Figure 2 - Facial view of the entire dentition. The patient's bruxism has resulted in short clinical crowns that will require crown lengthening prior to full-mouth restoration.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Lateral view of the model. Note the diagnostic waxup which results in increased vertical height.</span>

Figure 3 - Lateral view of the model. Note the diagnostic waxup which results in increased vertical height.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> An occlusal splint is fabricated and worn by the patient to determine the appropriate vertical dimension.</span>

Figure 4 - An occlusal splint is fabricated and worn by the patient to determine the appropriate vertical dimension.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> A black silk suture is used to visualize the alignment of the apical gingival margins of the anterior teeth.</span>

Figure 5 - A black silk suture is used to visualize the alignment of the apical gingival margins of the anterior teeth.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> The surgical outline is made to present the symmetry that will be duplicated in the underlying osseous structure. Gingival tissue is not removed from the lateral incisors.</span>

Figure 6 - The surgical outline is made to present the symmetry that will be duplicated in the underlying osseous structure. Gingival t...

Figure 6 - The surgical outline is made to present the symmetry that will be duplicated in the underlying osseous structure. Gingival tissue is not removed from the lateral incisors.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> The incision outline is evaluated with a silk suture to verify the proper height of the gingival margin.</span>

Figure 7 - The incision outline is evaluated with a silk suture to verify the proper height of the gingival margin.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> Measurements are taken prior to and during crown exposure to verify biologic width.</span>

Figure 8 - Measurements are taken prior to and during crown exposure to verify biologic width.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> The incised gingiva is removed from the buccal sulcus to expose the underlying bone.</span>

Figure 9 - The incised gingiva is removed from the buccal sulcus to expose the underlying bone.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> The flap is reflected and the osseous contour is evaluated. The buccal root surface of the lateral incisors should not be instrumented.</span>

Figure 10 - The flap is reflected and the osseous contour is evaluated. The buccal root surface of the lateral incisors should not be i...

Figure 10 - The flap is reflected and the osseous contour is evaluated. The buccal root surface of the lateral incisors should not be instrumented.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> Bone is removed with a chisel to the desired symmetry. The chisel is used to cut the outline; the final bone is removal is accomplished with a curette.</span>

Figure 11 - Bone is removed with a chisel to the desired symmetry. The chisel is used to cut the outline; the final bone is removal is...

Figure 11 - Bone is removed with a chisel to the desired symmetry. The chisel is used to cut the outline; the final bone is removal is accomplished with a curette.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 12. <span style='font-size: 16px; font-weight: normal'> The outline form and symmetry are verified during the bone removal procedure.</span>

Figure 12 - The outline form and symmetry are verified during the bone removal procedure.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 13. <span style='font-size: 16px; font-weight: normal'> The flap is returned to its prior position and placed approximately 2mm superior to the osseous outline.</span>

Figure 13 - The flap is returned to its prior position and placed approximately 2mm superior to the osseous outline.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 14. <span style='font-size: 16px; font-weight: normal'> Positioning and holding sutures are used to accurately place the flap in position</span>

Figure 14 - Positioning and holding sutures are used to accurately place the flap in position

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 15. <span style='font-size: 16px; font-weight: normal'> In order to maintain papillary height, the palatal papillae were not reflected.</span>

Figure 15 - In order to maintain papillary height, the palatal papillae were not reflected.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 16. <span style='font-size: 16px; font-weight: normal'> Facial view following 3 months of healing. Note the symmetry of the gingival margins prior to restorative treatment.</span>

Figure 16 - Facial view following 3 months of healing. Note the symmetry of the gingival margins prior to restorative treatment.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 17. <span style='font-size: 16px; font-weight: normal'> Preparation of teeth was performed 3.5 months postoperatively.</span>

Figure 17 - Preparation of teeth was performed 3.5 months postoperatively.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 18. <span style='font-size: 16px; font-weight: normal'> Following the crown lengthening procedure, full-coverage crown restorations were fabricated for the entire dentition.</span>

Figure 18 - Following the crown lengthening procedure, full-coverage crown restorations were fabricated for the entire dentition.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 19. <span style='font-size: 16px; font-weight: normal'> Postoperative facial view of the definitive crown restorations. Note the harmonious symmetry of the maxillary anterior dentition.</span>

Figure 19 - Postoperative facial view of the definitive crown restorations. Note the harmonious symmetry of the maxillary anterior dent...

Figure 19 - Postoperative facial view of the definitive crown restorations. Note the harmonious symmetry of the maxillary anterior dentition.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 20. <span style='font-size: 16px; font-weight: normal'> Right lateral view of the completed case. The gingival margins have accurately followed the outline created in the underlying bone.</span>

Figure 20 - Right lateral view of the completed case. The gingival margins have accurately followed the outline created in the underlyi...

Figure 20 - Right lateral view of the completed case. The gingival margins have accurately followed the outline created in the underlying bone.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 21. <span style='font-size: 16px; font-weight: normal'> Left lateral view of the definitive result. Note the integration of the restorations with the gingival tissue.</span>

Figure 21 - Left lateral view of the definitive result. Note the integration of the restorations with the gingival tissue.

Aesthetic Considerations for Surgical Crown Lengthening<br/> Figure 22. <span style='font-size: 16px; font-weight: normal'> Facial view of the simle line postoperatively. Note the increase in crown length and reduction in gingival display. Harmony in facial, dental, and gingival aesthetics has been established.</span>

Figure 22 - Facial view of the simle line postoperatively. Note the increase in crown length and reduction in gingival display. Harmony...

Figure 22 - Facial view of the simle line postoperatively. Note the increase in crown length and reduction in gingival display. Harmony in facial, dental, and gingival aesthetics has been established.

Surgical Considerations for Anterior Implant-Supported Reconstructions

Regenerative Therapy and Implant Placement for Missing Tooth #8 - Regenerative Therapy and Implant Placement for Missing Tooth #8

Regenerative Therapy and Implant Placement for Missing Tooth #8 - Regenerative Therapy and Implant Placement for Missing Tooth #8 Contributed by Sascha A. Jovanovic, DDS, MS on 4/20/2012

Regenerative Therapy and Implant Placement for Missing Tooth #8<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Facial view of a patient who presented for the replacement of tooth #8(11). Note the horizontal deficiency of tissue in the edentulous space and the gingival recession around tooth #9(21).</span>

Figure 1 - Facial view of a patient who presented for the replacement of tooth #8(11). Note the horizontal deficiency of tissue in the...

Figure 1 - Facial view of a patient who presented for the replacement of tooth #8(11). Note the horizontal deficiency of tissue in the edentulous space and the gingival recession around tooth #9(21).

Regenerative Therapy and Implant Placement for Missing Tooth #8<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Remote flap design with vertically divergent incisions were used to facilitate flap elevation. An implant was placed 2 mm apical of the anticipated gingival margin, which caused a dehiscence.</span>

Figure 2 - Remote flap design with vertically divergent incisions were used to facilitate flap elevation. An implant was placed 2 mm ap...

Figure 2 - Remote flap design with vertically divergent incisions were used to facilitate flap elevation. An implant was placed 2 mm apical of the anticipated gingival margin, which caused a dehiscence.

Regenerative Therapy and Implant Placement for Missing Tooth #8<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> The deficiency of tissue around the implant was treated with a particulated autograft, resorbable membrane, and a connective tissue graft. Note the increase in vertical and horizontal contour.</span>

Figure 3 - The deficiency of tissue around the implant was treated with a particulated autograft, resorbable membrane, and a connective...

Figure 3 - The deficiency of tissue around the implant was treated with a particulated autograft, resorbable membrane, and a connective tissue graft. Note the increase in vertical and horizontal contour.

Regenerative Therapy and Implant Placement for Missing Tooth #8<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> The flap was released at the base, replaced over the surgical site, and secured with mattress and interrupted sutures. Care was exercised to prevent papillae damage by suturing with microsutures.</span>

Figure 4 - The flap was released at the base, replaced over the surgical site, and secured with mattress and interrupted sutures. Care...

Figure 4 - The flap was released at the base, replaced over the surgical site, and secured with mattress and interrupted sutures. Care was exercised to prevent papillae damage by suturing with microsutures.

Regenerative Therapy and Implant Placement for Missing Tooth #8<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> An acrylic provisional prosthesis was bonded to adjacent teeth to prevent trauma to the surgical site during the healing period.</span>

Figure 5 - An acrylic provisional prosthesis was bonded to adjacent teeth to prevent trauma to the surgical site during the healing per...

Figure 5 - An acrylic provisional prosthesis was bonded to adjacent teeth to prevent trauma to the surgical site during the healing period.

Regenerative Therapy and Implant Placement for Missing Tooth #8<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> At abutment connection surgery, a palatal flap was elevated to permit access to the implant and to harvest connective tissue. Note the short buccal incisions and the use of a buccal pouch procedure.</span>

Figure 6 - At abutment connection surgery, a palatal flap was elevated to permit access to the implant and to harvest connective tissue...

Figure 6 - At abutment connection surgery, a palatal flap was elevated to permit access to the implant and to harvest connective tissue. Note the short buccal incisions and the use of a buccal pouch procedure.

Regenerative Therapy and Implant Placement for Missing Tooth #8<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> Occlusal view of the sutured tissues around a short, standard healing abutment that resulted in an abundance of soft tissues.</span>

Figure 7 - Occlusal view of the sutured tissues around a short, standard healing abutment that resulted in an abundance of soft tissues...

Figure 7 - Occlusal view of the sutured tissues around a short, standard healing abutment that resulted in an abundance of soft tissues.

Regenerative Therapy and Implant Placement for Missing Tooth #8<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> In the provisionalization phase, an acrylic crown restoration was placed to refine the aesthetic gingival contour over a 6-month period.</span>

Figure 8 - In the provisionalization phase, an acrylic crown restoration was placed to refine the aesthetic gingival contour over a 6-m...

Figure 8 - In the provisionalization phase, an acrylic crown restoration was placed to refine the aesthetic gingival contour over a 6-month period.

Regenerative Therapy and Implant Placement for Missing Tooth #8<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> Facial view of a prepared ceramic abutment that was used to ensure the aesthetics in the definitive crown restorations.</span>

Figure 9 - Facial view of a prepared ceramic abutment that was used to ensure the aesthetics in the definitive crown restorations.

Regenerative Therapy and Implant Placement for Missing Tooth #8<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> Facial view of the all-ceramic implant supported restoration, which exhibits a natural emergence profile and appearance.</span>

Figure 10 - Facial view of the all-ceramic implant supported restoration, which exhibits a natural emergence profile and appearance.

Regenerative Therapy and Implant Placement for Missing Tooth #8<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> Under transillumination, the optical properties of the implant-supported restoration were similar to those of the adjacent natural teeth.</span>

Figure 11 - Under transillumination, the optical properties of the implant-supported restoration were similar to those of the adjacent...

Figure 11 - Under transillumination, the optical properties of the implant-supported restoration were similar to those of the adjacent natural teeth.

Two-Stage Regenerative Therapy and Multiple Implant Placement - Two-Stage Regenerative Therapy and Multiple Implant Placement

Two-Stage Regenerative Therapy and Multiple Implant Placement - Two-Stage Regenerative Therapy and Multiple Implant Placement Contributed by Sascha A. Jovanovic, DDS, MS on 4/20/2012

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative facial view of a deficient anterior maxillary ridge in a partially edentulous patient.</span>

Figure 1 - Preoperative facial view of a deficient anterior maxillary ridge in a partially edentulous patient.

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> A remote flap design was used to perform flap elevation. Note the correct horizontal and vertical spacing of the three implants.</span>

Figure 2 - A remote flap design was used to perform flap elevation. Note the correct horizontal and vertical spacing of the three impla...

Figure 2 - A remote flap design was used to perform flap elevation. Note the correct horizontal and vertical spacing of the three implants.

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> A TR membrane was placed over the right site. The left site received an autograft and a resorbable membrane</span>

Figure 3 - A TR membrane was placed over the right site. The left site received an autograft and a resorbable membrane

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> The flap was released at the base and tension-free mattress and interrupted sutures were utilized to secure the margin.</span>

Figure 4 - The flap was released at the base and tension-free mattress and interrupted sutures were utilized to secure the margin.

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> During abutment connection, a tunnel procedure was utilized to access the site without causing further traumatization through the use of vertical incisions with traditional flap elevation.</span>

Figure 5 - During abutment connection, a tunnel procedure was utilized to access the site without causing further traumatization throug...

Figure 5 - During abutment connection, a tunnel procedure was utilized to access the site without causing further traumatization through the use of vertical incisions with traditional flap elevation.

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> The nonresorbable TR membrane was removed through the vestibular tunnel.</span>

Figure 6 - The nonresorbable TR membrane was removed through the vestibular tunnel.

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> The dimensions of the soft tissues were measured to determine if additional grafting was required. Note that the vertical incisions are within the keratinized tissue.</span>

Figure 7 - The dimensions of the soft tissues were measured to determine if additional grafting was required. Note that the vertical in...

Figure 7 - The dimensions of the soft tissues were measured to determine if additional grafting was required. Note that the vertical incisions are within the keratinized tissue.

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> A soft tissue graft was harvested from the palate and placed to further augment the site and provide sufficient tissue volume for the ridge.</span>

Figure 8 - A soft tissue graft was harvested from the palate and placed to further augment the site and provide sufficient tissue volum...

Figure 8 - A soft tissue graft was harvested from the palate and placed to further augment the site and provide sufficient tissue volume for the ridge.

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> Two weeks following abutment connection surgery, healing was evident around the abutments with minimal soft tissue scarring. Note the negative contour of the papillae between the implants.</span>

Figure 9 - Two weeks following abutment connection surgery, healing was evident around the abutments with minimal soft tissue scarring....

Figure 9 - Two weeks following abutment connection surgery, healing was evident around the abutments with minimal soft tissue scarring. Note the negative contour of the papillae between the implants.

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> Facial view of soft tissue healing 2 weeks following the placement of the acrylic provisional restoration.</span>

Figure 10 - Facial view of soft tissue healing 2 weeks following the placement of the acrylic provisional restoration.

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> Radiograph of the site 12 months following implant loading.</span>

Figure 11 - Radiograph of the site 12 months following implant loading.

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 12. <span style='font-size: 16px; font-weight: normal'> Facial view of the soft tissues with the modified prosthesis. Note the more natural appearance of the provisional restoration.</span>

Figure 12 - Facial view of the soft tissues with the modified prosthesis. Note the more natural appearance of the provisional restorati...

Figure 12 - Facial view of the soft tissues with the modified prosthesis. Note the more natural appearance of the provisional restoration.

Two-Stage Regenerative Therapy and Multiple Implant Placement<br/> Figure 13. <span style='font-size: 16px; font-weight: normal'> Final form, contour, and volume of the soft tissues. Six months were required to develop a stable emergence profile for the final restorations.</span>

Figure 13 - Final form, contour, and volume of the soft tissues. Six months were required to develop a stable emergence profile for the...

Figure 13 - Final form, contour, and volume of the soft tissues. Six months were required to develop a stable emergence profile for the final restorations.

Aesthetic Management of Extractions for Implant Site Development

Delayed Versus Staged Implant Placement - Delayed Versus Staged Implant Placement

Delayed Versus Staged Implant Placement - Delayed Versus Staged Implant Placement Contributed by Perry Klokkevold, DDS, MS on 4/20/2012

Delayed Versus Staged Implant Placement<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative view of tooth #7. Gingival inflammation and recession, along with root discoloration, caused poor aesthetics. Note evidence of gingival scarring from previous apical surgery.</span>

Figure 1 - Preoperative view of tooth #7. Gingival inflammation and recession, along with root discoloration, caused poor aesthetics. N...

Figure 1 - Preoperative view of tooth #7. Gingival inflammation and recession, along with root discoloration, caused poor aesthetics. Note evidence of gingival scarring from previous apical surgery.

Delayed Versus Staged Implant Placement<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Preoperative view of tooth #10. Previous endodontic treatment included placement of a post and crown. Note marginal gingival inflammation and recession, along with discoloration of the root.</span>

Figure 2 - Preoperative view of tooth #10. Previous endodontic treatment included placement of a post and crown. Note marginal gingival...

Figure 2 - Preoperative view of tooth #10. Previous endodontic treatment included placement of a post and crown. Note marginal gingival inflammation and recession, along with discoloration of the root.

Delayed Versus Staged Implant Placement<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> 3A. Preoperative radiograph of tooth #7 revealed a radiolucent lesion and moderate periodontal bone loss. 3B. Radiograph of tooth #10 revealed adequate interproximal bone support and no evidence of endodontic lesions.</span>

Figure 3 - 3A. Preoperative radiograph of tooth #7 revealed a radiolucent lesion and moderate periodontal bone loss. 3B. Radiograph of...

Figure 3 - 3A. Preoperative radiograph of tooth #7 revealed a radiolucent lesion and moderate periodontal bone loss. 3B. Radiograph of tooth #10 revealed adequate interproximal bone support and no evidence of endodontic lesions.

Delayed Versus Staged Implant Placement<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Following atraumatic extraction, all soft tissue was removed from the internal aspects of the extraction site and a bone graft was densely packed into the site.</span>

Figure 4 - Following atraumatic extraction, all soft tissue was removed from the internal aspects of the extraction site and a bone gra...

Figure 4 - Following atraumatic extraction, all soft tissue was removed from the internal aspects of the extraction site and a bone graft was densely packed into the site.

Delayed Versus Staged Implant Placement<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> The internal (nonporous) aspect of an e-PTFE barrier membrane was placed over the bone graft material. The membrane was positioned between the soft tissues and bone graft material and was secured with a cross mattress suture.</span>

Figure 5 - The internal (nonporous) aspect of an e-PTFE barrier membrane was placed over the bone graft material. The membrane was posi...

Figure 5 - The internal (nonporous) aspect of an e-PTFE barrier membrane was placed over the bone graft material. The membrane was positioned between the soft tissues and bone graft material and was secured with a cross mattress suture.

Delayed Versus Staged Implant Placement<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Six months postextraction of tooth #7, the barrier membrane was removed. At this time, the soft tissues had migrated under the membrane and over the bone graft to completely close the wound.</span>

Figure 6 - Six months postextraction of tooth #7, the barrier membrane was removed. At this time, the soft tissues had migrated under t...

Figure 6 - Six months postextraction of tooth #7, the barrier membrane was removed. At this time, the soft tissues had migrated under the membrane and over the bone graft to completely close the wound.

Delayed Versus Staged Implant Placement<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> Atraumatic extraction of the left maxillary lateral incisor was performed without incisions and soft tissue reflection.</span>

Figure 7 - Atraumatic extraction of the left maxillary lateral incisor was performed without incisions and soft tissue reflection.

Delayed Versus Staged Implant Placement<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> Surgical stent and guide pin in proper aesthetic position for staged implant placement in the right maxillary lateral incisor site. Note that the guide pin was completely covered by bone.</span>

Figure 8 - Surgical stent and guide pin in proper aesthetic position for staged implant placement in the right maxillary lateral inciso...

Figure 8 - Surgical stent and guide pin in proper aesthetic position for staged implant placement in the right maxillary lateral incisor site. Note that the guide pin was completely covered by bone.

Delayed Versus Staged Implant Placement<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> Surgical stent and guide pin in position for delayed implant placement in the site. A substantial portion of the guide pin was exposed due to a labial deficiency of bone.</span>

Figure 9 - Surgical stent and guide pin in position for delayed implant placement in the site. A substantial portion of the guide pin w...

Figure 9 - Surgical stent and guide pin in position for delayed implant placement in the site. A substantial portion of the guide pin was exposed due to a labial deficiency of bone.

Delayed Versus Staged Implant Placement<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> Implant in ideal prosthetic position at the staged implant placement site. Notice that the implant was completely covered with bone.</span>

Figure 10 - Implant in ideal "prosthetic" position at the staged implant placement site. Notice that the implant was completely covered...

Figure 10 - Implant in ideal "prosthetic" position at the staged implant placement site. Notice that the implant was completely covered with bone.

Delayed Versus Staged Implant Placement<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> Implant in ideal prosthetic position at the delayed implant placement site. Note that approximately 8 screw threads are visible on the exposed implant.</span>

Figure 11 - Implant in ideal "prosthetic" position at the delayed implant placement site. Note that approximately 8 screw threads are v...

Figure 11 - Implant in ideal "prosthetic" position at the delayed implant placement site. Note that approximately 8 screw threads are visible on the exposed implant.

Delayed Versus Staged Implant Placement<br/> Figure 12. <span style='font-size: 16px; font-weight: normal'> An e-PTFE barrier membrane was used without addition of bone graft to facilitate guided bone regeneration around the implant in the left maxillary lateral incisor site.</span>

Figure 12 - An e-PTFE barrier membrane was used without addition of bone graft to facilitate guided bone regeneration around the implan...

Figure 12 - An e-PTFE barrier membrane was used without addition of bone graft to facilitate guided bone regeneration around the implant in the left maxillary lateral incisor site.

Delayed Versus Staged Implant Placement<br/> Figure 13. <span style='font-size: 16px; font-weight: normal'> Soft tissue healing was apparent several months following staged implant placement. Note soft tissue ridge height is maintained relative to the adjacent papila.</span>

Figure 13 - Soft tissue healing was apparent several months following staged implant placement. Note soft tissue ridge height is mainta...

Figure 13 - Soft tissue healing was apparent several months following staged implant placement. Note soft tissue ridge height is maintained relative to the adjacent papila.

Delayed Versus Staged Implant Placement<br/> Figure 14. <span style='font-size: 16px; font-weight: normal'> Soft tissue healing several months after delayed implant placement. The soft tissue ridge height at this site is comparable to that achieved using a staged placement.</span>

Figure 14 - Soft tissue healing several months after delayed implant placement. The soft tissue ridge height at this site is comparable...

Figure 14 - Soft tissue healing several months after delayed implant placement. The soft tissue ridge height at this site is comparable to that achieved using a staged placement.

Delayed Versus Staged Implant Placement<br/> Figure 15. <span style='font-size: 16px; font-weight: normal'> At the time of the second-stage surgery, complete implant coverage is noted following removal of membrane from delayed implant placement site. Complete hard tissue coverage over the previously exposed implant threads is evident.</span>

Figure 15 - At the time of the second-stage surgery, complete implant coverage is noted following removal of membrane from delayed impl...

Figure 15 - At the time of the second-stage surgery, complete implant coverage is noted following removal of membrane from delayed implant placement site. Complete hard tissue coverage over the previously exposed implant threads is evident.

Delayed Versus Staged Implant Placement<br/> Figure 16. <span style='font-size: 16px; font-weight: normal'> Healing abutments were placed and flaps were sutured immediately following second-stage exposure. Wider incisions were necessary to expose and subsequently remove the nonresorbable e-PTFE barrier membrane.</span>

Figure 16 - Healing abutments were placed and flaps were sutured immediately following second-stage exposure. Wider incisions were nece...

Figure 16 - Healing abutments were placed and flaps were sutured immediately following second-stage exposure. Wider incisions were necessary to expose and subsequently remove the nonresorbable e-PTFE barrier membrane.

Delayed Versus Staged Implant Placement<br/> Figure 17. <span style='font-size: 16px; font-weight: normal'> 17A. Radiograph of the staged site following definitive reconstruction. 16B. Postoperative radiograph of the delayed placement site.</span>

Figure 17 - 17A. Radiograph of the staged site following definitive reconstruction. 16B. Postoperative radiograph of the delayed placem...

Figure 17 - 17A. Radiograph of the staged site following definitive reconstruction. 16B. Postoperative radiograph of the delayed placement site.

Delayed Versus Staged Implant Placement<br/> Figure 18. <span style='font-size: 16px; font-weight: normal'> Postoperative view of aesthetic, single-unit implant supported crown restoration. Proper soft tissue contours and interdental papillae were maintained.</span>

Figure 18 - Postoperative view of aesthetic, single-unit implant supported crown restoration. Proper soft tissue contours and interdent...

Figure 18 - Postoperative view of aesthetic, single-unit implant supported crown restoration. Proper soft tissue contours and interdental papillae were maintained.

Implant Periapical Lesions

Case 1 - Failing Fixed Partial Denture - Failing Fixed Partial Denture

Case 1 - Failing Fixed Partial Denture - Failing Fixed Partial Denture Contributed by Ziad N. Jalbout, DDS on 4/24/2012

Case 1 - Failing Fixed Partial Denture<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative radiograph demonstrated the presence of an implant periapical lesion.</span>

Figure 1 - Preoperative radiograph demonstrated the presence of an implant periapical lesion.

Case 1 - Failing Fixed Partial Denture<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Preoperative view of a sinus tract in the buccal mucosa of implant #5(14).</span>

Figure 2 - Preoperative view of a sinus tract in the buccal mucosa of implant #5(14).

Case 1 - Failing Fixed Partial Denture<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Following elevation of a full-thickness flap, the implant apex was resected to facilitate complete debridement of the granulation tissue.</span>

Figure 3 - Following elevation of a full-thickness flap, the implant apex was resected to facilitate complete debridement of the granul...

Figure 3 - Following elevation of a full-thickness flap, the implant apex was resected to facilitate complete debridement of the granulation tissue.

Case 1 - Failing Fixed Partial Denture<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> 4A. The bone defect was grafted with particulate bovine bone. 4B. The defect was covered with a bioabsorbable collagen membrane.</span>

Figure 4 - 4A. The bone defect was grafted with particulate bovine bone. 4B. The defect was covered with a bioabsorbable collagen membr...

Figure 4 - 4A. The bone defect was grafted with particulate bovine bone. 4B. The defect was covered with a bioabsorbable collagen membrane.

Case 1 - Failing Fixed Partial Denture<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> 5A. Postoperative radiograph demonstrated closure of the implant periapical lesion. 5B. Postoperative radiograph following 22 months of healing.</span>

Figure 5 - 5A. Postoperative radiograph demonstrated closure of the implant periapical lesion. 5B. Postoperative radiograph following 2...

Figure 5 - 5A. Postoperative radiograph demonstrated closure of the implant periapical lesion. 5B. Postoperative radiograph following 22 months of healing.

Case 1 - Failing Fixed Partial Denture<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Postoperative buccal view demonstrated aesthetic healing without lesion recurrence.</span>

Figure 6 - Postoperative buccal view demonstrated aesthetic healing without lesion recurrence.

Case 2 -- Replacement of Tooth #9 - Replacement of Tooth #9

Case 2 -- Replacement of Tooth #9 - Replacement of Tooth #9 Contributed by Ziad Jalbout, DDS on 4/24/2012

Case 2 -- Replacement of Tooth #9<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> 1A. Preoperative radiograph prior to Stage I surgery demonstrated residual bone radiolucency one year following extraction. 1B. A periapical lesion was radiographically observed 5 months following implant placement.</span>

Figure 1 - 1A. Preoperative radiograph prior to Stage I surgery demonstrated residual bone radiolucency one year following extraction....

Figure 1 - 1A. Preoperative radiograph prior to Stage I surgery demonstrated residual bone radiolucency one year following extraction. 1B. A periapical lesion was radiographically observed 5 months following implant placement.

Case 2 -- Replacement of Tooth #9<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Clinical evaluation prior to surgical intervention revealed the presence of a sinus tract in the buccal mucosa of implant #9.</span>

Figure 2 - Clinical evaluation prior to surgical intervention revealed the presence of a sinus tract in the buccal mucosa of implant #9...

Figure 2 - Clinical evaluation prior to surgical intervention revealed the presence of a sinus tract in the buccal mucosa of implant #9.

Case 2 -- Replacement of Tooth #9<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Granulation tissue filled the periapical defect at the apex of the implant.</span>

Figure 3 - Granulation tissue filled the periapical defect at the apex of the implant.

Case 2 -- Replacement of Tooth #9<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> The lesion was debrided around the implant apex following elevation of a semilunar flap.</span>

Figure 4 - The lesion was debrided around the implant apex following elevation of a semilunar flap.

Case 2 -- Replacement of Tooth #9<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> A particulate bovine bone material was utilized to graft the site.</span>

Figure 5 - A particulate bovine bone material was utilized to graft the site.

Case 2 -- Replacement of Tooth #9<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> The defect site was successfully grafted with a particulate bovine material.</span>

Figure 6 - The defect site was successfully grafted with a particulate bovine material.

Case 2 -- Replacement of Tooth #9<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> The bone defect was covered with a bioabsorbable glycolic and lactic copolymer membrane.</span>

Figure 7 - The bone defect was covered with a bioabsorbable glycolic and lactic copolymer membrane.

Case 2 -- Replacement of Tooth #9<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> 8A. Radiograph exhibited site following 13 months of healing. 8B. Radiograph indicated complete resolution of the lesion 2 years following treatment.</span>

Figure 8 - 8A. Radiograph exhibited site following 13 months of healing. 8B. Radiograph indicated complete resolution of the lesion 2 y...

Figure 8 - 8A. Radiograph exhibited site following 13 months of healing. 8B. Radiograph indicated complete resolution of the lesion 2 years following treatment.

Case 3 -- Restoration of Failing FPD on Tooth #8 - Restoration of Failing FPD on Tooth #8

Case 3 -- Restoration of Failing FPD on Tooth #8 - Restoration of Failing FPD on Tooth #8 Contributed by Ziad Jalbout, DDS on 4/24/2012

Case 3 -- Restoration of Failing FPD on Tooth #8<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> 1A. Preoperative radiograph demonstrated an implant periapical lesion. 1B. Postoperative radiograph 4 months following treatment revealed complete elimination of the defect.</span>

Figure 1 - 1A. Preoperative radiograph demonstrated an implant periapical lesion. 1B. Postoperative radiograph 4 months following treat...

Figure 1 - 1A. Preoperative radiograph demonstrated an implant periapical lesion. 1B. Postoperative radiograph 4 months following treatment revealed complete elimination of the defect.

Case 4 -- Sinus Tract on Implant at Site #5 - Sinus Tract on Implant at Site #5

Case 4 -- Sinus Tract on Implant at Site #5 - Sinus Tract on Implant at Site #5 Contributed by Ziad Jalbout, DDS on 4/24/2012

Case 4 -- Sinus Tract on Implant at Site #5<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative periapical radiograph revealed radiolucency at the apex of the implant.</span>

Figure 1 - Preoperative periapical radiograph revealed radiolucency at the apex of the implant.

Case 4 -- Sinus Tract on Implant at Site #5<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> The apex of the implant was located and the lesion debrided.</span>

Figure 2 - The apex of the implant was located and the lesion debrided.

Case 4 -- Sinus Tract on Implant at Site #5<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Buccal view of the graft material during placement.</span>

Figure 3 - Buccal view of the graft material during placement.

Case 4 -- Sinus Tract on Implant at Site #5<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Postoperative radiograph following 7 years of healing demonstrated complete bone healing.</span>

Figure 4 - Postoperative radiograph following 7 years of healing demonstrated complete bone healing.

Plasma-Rich Growth Factors in Oral Surgery

PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Prosthesis - PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Pr...

PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Prosthesis - PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Prosthesis Contributed by Eduardo Anitua, MD, DDS on 5/22/2012

$PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Prosthesis Figure 1. A 58-year-old female patient presented with a large periodontal defect, radicular fracture, and clinical mobility in the existing restoration. Extraction tooth #4(15) was advised.$ Figure 1 - A 58-year-old female patient presented with a large periodontal defect, radicular fracture, and clinical mobility in the exi...

Figure 1 - A 58-year-old female patient presented with a large periodontal defect, radicular fracture, and clinical mobility in the existing restoration. Extraction tooth #4(15) was advised.

PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Prosthesis<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Two implants were placed immediately following extraction.</span>

Figure 2 - Two implants were placed immediately following extraction.

PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Prosthesis<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> The extraction defect was filled with a plasma-rich growth factor (PRGF) preparation combined with autogenous bone particles.</span>

Figure 3 - The extraction defect was filled with a plasma-rich growth factor (PRGF) preparation combined with autogenous bone particles...

Figure 3 - The extraction defect was filled with a plasma-rich growth factor (PRGF) preparation combined with autogenous bone particles.

PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Prosthesis<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> The flap was sutured and the defect zone filled with an additional layer of fibrin.</span>

Figure 4 - The flap was sutured and the defect zone filled with an additional layer of fibrin.

PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Prosthesis<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Postoperative view 4 days following healing.</span>

Figure 5 - Postoperative view 4 days following healing.

PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Prosthesis<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Complete epithelialization and healing were observed 4 months postoperatively, and the implant screw was not exposed.</span>

Figure 6 - Complete epithelialization and healing were observed 4 months postoperatively, and the implant screw was not exposed.

PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Prosthesis<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> The defect demonstrated complete bone fill during second-stage surgery.</span>

Figure 7 - The defect demonstrated complete bone fill during second-stage surgery.

PRGF in Replacement of Two-Unit Maxillary Right Cantilever Fixed Prosthesis<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> Postoperative radiograph demonstrated complete bone fill and stable implant positioning following 3 years of function.</span>

Figure 8 - Postoperative radiograph demonstrated complete bone fill and stable implant positioning following 3 years of function.

PRGF in Replacement of Teeth #13 to #15 - PRGF in Replacement of Teeth #13 to #15

PRGF in Replacement of Teeth #13 to #15 - PRGF in Replacement of Teeth #13 to #15 Contributed by Eduardo Anitua, MD, DDS on 5/22/2012

PRGF in Replacement of Teeth #13 to #15<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative radiograph demonstrates the presence of pneumatization in the sinus region. Sinus elevation with lateral corticotomy was required to facilitate implant placement.</span>

Figure 1 - Preoperative radiograph demonstrates the presence of pneumatization in the sinus region. Sinus elevation with lateral cortic...

Figure 1 - Preoperative radiograph demonstrates the presence of pneumatization in the sinus region. Sinus elevation with lateral corticotomy was required to facilitate implant placement.

PRGF in Replacement of Teeth #13 to #15<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Ultrasounds were utilized for flap elevation to prevent damage to the schneiderian membrane.</span>

Figure 2 - Ultrasounds were utilized for flap elevation to prevent damage to the schneiderian membrane.

PRGF in Replacement of Teeth #13 to #15<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> A periostotome was utilized to remove the flap cover and enable conservation of the membrane.</span>

Figure 3 - A periostotome was utilized to remove the flap cover and enable conservation of the membrane.

PRGF in Replacement of Teeth #13 to #15<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> A small mixture of autologous bone, resorbable hydroxyapatite, and PRGF was placed in the sinus region following implant placement. A bioabsorbable membrane steeped in PRGF was used to cover the exposed region.</span>

Figure 4 - A small mixture of autologous bone, resorbable hydroxyapatite, and PRGF was placed in the sinus region following implant pla...

Figure 4 - A small mixture of autologous bone, resorbable hydroxyapatite, and PRGF was placed in the sinus region following implant placement. A bioabsorbable membrane steeped in PRGF was used to cover the exposed region.

PRGF in Replacement of Teeth #13 to #15<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Radiographic evaluation demonstrated successful implant placement.</span>

Figure 5 - Radiographic evaluation demonstrated successful implant placement.

PRGF in Replacement of Teeth #13 to #15<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Significant tissue regeneration was observed during second-stage surgery following 8 months of healing.</span>

Figure 6 - Significant tissue regeneration was observed during second-stage surgery following 8 months of healing.

PRGF in Replacement of Teeth #13 to #15<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> A third implant was placed in the grafted region, and a biopsy was obtained.</span>

Figure 7 - A third implant was placed in the grafted region, and a biopsy was obtained.

PRGF in Replacement of Teeth #13 to #15<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> A biopsy obtained from the lower layer of the maxillary region demonstrated the presence of well-ordered trabeculae. Osteocytes and some components of chronic inflammatory tissue (infiltrate) were also observed.</span>

Figure 8 - A biopsy obtained from the lower layer of the maxillary region demonstrated the presence of well-ordered trabeculae. Osteocy...

Figure 8 - A biopsy obtained from the lower layer of the maxillary region demonstrated the presence of well-ordered trabeculae. Osteocytes and some components of chronic inflammatory tissue (infiltrate) were also observed.

PRGF in Replacement of Teeth #13 to #15<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> The biopsy obtained from the flap elevation site indicated the presence of grafted bone separated from the base of the sinus, which is a more osteogenic bed. The trabeculae were poorly organized and indicated the development of immature spongy bone.</span>

Figure 9 - The biopsy obtained from the flap elevation site indicated the presence of grafted bone separated from the base of the sinus...

Figure 9 - The biopsy obtained from the flap elevation site indicated the presence of grafted bone separated from the base of the sinus, which is a more osteogenic bed. The trabeculae were poorly organized and indicated the development of "immature spongy bone".

PRGF in Replacement of Teeth #13 to #15<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> Postoperative radiographic evaluation 3 years following healing indicated complete implant integration.</span>

Figure 10 - Postoperative radiographic evaluation 3 years following healing indicated complete implant integration.

PRGF in Replacement of Teeth #13 to #15<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> Subsequent sinus elevation was performed to enable implant placement in the contralateral hemiarcade, without PRGF.</span>

Figure 11 - Subsequent sinus elevation was performed to enable implant placement in the contralateral hemiarcade, without PRGF.

Preprosthetic Clinical Crown Lengthening Procedures in the Anterior Maxilla

Gingivectomy for First Premolar Tooth - Gingivectomy for First Premolar Tooth

Gingivectomy for First Premolar Tooth - Gingivectomy for First Premolar Tooth Contributed by Carlos E. Nemcovsky, DMD on 5/22/2012

Gingivectomy for First Premolar Tooth<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative left lateral view of uneven buccal gingival margins between the provisional crown restoration and the proximal teeth.</span>

Figure 1 - Preoperative left lateral view of uneven buccal gingival margins between the provisional crown restoration and the proximal...

Figure 1 - Preoperative left lateral view of uneven buccal gingival margins between the provisional crown restoration and the proximal teeth.

Gingivectomy for First Premolar Tooth<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> An internal bevel gingivectomy was performed, and the provisional crown restoration was readapted.</span>

Figure 2 - An internal bevel gingivectomy was performed, and the provisional crown restoration was readapted.

Gingivectomy for First Premolar Tooth<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> The definitive restoration was placed. Note the enhanced postoperative symmetry of the gingival aspect.</span>

Figure 3 - The definitive restoration was placed. Note the enhanced postoperative symmetry of the gingival aspect.

Single-Tooth Periodontal Flap Surgery - Single-Tooth Periodontal Flap Surgery

Single-Tooth Periodontal Flap Surgery - Single-Tooth Periodontal Flap Surgery Contributed by Carlos E. Nemcovsky, DMD on 5/22/2012

Single-Tooth Periodontal Flap Surgery<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative facial view of central incisors with provisional restorations. Note the uneven gingival margins.</span>

Figure 1 - Preoperative facial view of central incisors with provisional restorations. Note the uneven gingival margins.

Single-Tooth Periodontal Flap Surgery<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> The buccal and palatal flaps were independently sutured with vertical mattress sutures utilizing a sling technique.</span>

Figure 2 - The buccal and palatal flaps were independently sutured with vertical mattress sutures utilizing a sling technique.

Single-Tooth Periodontal Flap Surgery<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Simple sutures were utilized to pull the papillae coronally; buccal and palatal sutures were connected over the provisional restorations at each interdental area.</span>

Figure 3 - Simple sutures were utilized to pull the papillae coronally; buccal and palatal sutures were connected over the provisional...

Figure 3 - Simple sutures were utilized to pull the papillae coronally; buccal and palatal sutures were connected over the provisional restorations at each interdental area.

Single-Tooth Periodontal Flap Surgery<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Postoperative facial view of the enhanced gingival margins and the definitive ceramic restoration.</span>

Figure 4 - Postoperative facial view of the enhanced gingival margins and the definitive ceramic restoration.

Periodontal Flap Surgery with Forced Eruption - Periodontal Flap Surgery with Forced Eruption

Periodontal Flap Surgery with Forced Eruption - Periodontal Flap Surgery with Forced Eruption Contributed by Carlos E. Nemcovsky, DMD on 5/22/2012

$Periodontal Flap Surgery with Forced Eruption Figure 1. Preoperative buccal view of the maxillary incisors following traumatic injury. The left central incisor exhibited a deep subgingival fracture.$ Figure 1 - Preoperative buccal view of the maxillary incisors following traumatic injury. The left central incisor exhibited a deep sub...

Figure 1 - Preoperative buccal view of the maxillary incisors following traumatic injury. The left central incisor exhibited a deep subgingival fracture.

Periodontal Flap Surgery with Forced Eruption<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Facial view following completion of orthodontic extrusion and elevation of full-thickness flaps. The alveolar bone accompanied the tooth movement.</span>

Figure 2 - Facial view following completion of orthodontic extrusion and elevation of full-thickness flaps. The alveolar bone accompani...

Figure 2 - Facial view following completion of orthodontic extrusion and elevation of full-thickness flaps. The alveolar bone accompanied the tooth movement.

Periodontal Flap Surgery with Forced Eruption<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> The desired bone architecture was achieved following ostectomy, osteoplasty, and root planing of the left central incisor.</span>

Figure 3 - The desired bone architecture was achieved following ostectomy, osteoplasty, and root planing of the left central incisor.

Periodontal Flap Surgery with Forced Eruption<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Postsurgical view of the definitive crown restorations demonstrated the preservation of the essential interdental papillae.</span>

Figure 4 - Postsurgical view of the definitive crown restorations demonstrated the preservation of the essential interdental papillae.

Periodontal Flap Surgery for Multiple Teeth - Periodontal Flap Surgery for Multiple Teeth

Periodontal Flap Surgery for Multiple Teeth - Periodontal Flap Surgery for Multiple Teeth Contributed by Carlos E. Nemcovsky, DMD on 5/22/2012

Periodontal Flap Surgery for Multiple Teeth<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative view of unaesthetic restorations with an uneven gingival margin, minimal interdental papillae, and excessive gingival display.</span>

Figure 1 - Preoperative view of unaesthetic restorations with an uneven gingival margin, minimal interdental papillae, and excessive gi...

Figure 1 - Preoperative view of unaesthetic restorations with an uneven gingival margin, minimal interdental papillae, and excessive gingival display.

Periodontal Flap Surgery for Multiple Teeth<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> A submarginal scalloped incision was designed to approximate the desired gingival margin form. The internal beveled incision preserved the interdental papillae.</span>

Figure 2 - A submarginal scalloped incision was designed to approximate the desired gingival margin form. The internal beveled incision...

Figure 2 - A submarginal scalloped incision was designed to approximate the desired gingival margin form. The internal beveled incision preserved the interdental papillae.

Periodontal Flap Surgery for Multiple Teeth<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Occlusal view of buccal and palatal flaps independently secured with continuous vertical mattress sutures to apically reposition the gingival margin.</span>

Figure 3 - Occlusal view of buccal and palatal flaps independently secured with continuous vertical mattress sutures to apically reposi...

Figure 3 - Occlusal view of buccal and palatal flaps independently secured with continuous vertical mattress sutures to apically reposition the gingival margin.

Periodontal Flap Surgery for Multiple Teeth<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> The provisional restorations were recemented. Flattened interdental papillae are evident following surgery.</span>

Figure 4 - The provisional restorations were recemented. Flattened interdental papillae are evident following surgery.

Periodontal Flap Surgery for Multiple Teeth<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Simple sutures were utilized to coronally pull and enlarge the papillae. Buccal and palatal sutures were connected over the provisional restorations.</span>

Figure 5 - Simple sutures were utilized to coronally pull and enlarge the papillae. Buccal and palatal sutures were connected over the...

Figure 5 - Simple sutures were utilized to coronally pull and enlarge the papillae. Buccal and palatal sutures were connected over the provisional restorations.

Periodontal Flap Surgery for Multiple Teeth<br/> Figure 17. <span style='font-size: 16px; font-weight: normal'> Postoperative view of the enhanced gingival margin and aesthetic reconstruction of the interdental papillae provided by the definitive full-coverage crown restorations.</span>

Figure 17 - Postoperative view of the enhanced gingival margin and aesthetic reconstruction of the interdental papillae provided by the...

Figure 17 - Postoperative view of the enhanced gingival margin and aesthetic reconstruction of the interdental papillae provided by the definitive full-coverage crown restorations.

Diabetes Mellitus as a Risk Factor for Periodontal Disease

Impact of Diabetes on the Oral Environment - Impact of Diabetes on the Oral Environment

Impact of Diabetes on the Oral Environment - Impact of Diabetes on the Oral Environment Contributed by Deborah M. Lyle, RDH, MS on 5/29/2012

Impact of Diabetes on the Oral Environment<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Oral candidiasis is associated with an increase in salivary glucose, along with decreased saliva and impaired immune system.</span>

Figure 1 - Oral candidiasis is associated with an increase in salivary glucose, along with decreased saliva and impaired immune system....

Figure 1 - Oral candidiasis is associated with an increase in salivary glucose, along with decreased saliva and impaired immune system.

Impact of Diabetes on the Oral Environment<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Patients with diabetes may also have xerostomia, which can result in an increased incidence of caries and soft tissue ulceration.</span>

Figure 2 - Patients with diabetes may also have xerostomia, which can result in an increased incidence of caries and soft tissue ulcera...

Figure 2 - Patients with diabetes may also have xerostomia, which can result in an increased incidence of caries and soft tissue ulceration.

Impact of Diabetes on the Oral Environment<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> A patient who has diabetes mellitus and moderate to severe periodontal disease.</span>

Figure 3 - A patient who has diabetes mellitus and moderate to severe periodontal disease.

Severe Localized Periodontal Disease

Cemental Tears Related to Severe Localized Periodontal Disease - Cemental Tears Related to Severe Localized Periodontal Disease

Cemental Tears Related to Severe Localized Periodontal Disease - Cemental Tears Related to Severe Localized Periodontal Disease Contributed by Michael A. Brunsvold, DDS, MS on 6/27/2012

Cemental Tears Related to Severe Localized Periodontal Disease<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> A. Preoperative radiograph demonstrates severe localized periodontal disease associated with a cemental tear. B. The crown was bonded for temporary replacement. Note the remaining cementum fragment.</span>

Figure 1 - A. Preoperative radiograph demonstrates severe localized periodontal disease associated with a cemental tear. B. The crown w...

Figure 1 - A. Preoperative radiograph demonstrates severe localized periodontal disease associated with a cemental tear. B. The crown was bonded for temporary replacement. Note the remaining cementum fragment.

Cemental Tears Related to Severe Localized Periodontal Disease<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> A draining fistula was noted in the region of the extraction socket 8 months following the removal of the incisor, which was considered beyond repair.</span>

Figure 2 - A draining fistula was noted in the region of the extraction socket 8 months following the removal of the incisor, which was...

Figure 2 - A draining fistula was noted in the region of the extraction socket 8 months following the removal of the incisor, which was considered beyond repair.

Cemental Tears Related to Severe Localized Periodontal Disease<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> A small flap was reflected to expose the nidus of infection. A fragment of cementum was removed.</span>

Figure 3 - A small flap was reflected to expose the nidus of infection. A fragment of cementum was removed.

Cemental Tears Related to Severe Localized Periodontal Disease<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Postoperative radiograph of bone at extraction site at 1-year follow-up exhibits normal bone healing.</span>

Figure 4 - Postoperative radiograph of bone at extraction site at 1-year follow-up exhibits normal bone healing.

Cemental Tears Related to Severe Localized Periodontal Disease<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Postoperative facial view 2 years following removal of the cementum fragment demonstrates complete healing. Note that the bonded fixed partial denture is in place.</span>

Figure 5 - Postoperative facial view 2 years following removal of the cementum fragment demonstrates complete healing. Note that the bo...

Figure 5 - Postoperative facial view 2 years following removal of the cementum fragment demonstrates complete healing. Note that the bonded fixed partial denture is in place.

Hard and Soft Tissue Management for the Restoration of Traumatized Anterior Teeth

Restoring a Coronal Fracture of the Maxillary Right Central Incisor - Forced extrusion and pre-prosthetic management of coronally fractured tooth...

Restoring a Coronal Fracture of the Maxillary Right Central Incisor - Forced extrusion and pre-prosthetic management of coronally fractured tooth #8 Contributed by Samuele Valerio, MD, DDS on 8/9/2012

$Restoring a Coronal Fracture of the Maxillary Right Central Incisor Figure 1. Facial view of coronal fracture on tooth #8(11) with invasive margins evident in the vicinity of the alveolar ridge.$ Figure 1 - Facial view of coronal fracture on tooth #8(11) with invasive margins evident in the vicinity of the alveolar ridge.

Figure 1 - Facial view of coronal fracture on tooth #8(11) with invasive margins evident in the vicinity of the alveolar ridge.

Restoring a Coronal Fracture of the Maxillary Right Central Incisor<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> 2A. Radiograph of an endodontic lesion following trauma 2B. Apexification is induced with calcium hydroxide 2C. Radiograph following completion of endodontic therapy.</span>

Figure 2 - 2A. Radiograph of an endodontic lesion following trauma 2B. Apexification is induced with calcium hydroxide 2C. Radiograph f...

Figure 2 - 2A. Radiograph of an endodontic lesion following trauma 2B. Apexification is induced with calcium hydroxide 2C. Radiograph following completion of endodontic therapy.

Restoring a Coronal Fracture of the Maxillary Right Central Incisor<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> To protect the exposed root surface, an endodontic post was placed in the canal. A provisional restoration would be used to facilitate orthodontic extrusion.</span>

Figure 3 - To protect the exposed root surface, an endodontic post was placed in the canal. A provisional restoration would be used to...

Figure 3 - To protect the exposed root surface, an endodontic post was placed in the canal. A provisional restoration would be used to facilitate orthodontic extrusion.

Restoring a Coronal Fracture of the Maxillary Right Central Incisor<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Facial view of extrusive therapy following 1 week of treatment.</span>

Figure 4 - Facial view of extrusive therapy following 1 week of treatment.

Restoring a Coronal Fracture of the Maxillary Right Central Incisor<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Extrusive therapy of the right central incisor following 3 weeks of treatment.</span>

Figure 5 - Extrusive therapy of the right central incisor following 3 weeks of treatment.

Restoring a Coronal Fracture of the Maxillary Right Central Incisor<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Following 5 weeks of extrusive therapy, the gingival margin had moved coronoapically.</span>

Figure 6 - Following 5 weeks of extrusive therapy, the gingival margin had moved coronoapically.

Restoring a Coronal Fracture of the Maxillary Right Central Incisor<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> The periodontal fibers were circumferentially resected at the conclusion or orthodontic extrusion.</span>

Figure 7 - The periodontal fibers were circumferentially resected at the conclusion or orthodontic extrusion.

Restoring a Coronal Fracture of the Maxillary Right Central Incisor<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> Facial view of the provisional restorations used for postorthodontic maintenance and conditioning of the marginal tissues.</span>

Figure 8 - Facial view of the provisional restorations used for postorthodontic maintenance and conditioning of the marginal tissues.

Restoring a Coronal Fracture of the Maxillary Right Central Incisor<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> Occlusal view of the prepared teeth following the provisionalization stage.</span>

Figure 9 - Occlusal view of the prepared teeth following the provisionalization stage.

Restoring a Coronal Fracture of the Maxillary Right Central Incisor<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> Facial view of the definitive full-coverage crown restorations, which were seated with a glass-ionomer cement.</span>

Figure 10 - Facial view of the definitive full-coverage crown restorations, which were seated with a glass-ionomer cement.

Restoring a Coronal Fracture of the Maxillary Right Central Incisor<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> Postoperative radiograph indicates the balance between the restorations and the underlying supporting tissues.</span>

Figure 11 - Postoperative radiograph indicates the balance between the restorations and the underlying supporting tissues.

Restoring a Coronal Fracture of the Maxillary Right Central Incisor<br/> Figure 12. <span style='font-size: 16px; font-weight: normal'> Three-year postoperative view of the definitive restorations. Note the optimum emergence profile and the harmonious gingival contour.</span>

Figure 12 - Three-year postoperative view of the definitive restorations. Note the optimum emergence profile and the harmonious gingiva...

Figure 12 - Three-year postoperative view of the definitive restorations. Note the optimum emergence profile and the harmonious gingival contour.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor - Orthodontic stabilization and pre-prosthetic management of dilacerated tooth...

Restoring a Coronal Fracture of the Maxillary Left Central Incisor - Orthodontic stabilization and pre-prosthetic management of dilacerated tooth #9 Contributed by Samuele Valerio, MD, DDS on 8/9/2012

$Restoring a Coronal Fracture of the Maxillary Left Central Incisor Figure 1. Preoperative view of patient demonstrates coronal fracture of tooth #9(21) and structural malformation following dilaceration.$ Figure 1 - Preoperative view of patient demonstrates coronal fracture of tooth #9(21) and structural malformation following dilaceratio...

Figure 1 - Preoperative view of patient demonstrates coronal fracture of tooth #9(21) and structural malformation following dilaceration.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Orthodontic stabilization was achieved following extrusion without cutting of the fibers.</span>

Figure 2 - Orthodontic stabilization was achieved following extrusion without cutting of the fibers.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> After 4 months of orthodontic therapy, bone formation was observed at the cementoenamel junction of the extruded tooth.</span>

Figure 3 - After 4 months of orthodontic therapy, bone formation was observed at the cementoenamel junction of the extruded tooth.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Recovery of bone morphology symmetric to adjacent central incisor. Volumetric difference was evident between the two roots.</span>

Figure 4 - Recovery of bone morphology symmetric to adjacent central incisor. Volumetric difference was evident between the two roots.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> 5A. Facial view of the prepared tooth. 5B. The fit of the coping was verified prior to the fabrication of the definitive restoration.</span>

Figure 5 - 5A. Facial view of the prepared tooth. 5B. The fit of the coping was verified prior to the fabrication of the definitive res...

Figure 5 - 5A. Facial view of the prepared tooth. 5B. The fit of the coping was verified prior to the fabrication of the definitive restoration.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> The provisional crown was fabricated of composite resin to permit any morphological corrections.</span>

Figure 6 - The provisional crown was fabricated of composite resin to permit any morphological corrections.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> A compound was added to or removed from the crown as necessary.</span>

Figure 7 - A compound was added to or removed from the crown as necessary.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> The emergence profile of the provisional restoration was modified to match that of the contralateral tooth.</span>

Figure 8 - The emergence profile of the provisional restoration was modified to match that of the contralateral tooth.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> Occlusal view of the impression used to record the position of the cemented crown restoration.</span>

Figure 9 - Occlusal view of the impression used to record the position of the cemented crown restoration.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> A model that replicated the modified position of the tissues was poured to permit the fabrication of the definitive ceramic restoration.</span>

Figure 10 - A model that replicated the modified position of the tissues was poured to permit the fabrication of the definitive ceramic...

Figure 10 - A model that replicated the modified position of the tissues was poured to permit the fabrication of the definitive ceramic restoration.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> For a natural emergence profile, it should be varied not at the gingival margin but a minimum of 1 mm coronally.</span>

Figure 11 - For a natural emergence profile, it should be varied not at the gingival margin but a minimum of 1 mm coronally.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 12. <span style='font-size: 16px; font-weight: normal'> 12A. Preoperative radiograph of the site. 12B. Postoperative radiograph of the restored site. Note the extent of the extrusive movement.</span>

Figure 12 - 12A. Preoperative radiograph of the site. 12B. Postoperative radiograph of the restored site. Note the extent of the extrus...

Figure 12 - 12A. Preoperative radiograph of the site. 12B. Postoperative radiograph of the restored site. Note the extent of the extrusive movement.

Restoring a Coronal Fracture of the Maxillary Left Central Incisor<br/> Figure 13. <span style='font-size: 16px; font-weight: normal'> Postoperative facial view of the definitive full-coverage crown restoration, which is virtually indistinguishable from the adjacent central incisor.</span>

Figure 13 - Postoperative facial view of the definitive full-coverage crown restoration, which is virtually indistinguishable from the...

Figure 13 - Postoperative facial view of the definitive full-coverage crown restoration, which is virtually indistinguishable from the adjacent central incisor.

Advanced Perio-Plastic Surgery

Treatment of Root Recession on Tooth #11 Using Connective Tissue Graft - CTG for repair of gingival recession using a macrosurgical approach.

Treatment of Root Recession on Tooth #11 Using Connective Tissue Graft - CTG for repair of gingival recession using a macrosurgical approach. Contributed by Rino Burkhardt, DMD on 8/14/2012

Treatment of Root Recession on Tooth #11 Using Connective Tissue Graft<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative buccal view of root recession of the maxillary left canine.</span>

Figure 1 - Preoperative buccal view of root recession of the maxillary left canine.

Treatment of Root Recession on Tooth #11 Using Connective Tissue Graft<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Macrosurgical coverage of the root recession is achieved with a connective tissue graft.</span>

Figure 2 - Macrosurgical coverage of the root recession is achieved with a connective tissue graft.

Treatment of Root Recession on Tooth #11 Using Connective Tissue Graft<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Buccal view of the root recession site 3 day following the completion of the surgical procedure.</span>

Figure 3 - Buccal view of the root recession site 3 day following the completion of the surgical procedure.

Treatment of Root Recession on Tooth #11 Using Connective Tissue Graft<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Buccal view of the surgical site 4 weeks postoperatively. Note slight inflammation and small portions of uncovered root surface.</span>

Figure 4 - Buccal view of the surgical site 4 weeks postoperatively. Note slight inflammation and small portions of uncovered root surf...

Figure 4 - Buccal view of the surgical site 4 weeks postoperatively. Note slight inflammation and small portions of uncovered root surface.

Treatment of Root Recession on Tooth #11 Using Connective Tissue Graft<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Postoperative view of the macrosurgical site approximately 1 year following treatment. Note the visible root surface and scars.</span>

Figure 5 - Postoperative view of the macrosurgical site approximately 1 year following treatment. Note the visible root surface and sca...

Figure 5 - Postoperative view of the macrosurgical site approximately 1 year following treatment. Note the visible root surface and scars.

Treatment of Root Recession on Tooth #6 Using Connective Tissue Graft - GTC for repair of gingival recession using a microsurgical approach

Treatment of Root Recession on Tooth #6 Using Connective Tissue Graft - GTC for repair of gingival recession using a microsurgical approach Contributed by Rino Burkhardt, DMD on 8/14/2012

Treatment of Root Recession on Tooth #6 Using Connective Tissue Graft<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative view of root recession present on same patient at the site of tooth #6(13).</span>

Figure 1 - Preoperative view of root recession present on same patient at the site of tooth #6(13).

Treatment of Root Recession on Tooth #6 Using Connective Tissue Graft<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Buccal view of the surgical site following microsurgical coverage with a connective tissue graft.</span>

Figure 2 - Buccal view of the surgical site following microsurgical coverage with a connective tissue graft.

Treatment of Root Recession on Tooth #6 Using Connective Tissue Graft<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Three-day postoperative view of the root recession site.</span>

Figure 3 - Three-day postoperative view of the root recession site.

Treatment of Root Recession on Tooth #6 Using Connective Tissue Graft<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Buccal view of the site of root recession 4 weeks postoperatively. Compare with results achieved with the macrosurgical technique.</span>

Figure 4 - Buccal view of the site of root recession 4 weeks postoperatively. Compare with results achieved with the macrosurgical tech...

Figure 4 - Buccal view of the site of root recession 4 weeks postoperatively. Compare with results achieved with the macrosurgical technique.

Treatment of Root Recession on Tooth #6 Using Connective Tissue Graft<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Postoperative view of the microsurgical site approximately 1 year following treatment. Total coverage is observed with few visible scar formations.</span>

Figure 5 - Postoperative view of the microsurgical site approximately 1 year following treatment. Total coverage is observed with few v...

Figure 5 - Postoperative view of the microsurgical site approximately 1 year following treatment. Total coverage is observed with few visible scar formations.

Treatment of Maxillary Ridge Defect Using Microsurgical Approach - Seibert Class II ridge defect treated using periodontal microsurgery

Treatment of Maxillary Ridge Defect Using Microsurgical Approach - Seibert Class II ridge defect treated using periodontal microsurgery Contributed by Rino Burkhardt, DmD on 8/14/2012

Treatment of Maxillary Ridge Defect Using Microsurgical Approach<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative occlusal view of a maxillary ridge defect (Seibert Class II) in the left central incisor region.</span>

Figure 1 - Preoperative occlusal view of a maxillary ridge defect (Seibert Class II) in the left central incisor region.

Treatment of Maxillary Ridge Defect Using Microsurgical Approach<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Occlusal view of the surgical site demonstrates the use of 8-0 and 10-0 suture materials to secure the graft in place.</span>

Figure 2 - Occlusal view of the surgical site demonstrates the use of 8-0 and 10-0 suture materials to secure the graft in place.

Treatment of Maxillary Ridge Defect Using Microsurgical Approach<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Buccal view of the wound closure following microsurgical soft tissue augmentation.</span>

Figure 3 - Buccal view of the wound closure following microsurgical soft tissue augmentation.

Treatment of Maxillary Ridge Defect Using Microsurgical Approach<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Occlusal view of wound closure over the site of the soft tissue augmentation.</span>

Figure 4 - Occlusal view of wound closure over the site of the soft tissue augmentation.

Treatment of Maxillary Ridge Defect Using Microsurgical Approach<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Postoperative occlusal view 3 months following treatment.</span>

Figure 5 - Postoperative occlusal view 3 months following treatment.

Treatment of Maxillary Ridge Defect Using Microsurgical Approach<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Postoperative buccal view (at 3 months) during initiation of tissue sculpting.</span>

Figure 6 - Postoperative buccal view (at 3 months) during initiation of tissue sculpting.

Treatment of Maxillary Ridge Defect Using Microsurgical Approach<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> Insertion of the metal-supported long-term provisional fixed partial denture to create papillae with continuous lateral pressure of the pontic to open the interdental spaces.</span>

Figure 7 - Insertion of the metal-supported long-term provisional fixed partial denture to create papillae with continuous lateral pres...

Figure 7 - Insertion of the metal-supported long-term provisional fixed partial denture to create papillae with continuous lateral pressure of the pontic to open the interdental spaces.

Advanced Periodontal Disease

Management of Periodontally Involved Maxillary Anterior Dentition - 10-year report of combined periodontal and orthodontic therapy for advanced a...

Management of Periodontally Involved Maxillary Anterior Dentition - 10-year report of combined periodontal and orthodontic therapy for advanced adult periodontitis Contributed by Cobi J. Landsberg, DDS on 8/14/2012

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative radiographs upon presentation. Note the insufficient osseous support available for intra-arch integrity.</span>

Figure 1 - Preoperative radiographs upon presentation. Note the insufficient osseous support available for intra-arch integrity.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Generalized pink to red marginal and papillary discolorations that were less pronounced on the buccal surfaces of each arch were evident during the clinical intraoral evaluation.</span>

Figure 2 - Generalized pink to red marginal and papillary discolorations that were less pronounced on the buccal surfaces of each arch...

Figure 2 - Generalized pink to red marginal and papillary discolorations that were less pronounced on the buccal surfaces of each arch were evident during the clinical intraoral evaluation.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Moderate calculus accumulations were located on the mandibular incisors, and pocket depths in the maxillary anterior region ranged from 7 mm to 10 mm at the palatal aspects of the central incisors.</span>

Figure 3 - Moderate calculus accumulations were located on the mandibular incisors, and pocket depths in the maxillary anterior region...

Figure 3 - Moderate calculus accumulations were located on the mandibular incisors, and pocket depths in the maxillary anterior region ranged from 7 mm to 10 mm at the palatal aspects of the central incisors.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> The gingival bleeding index was 70% and suppuration was present on tooth #8(11) and #9(21).</span>

Figure 4 - The gingival bleeding index was 70% and suppuration was present on tooth #8(11) and #9(21).

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Following the hygenic phase of treatment, periodontal surgery was initiated at the maxillary anterior region. Intrasulcular incisions on the labial and palatal aspects were performed between teeth #6(13) and #11(23).</span>

Figure 5 - Following the hygenic phase of treatment, periodontal surgery was initiated at the maxillary anterior region. Intrasulcular...

Figure 5 - Following the hygenic phase of treatment, periodontal surgery was initiated at the maxillary anterior region. Intrasulcular incisions on the labial and palatal aspects were performed between teeth #6(13) and #11(23).

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Wide full-thickness flaps were elevated to improve visualizations and access to the circumferential defects present around teeth #8(11) and #9(21). Care was taken to preserve the interdental papillae. Calculus deposits were located in the deeper apical regions of the roots.</span>

Figure 6 - Wide full-thickness flaps were elevated to improve visualizations and access to the circumferential defects present around t...

Figure 6 - Wide full-thickness flaps were elevated to improve visualizations and access to the circumferential defects present around teeth #8(11) and #9(21). Care was taken to preserve the interdental papillae. Calculus deposits were located in the deeper apical regions of the roots.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> The intrabony defects were thoroughly debrided and hand instrumented to achieve smooth surfaces devoid of necrotic root cement. Chemical conditioning, bone grafting, and guided tissue regeneration were not performed.</span>

Figure 7 - The intrabony defects were thoroughly debrided and hand instrumented to achieve smooth surfaces devoid of necrotic root ceme...

Figure 7 - The intrabony defects were thoroughly debrided and hand instrumented to achieve smooth surfaces devoid of necrotic root cement. Chemical conditioning, bone grafting, and guided tissue regeneration were not performed.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> Since no soft tissue was sacraficed during flap elevation, tension-free approximation of the flaps was implemented to completely cover and seal the surgical field.</span>

Figure 8 - Since no soft tissue was sacraficed during flap elevation, tension-free approximation of the flaps was implemented to comple...

Figure 8 - Since no soft tissue was sacraficed during flap elevation, tension-free approximation of the flaps was implemented to completely cover and seal the surgical field.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> Interdental vertical mattress sutures were utilized to ensure primary healing between the flaps and to achieve interdental papillae that were devoid of craters. To improve adaptation of the large palatal flap to the bone and roots, long mattress and figure-eight sutures were used.</span>

Figure 9 - Interdental vertical mattress sutures were utilized to ensure primary healing between the flaps and to achieve interdental p...

Figure 9 - Interdental vertical mattress sutures were utilized to ensure primary healing between the flaps and to achieve interdental papillae that were devoid of craters. To improve adaptation of the large palatal flap to the bone and roots, long mattress and "figure-eight" sutures were used.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> While healing was uneventful, an unavoidable minor recession of the gingiva and the interdental papillae was noted. Pocket depths were reduced to 1 mm to 2 mm. Patient motivation and compliance remained excellent throughout the surgical and immediate postoperative phases.</span>

Figure 10 - While healing was uneventful, an unavoidable minor recession of the gingiva and the interdental papillae was noted. Pocket...

Figure 10 - While healing was uneventful, an unavoidable minor recession of the gingiva and the interdental papillae was noted. Pocket depths were reduced to 1 mm to 2 mm. Patient motivation and compliance remained excellent throughout the surgical and immediate postoperative phases.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> Orthodontic treatment was initiated 2 months following completion of periodontal surgery.</span>

Figure 11 - Orthodontic treatment was initiated 2 months following completion of periodontal surgery.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 12. <span style='font-size: 16px; font-weight: normal'> Once the mandibular front sextant was aligned, overjet occlusal relationships were established to allow retraction and approximation of the maxillary front teeth.</span>

Figure 12 - Once the mandibular front sextant was aligned, overjet occlusal relationships were established to allow retraction and appr...

Figure 12 - Once the mandibular front sextant was aligned, overjet occlusal relationships were established to allow retraction and approximation of the maxillary front teeth.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 13. <span style='font-size: 16px; font-weight: normal'> Following achievement of the desired intra- and interarch tooth alignment, fixed lingual retainers were attached to both dental arches using 0.6 mm stainless steel wires and acrylic glue.</span>

Figure 13 - Following achievement of the desired intra- and interarch tooth alignment, fixed lingual retainers were attached to both de...

Figure 13 - Following achievement of the desired intra- and interarch tooth alignment, fixed lingual retainers were attached to both dental arches using 0.6 mm stainless steel wires and acrylic glue.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 14. <span style='font-size: 16px; font-weight: normal'> Supportive periodontal treatment is administered using a regular recall program every 3 months.</span>

Figure 14 - Supportive periodontal treatment is administered using a regular recall program every 3 months.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 15. <span style='font-size: 16px; font-weight: normal'> Ten years following initial treatment, the patient demonstrated healthy functional dentition with slight spacing between teeth #8(11), #9(21), and #10(22).</span>

Figure 15 - Ten years following initial treatment, the patient demonstrated healthy functional dentition with slight spacing between te...

Figure 15 - Ten years following initial treatment, the patient demonstrated healthy functional dentition with slight spacing between teeth #8(11), #9(21), and #10(22).

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 16. <span style='font-size: 16px; font-weight: normal'> Radiographic evaluation demonstrates maintenance of adequate alveolar support and crestal osseous profiles consistent with healthy bone. Further treatment is not anticipated unless deleterious changes are noted.</span>

Figure 16 - Radiographic evaluation demonstrates maintenance of adequate alveolar support and crestal osseous profiles consistent with...

Figure 16 - Radiographic evaluation demonstrates maintenance of adequate alveolar support and crestal osseous profiles consistent with healthy bone. Further treatment is not anticipated unless deleterious changes are noted.

Management of Periodontally Involved Maxillary Anterior Dentition<br/> Figure 17. <span style='font-size: 16px; font-weight: normal'> Postoperative radiographs demonstrate an improved tooth to root ratio, crestal bone profiles, and tooth stability.</span>

Figure 17 - Postoperative radiographs demonstrate an improved tooth to root ratio, crestal bone profiles, and tooth stability.

Management of Radicular Anomalies

Treatment Options for the Radicular Lingual Groove - Diagnosing various forms of radicular lingual grooves and their prognoses.

Treatment Options for the Radicular Lingual Groove - Diagnosing various forms of radicular lingual grooves and their prognoses. Contributed by Tom G. Gound, DDS, MS on 11/21/2012

Treatment Options for the Radicular Lingual Groove<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Case 1. Radiograph of a radicular lingual groove in maxillary left lateral incisor. Note radiolucent parapulpal line superimposed over root canal.</span>

Figure 1 - Case 1. Radiograph of a radicular lingual groove in maxillary left lateral incisor. Note radiolucent "parapulpal line" super...

Figure 1 - Case 1. Radiograph of a radicular lingual groove in maxillary left lateral incisor. Note radiolucent "parapulpal line" superimposed over root canal.

Treatment Options for the Radicular Lingual Groove<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Case 2. Radiograph of RLG in the maxillary lateral incisor. Endodontic treatment was completed 10 years previously; RLG was not diagnosed. Tooth was extracted.</span>

Figure 2 - Case 2. Radiograph of RLG in the maxillary lateral incisor. Endodontic treatment was completed 10 years previously; RLG was...

Figure 2 - Case 2. Radiograph of RLG in the maxillary lateral incisor. Endodontic treatment was completed 10 years previously; RLG was not diagnosed. Tooth was extracted.

Treatment Options for the Radicular Lingual Groove<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Palatal view of the maxillary site with gingival irritation present.</span>

Figure 3 - Palatal view of the maxillary site with gingival irritation present.

Treatment Options for the Radicular Lingual Groove<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Palatal view. Periodontal probing reveals a 10-mm pocket.</span>

Figure 4 - Palatal view. Periodontal probing reveals a 10-mm pocket.

Treatment Options for the Radicular Lingual Groove<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> 5A. Radiograph of the extracted maxillary lateral incisor with one canal. 5B. Photograph of the extracted tooth with mild form of simple radicular lingual groove.</span>

Figure 5 - 5A. Radiograph of the extracted maxillary lateral incisor with one canal. 5B. Photograph of the extracted tooth with mild fo...

Figure 5 - 5A. Radiograph of the extracted maxillary lateral incisor with one canal. 5B. Photograph of the extracted tooth with mild form of simple radicular lingual groove.

Treatment Options for the Radicular Lingual Groove<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Case 3. Radiograph of maxillary lateral incisor. Endodontic therapy began 1 year previously; RLG was diagnosed and the tooth was extracted.</span>

Figure 6 - Case 3. Radiograph of maxillary lateral incisor. Endodontic therapy began 1 year previously; RLG was diagnosed and the tooth...

Figure 6 - Case 3. Radiograph of maxillary lateral incisor. Endodontic therapy began 1 year previously; RLG was diagnosed and the tooth was extracted.

Treatment Options for the Radicular Lingual Groove<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> Preoperative clinical view. The groove is evident on the lingual surface.</span>

Figure 7 - Preoperative clinical view. The groove is evident on the lingual surface.

Treatment Options for the Radicular Lingual Groove<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> 8A. Lingual view of the extracted tooth. A large groove is evident between the fused roots. 8B. Radiograph exhibits the second root and canal; neither was evident on preoperative radiographs.</span>

Figure 8 - 8A. Lingual view of the extracted tooth. A large groove is evident between the fused roots. 8B. Radiograph exhibits the seco...

Figure 8 - 8A. Lingual view of the extracted tooth. A large groove is evident between the fused roots. 8B. Radiograph exhibits the second root and canal; neither was evident on preoperative radiographs.

Treatment Options for the Radicular Lingual Groove<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> 9A. Case 4. Radiograph of the files in both canals. 9B. Lateral view of radiograph of the files in both canals. Note parapulpal line.</span>

Figure 9 - 9A. Case 4. Radiograph of the files in both canals. 9B. Lateral view of radiograph of the files in both canals. Note parapul...

Figure 9 - 9A. Case 4. Radiograph of the files in both canals. 9B. Lateral view of radiograph of the files in both canals. Note parapulpal line.

Treatment Options for the Radicular Lingual Groove<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> Case 5. Clinical evaluation of a 9-mm suppurative periodontal pocket palatal to the maxillary left central incisor. No apparent inflammation is present.</span>

Figure 10 - Case 5. Clinical evaluation of a 9-mm suppurative periodontal pocket palatal to the maxillary left central incisor. No appa...

Figure 10 - Case 5. Clinical evaluation of a 9-mm suppurative periodontal pocket palatal to the maxillary left central incisor. No apparent inflammation is present.

Treatment Options for the Radicular Lingual Groove<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> Radiograph sent by referring clinician. Root canal therapy had been deemed impossible due to periodontal-pulpal involvement. Significant radiolucency suggests complex RLG.</span>

Figure 11 - Radiograph sent by referring clinician. Root canal therapy had been deemed impossible due to periodontal-pulpal involvement...

Figure 11 - Radiograph sent by referring clinician. Root canal therapy had been deemed impossible due to periodontal-pulpal involvement. Significant radiolucency suggests complex RLG.

Treatment Options for the Radicular Lingual Groove<br/> Figure 12. <span style='font-size: 16px; font-weight: normal'> Saucerization of the entire groove, including pulp tissue and palatal half of the canal. Medium and fine round diamond burs used to plasty the root to the apex.</span>

Figure 12 - Saucerization of the entire groove, including pulp tissue and palatal half of the canal. Medium and fine round diamond burs...

Figure 12 - Saucerization of the entire groove, including pulp tissue and palatal half of the canal. Medium and fine round diamond burs used to plasty the root to the apex.

Treatment Options for the Radicular Lingual Groove<br/> Figure 13. <span style='font-size: 16px; font-weight: normal'> Dense particulate hydroxyapatite is used to fill the RLG defect to the crest of the surrounding bone. Flap is repositioned an closed with silk suture. Healing is uneventful.</span>

Figure 13 - Dense particulate hydroxyapatite is used to fill the RLG defect to the crest of the surrounding bone. Flap is repositioned...

Figure 13 - Dense particulate hydroxyapatite is used to fill the RLG defect to the crest of the surrounding bone. Flap is repositioned an closed with silk suture. Healing is uneventful.

Treatment Options for the Radicular Lingual Groove<br/> Figure 14. <span style='font-size: 16px; font-weight: normal'> One-year postoperative radiograph indicates increased radiolucency of the apical half of the root.</span>

Figure 14 - One-year postoperative radiograph indicates increased radiolucency of the apical half of the root.

Treatment Options for the Radicular Lingual Groove<br/> Figure 15. <span style='font-size: 16px; font-weight: normal'> Palatal view at 18 months demonstrates gingival tissue health with attachment gain of 7 mm. The palatal aspect of the tooth probed 4 mm without bleeding.</span>

Figure 15 - Palatal view at 18 months demonstrates gingival tissue health with attachment gain of 7 mm. The palatal aspect of the tooth...

Figure 15 - Palatal view at 18 months demonstrates gingival tissue health with attachment gain of 7 mm. The palatal aspect of the tooth probed 4 mm without bleeding.

Treatment Options for the Radicular Lingual Groove<br/> Figure 16. <span style='font-size: 16px; font-weight: normal'> Clinical follow-up at 18 months postoperatively demonstrates that the maxillary left central incisor is comparable to the vital right central incisor in color and contour.</span>

Figure 16 - Clinical follow-up at 18 months postoperatively demonstrates that the maxillary left central incisor is comparable to the v...

Figure 16 - Clinical follow-up at 18 months postoperatively demonstrates that the maxillary left central incisor is comparable to the vital right central incisor in color and contour.

Treatment of Gingival Recession

Connective Tissue Allograft Used to Manage Generalized Gingival Recession - The treatment of gingival recession through the creation of a "tunnel...

Connective Tissue Allograft Used to Manage Generalized Gingival Recession - The treatment of gingival recession through the creation of a "tunnel" beneath the buccal mucosa allows coronal repositioning of the soft tissue with predictable root coverage and aesthetics. Vertical incisions on either sid...

Connective Tissue Allograft Used to Manage Generalized Gingival Recession<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative view demonstrates the presence of generalized mild to moderate gingival recession on teeth #6(13) through #8(11).</span>

Figure 1 - Preoperative view demonstrates the presence of generalized mild to moderate gingival recession on teeth #6(13) through #8(11...

Figure 1 - Preoperative view demonstrates the presence of generalized mild to moderate gingival recession on teeth #6(13) through #8(11).

Connective Tissue Allograft Used to Manage Generalized Gingival Recession<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> A periosteal elevator was carefully utilized to raise a buccal flap and maintain the interdental papillae.</span>

Figure 2 - A periosteal elevator was carefully utilized to raise a buccal flap and maintain the interdental papillae.

Connective Tissue Allograft Used to Manage Generalized Gingival Recession<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> The acellular dermal connective tissue allograft was placed beneath the gingival flap.</span>

Figure 3 - The acellular dermal connective tissue allograft was placed beneath the gingival flap.

Connective Tissue Allograft Used to Manage Generalized Gingival Recession<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> The gingival flap was repositioned over the allograft in the coronal position and secured with plain gut sutures.</span>

Figure 5 - The gingival flap was repositioned over the allograft in the coronal position and secured with plain gut sutures.

Connective Tissue Allograft Used to Manage Generalized Gingival Recession<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Postoperative view 1 week following treatment indicated successful healing. Many of the sutures were resorbed or had fallen out.</span>

Figure 6 - Postoperative view 1 week following treatment indicated successful healing. Many of the sutures were resorbed or had fallen...

Figure 6 - Postoperative view 1 week following treatment indicated successful healing. Many of the sutures were resorbed or had fallen out.

Connective Tissue Allograft Used to Manage Generalized Gingival Recession<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> Postoperative view 10 weeks following treatment demonstrates significant root coverage and a normal appearance of the interdental papillae.</span>

Figure 7 - Postoperative view 10 weeks following treatment demonstrates significant root coverage and a normal appearance of the interd...

Figure 7 - Postoperative view 10 weeks following treatment demonstrates significant root coverage and a normal appearance of the interdental papillae.

Treatment of Gingival Recession with a Modified "Tunnel" Technique and an Acellular Dermal Connective Tissue Allograft - A 39 year old nonsmoking...

Treatment of Gingival Recession with a Modified "Tunnel" Technique and an Acellular Dermal Connective Tissue Allograft - A 39 year old nonsmoking male patient presented with a noncontributory medical history and mild to moderate gingival recession on teeth #11(23) through #13(25) Contributed by...

Treatment of Gingival Recession with a Modified 'Tunnel' Technique and an Acellular Dermal Connective Tissue Allograft<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative view of teeth #11(23) through #13(25). Note the presence of mild to moderate gingival recession and varying amounts of attached keratinized soft tissue.</span>

Figure 1 - Preoperative view of teeth #11(23) through #13(25). Note the presence of mild to moderate gingival recession and varying amo...

Figure 1 - Preoperative view of teeth #11(23) through #13(25). Note the presence of mild to moderate gingival recession and varying amounts of attached keratinized soft tissue.

Treatment of Gingival Recession with a Modified 'Tunnel' Technique and an Acellular Dermal Connective Tissue Allograft<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Vertical incisions were made in the gingival suculus that extended from the middle of the papillae adjacent to the treatment side apically into the mucosa.</span>

Figure 2 - Vertical incisions were made in the gingival suculus that extended from the middle of the papillae adjacent to the treatment...

Figure 2 - Vertical incisions were made in the gingival suculus that extended from the middle of the papillae adjacent to the treatment side apically into the mucosa.

Treatment of Gingival Recession with a Modified 'Tunnel' Technique and an Acellular Dermal Connective Tissue Allograft<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Buccal view following placement of the acellular dermal connective tissue allograft beneath the gingival flap.</span>

Figure 3 - Buccal view following placement of the acellular dermal connective tissue allograft beneath the gingival flap.

Treatment of Gingival Recession with a Modified 'Tunnel' Technique and an Acellular Dermal Connective Tissue Allograft<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Plain gut sutures were utilized to secure the gingival flap over the allograft in the coronal position. Surgical dressing was not required.</span>

Figure 4 - Plain gut sutures were utilized to secure the gingival flap over the allograft in the coronal position. Surgical dressing wa...

Figure 4 - Plain gut sutures were utilized to secure the gingival flap over the allograft in the coronal position. Surgical dressing was not required.

Treatment of Gingival Recession with a Modified 'Tunnel' Technique and an Acellular Dermal Connective Tissue Allograft<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Postoperative buccal view 1 week following treatment demonstrates resorbed or lost sutures and uneventful healing</span>

Figure 5 - Postoperative buccal view 1 week following treatment demonstrates resorbed or lost sutures and uneventful healing

Treatment of Gingival Recession with a Modified 'Tunnel' Technique and an Acellular Dermal Connective Tissue Allograft<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Postoperative view 8 weeks following treatment indicates little gingival recession, increased root coverage, and enhanced aesthetics of the interdental papillae and surrounding tissues.</span>

Figure 6 - Postoperative view 8 weeks following treatment indicates little gingival recession, increased root coverage, and enhanced ae...

Figure 6 - Postoperative view 8 weeks following treatment indicates little gingival recession, increased root coverage, and enhanced aesthetics of the interdental papillae and surrounding tissues.

Connective Tissue Grafting for Root Coverage in Multiple Class III Gingival Recessions - Connective Tissue Grafting for Root Coverage in Multiple...

Connective Tissue Grafting for Root Coverage in Multiple Class III Gingival Recessions - Connective Tissue Grafting for Root Coverage in Multiple Class III Gingival Recessions Contributed by Koichi Ito, DDS, MSD, PhD on 6/19/2012

Connective Tissue Grafting for Root Coverage in Multiple Class III Gingival Recessions<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative facial view of exposed roots. Teeth #23(32) through #25(41) were noted to have inadequate volume of keratinized tissue and attached gingiva.</span>

Figure 1 - Preoperative facial view of exposed roots. Teeth #23(32) through #25(41) were noted to have inadequate volume of keratinized...

Figure 1 - Preoperative facial view of exposed roots. Teeth #23(32) through #25(41) were noted to have inadequate volume of keratinized tissue and attached gingiva.

Connective Tissue Grafting for Root Coverage in Multiple Class III Gingival Recessions<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> An envelope-type, partial-thickness flap was created, and the keratinized interdental gingiva was cut into a beveled shape.</span>

Figure 2 - An envelope-type, partial-thickness flap was created, and the keratinized interdental gingiva was cut into a beveled shape.

Connective Tissue Grafting for Root Coverage in Multiple Class III Gingival Recessions<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> The bone around teeth #24 and #25 had receded approximately 6mm, while bone recession around tooth #23 was approximately 4mm.</span>

Figure 3 - The bone around teeth #24 and #25 had receded approximately 6mm, while bone recession around tooth #23 was approximately 4mm...

Figure 3 - The bone around teeth #24 and #25 had receded approximately 6mm, while bone recession around tooth #23 was approximately 4mm.

Connective Tissue Grafting for Root Coverage in Multiple Class III Gingival Recessions<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Following debridement, the root surfaces were rinsed with sterile saline and etched with 36% orthophosphoric acid for 15 seconds to remove the smear layer.</span>

Figure 4 - Following debridement, the root surfaces were rinsed with sterile saline and etched with 36% orthophosphoric acid for 15 sec...

Figure 4 - Following debridement, the root surfaces were rinsed with sterile saline and etched with 36% orthophosphoric acid for 15 seconds to remove the smear layer.

Connective Tissue Grafting for Root Coverage in Multiple Class III Gingival Recessions<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Following acid etching, the root surfaces were thoroughly rinsed with saline, and an enamel matrix derivative was immediately applied.</span>

Figure 5 - Following acid etching, the root surfaces were thoroughly rinsed with saline, and an enamel matrix derivative was immediatel...

Figure 5 - Following acid etching, the root surfaces were thoroughly rinsed with saline, and an enamel matrix derivative was immediately applied.

Connective Tissue Grafting for Root Coverage in Multiple Class III Gingival Recessions<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> To cover the exposed roots, the prepared connective tissue graft was placed over the recipient site and sutured with surgical gut.</span>

Figure 6 - To cover the exposed roots, the prepared connective tissue graft was placed over the recipient site and sutured with surgica...

Figure 6 - To cover the exposed roots, the prepared connective tissue graft was placed over the recipient site and sutured with surgical gut.

Connective Tissue Grafting for Root Coverage in Multiple Class III Gingival Recessions<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> The flap was replaced over the connective tissue graft and sutured with surgical gut. No attempt was made to cover the donor tissue completely.</span>

Figure 7 - The flap was replaced over the connective tissue graft and sutured with surgical gut. No attempt was made to cover the donor...

Figure 7 - The flap was replaced over the connective tissue graft and sutured with surgical gut. No attempt was made to cover the donor tissue completely.