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cosmetic dentistry_ beauty & science

12 I I case report _ periodontal surgery be employed to cover the re- cessedareaandthenewlyex- posed recipient buccal blood supply of tooth #27. To sta- bilise the graft in our desired position, a sling suturing technique was utilised. The area was covered with a pe- riodontal dressing (COE-PAK, GC). Tetracycline 250 mg wasprescribedq.i.d.forseven days. An analgesic was also prescribed. The results present an ob- viously healthy and restored symmetrical, pink zone of attached gingiva and conti- nuity with the adjacent area. The recession was gone, the length and width of the at- tachedgingivalwassymmet- rically blended with the adja- centarea,andthefrenumpull had been corrected. Figure 2, taken 15 years post-operatively, attests to the du- rability of the results using this technique. Theresultsenabledthepatienttosmilewithcon- fidence, without hesitation. She no longer had the reflexive action of holding her lip back. The proce- dures also permitted her to maintain good oral hy- giene,reassuredherthatherteethwouldberetained (recession indicates age to some), and achieved a maintainable, normal colour balance, which collec- tively created an aesthetically pleasing appearance. _Case II The predictability of the results of root recession coveragehasbeenimprovedinrecentyearswiththe utilisation of guided tissue regeneration (GTR). This casedemonstratesanothergingivalgrafttechnique: the coronal repositioned gingival graft. It uses GTR using an acellular collagen membrane, which adds to the predictability of acquiring a blood supply. The resultant zone of attached gingival and root cover- age blend aesthetically into the background with a symmetrical width and lateral flow of healthy, pink keratinised tissue. From the initial appearance of tooth #11 (Fig. 3), the longer-appearing cuspid with recession is evi- dent, which made it stand out and caused the area to be unattractive and noticeable. Figures 4a and b show the acellular membrane placed over the ex- posed buccal root of #11, after the buccal flap had been reflected. The tissue was sutured with a con- tinuous suture covering the exposed root in the de- siredfinalpositionandtheacellularmembrane(Fig.5; the acellular collagen preferred in this technique in my office is supplied by CK Dental). Figure 6 shows the healed area four months later. The recession had been reclaimed by a healthy attached gingival zone. The results allowed a symmetrical appearing zone of pink, keratinised tissue to blend into the area. The cuspid no longer appeared to be greater in length than the surrounding dentition. The linear, even shape of the teeth was aesthetically pleasing. The overall result is easily maintained by the background of correct colour, texture, and symmetrical zone of appearance and health. _Summary Fortunately,intheseparticularcases,thepatients’ dental awareness made it possible for them to re- quest correction of their oral health and aesthetics. These illustrations demonstrate the aesthetic aware- ness and desires of today’s society. Practitioners must beabletorecogniseandworktowardsthesegoals.By creatively using variations of techniques to achieve such results, the art of dentistry is mastered. Achiev- ing health is primary, but providing a maintainable, healthyandpleasingappearanceisalsosignificantly desirable and important._ Editorial note: Part I of this series—Cosmetic periodontal surgery: Pre-prosthetic soft-tissue ridge augmentation— waspublishedin cosmetic dentistry Vol. 3, Issue 4/09. A PDFisavailablefromthepublisher. cosmeticdentistry 4_2011 Dr David L.Hoexter is a clinicalprofessorinPeriodontics atTemple University, Philadelphia,and Director of the InternationalAcademy for Dental Facial Esthetics.He is a diplomate of implantology in the International Congress of Oral Implantologists and theAmerican Society of Osseointegration,and a diplomate of theAmerican Board ofAesthetic Dentistry.Hoexter lectures throughout the world and has published nationally and internationally.He has been awarded 11 fellowships,including Fellow of theAmerican College of Dentists,of the International College of Dentists,and of the Pierre FauchardAcademy.He maintains a practice at 654 MadisonAve.,NewYork City,that specialises in periodontics,implantology and aesthetic surgery.He can be contacted on +1 212 355 0004 or at drdavidlh@aol.com. cosmeticdentistry _about the author Fig. 6 Fig. 5