Recession is a frequent finding in many of our patients. Deciding when to treat can sometimes be a difficult decision. The case below highlights an ideal case for correction. We noted a progression of recession, thin tissue architecture and lack of keratinized gingiva. An allograft procedure was completed on teeth 5, 6 an 7 which all had deficient keratinized gingiva. The photo on the right represents the results after several months of healing. Notice the excellent color match and complete resolution of the recession defect. In many cases full recession correction can be obtained. Generally, the earlier the referral the better the results. Discomfort from this procedure is also minimized because no palatal graft was harvested.
The following case treated by Dr. Amalfitano highlights the dramatic results that crown lengthening can provide. The pre-treatment photo shows short teeth and excessive gum tissue. The surgical procedure is generally associated with low pain and the results are long lasting.
Recession can be treated in a variety of methods including a free gingival graft, connective tissue graft, coronal positioned graft or an allograft procedure. Due to a variety of factors our office chose to treat the area below with an allograft procedure. Cadaver tissue was used to thicken the amount of connective tissue. The patient had uneventful healing and a low level of discomfort or other post surgical problem. As can be seen from the final picture, complete root coverage was obtained. Our office has extensive experience in treating areas such as the case highlighted below.
Most implants are planned while the tooth is still present. The decision then becomes, do I take the tooth out and let it heal or do I have the tooth extracted and place a bone graft? I have become increasingly convinced through experience, and the literature supports, the immediate insertion of a bone grafting material whenever possible. Removal of the tooth should have as its primary goal of saving as much bone architecture as possible. This must include meticulous surgical technique. Specific instrumentation that I have found to be invaluable include piezo-surgical instruments that minimize loss of delicate bone structures such as the thin facial plates on maxillary anterior teeth.
Sectioning of teeth is used more often than not so as not to damage supporting bone architecture. Meticulous debridement of the extraction socket is also a prerequisite to success. Surgical planning should also incorporate a plan as to whether primary closure is feasible. Material selection should be based on sound research and on repeated surgical evaluation. My office can help your patients maximize their potential for socket preservation and subsequent implant placement.
Gingival lesions such as the one below are challenging. A meticulous surgical technique must be used to minimize damage to adjacent tissues. Removing the tissue for biopsy requires a surgical plan that preserves as much normal tissue as possible including keratinized gingiva. The lesion was removed entirely with special attention to preservation of keratinized gingiva. A surgical flap was designed so that once the lesion was removed adequate tissue remained to cover the defect. The biopsy report stated that this was a pyogenic granuloma. Please note the excellent healing post surgery with minimal recession and preservation of tissues I the are despite the wide excision. If you or your office has concerns about lesion removal along the gingival tissue margins we are capable of ensuring as esthetic a result as possible.
Recession of gingiva and lack of keratinized gingiva are indications for grafting. In the case highlighted below, a gingival graft harvested from the palate was recommended. It was felt that the predictability of a connective tissue or allograft procedure was less than a keratinized gingival graft. Also due to the fact that this is not a high esthetic demand area, the free-ginigival graft was used. As can be seen there is a color discrepancy with the donor graft being less vascularized than surrounding tissues however it is firmly integrated and increased the amount of keratinized tissues thus stabilizing the area. When recession is diagnosed we can help institute a surgical plan that will optimize the long term prognosis of the teeth involved.
