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Dental Tribune U.S. Edition | November 2012 A3 Publisher & Chairman Torsten Oemus t.oemus@dental-tribune.com Chief OPerating OffiCer Eric Seid e.seid@dental-tribune.com grOuP editOr Robin Goodman r.goodman@dental-tribune.com editOr in Chief dental tribune Dr. David L. Hoexter feedback@dental-tribune.com managing editOr u.s. and Canada editiOns Robert Selleck r.selleck@dental-tribune.com managing editOr Fred Michmershuizen f.michmershuizen@dental-tribune.com managing editOr Sierra Rendon s.rendon@dental-tribune.com managing editOr shOw dailies Kristine Colker k.colker@dental-tribune.com PrOduCt/aCCOunt manager Mara Zimmerman m.zimmerman@dental-tribune.com PrOduCt/aCCOunt manager Charles Serra c.serra@dental-tribune.com marketing direCtOr Anna Kataoka-Wlodarczyk a.wlodarczyk@dental-tribune.com C.e. direCtOr Christiane Ferret c.ferret@dtstudyclub.com aCCOunting COOrdinatOr Nirmala Singh n.singh@dental-tribune.com Tribune America, LLC 116 West 23rd St., Ste. #500 New York, N.Y. 10011 (212) 244-7181 Published by Tribune America © 2012 Tribune America, LLC All rights reserved. Dental Tribune strives to maintain the utmost accu- racy in its news and clinical reports. If you find a fac- tual error or content that requires clarification, please contact Managing Editor Robert Selleck at r.selleck@ dental-tribune.com. Dental Tribune cannot assume responsibility for the validity of product claims or for typographical errors. The publisher also does not assume responsibility for product names or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Tribune America. editOrial bOard Dr. Joel Berg Dr. L. Stephen Buchanan Dr. Arnaldo Castellucci Dr. Gorden Christensen Dr. Rella Christensen Dr. William Dickerson Hugh Doherty Dr. James Doundoulakis Dr. David Garber Dr. Fay Goldstep Dr. Howard Glazer Dr. Harold Heymann Dr. Karl Leinfelder Dr. Roger Levin Dr. Carl E. Misch Dr. Dan Nathanson Dr. Chester Redhead Dr. Irwin Smigel Dr. Jon Suzuki Dr. Dennis Tartakow Dr. Dan Ward Tell us what you think! Do you have general comments or criti- cism you would like to share? Is there a particular topic you would like to see articles about in Dental Tribune? Let us know by e-mailing feedback@dental- tribune.com. We look forward to hear- ing from you! If you would like to make any change to your subscription (name, address or to opt out) please send us an e-mail at database@dental-tribune.com and be sure to include which publica- tion you are referring to. Also, please note that subscription changes can take up to six weeks to process. DENTAL TRIBUNE The World’s Dental Newspaper · US Edition ” See SYMMETRY, page A4 Cosmetic periodontal surgery (Part 3): Zones of symmetry By David L. Hoexter, DMD, FACD, FICD, Editor in Chief In Part 3 of this series on cosmetic peri- odontal surgery, I again emphasize the necessity of a complimentary healthy background of the periodontia — with the goal of enhancing the desired smile. In Parts 1 and 2 of this series, we described what a healthy periodontia entailed — a complementary, healthy surrounding tis- sue and color — and keratinized attached gingival, appearing as a whitish-pink col- or, separated at the mucogingival junc- tion from the movable nonkeratinized alveolar mucosa of a reddish-blue color. This article will concentrate on the sym- metry of the periodontal background’s colors to afford the emphasis of the ap- pearance of the teeth we wish to stand out to create that “smile.” In this article, the symmetry of attention of the kera- tinized attached gingiva — needed to achieve the background support of the fi- nal image — should be measured by both the vertical and horizontal dimensions, and is often overlooked. Healthy keratinized attached gingival is desirable to surround the natural tooth to aid in the hygienic maintenance of the natural tooth or the endosseous implant. The patient can rub the keratinized tissue with several choices of instruments to re- move the localized biofilms to preserve the health of the area. Healthy gingival color can vary Healthy keratinized attached gingival does not necessarily have to appear a pinkish-white color. It depends on the melanin pigmentation that the individ- ual has in his or her epithelial basement membrane. For example, people of Mediterranean origin appear to have areas of gingiva that vary with some darker and some lighter zones. It’s just like the way some people have facial skin with freckles and some don’t. In normal epithelium, the color does not necessarily represent pathology, but rather healthy, natural epithelium. However, when we discuss esthetic den- tistry today, the culture that we are deal- ing with plays a factor too. For example, centuries ago in Japan, a woman’s most desirable smile was one that showed black teeth. In general today, we wish the appear- ance of bright-appearing teeth — framed by pinkish-white keratinized gingiva. The gingival should surround and protect our desired image, enhancing and attracting it. It certainly should not detract from our goal. Therefore the keratinized gingival should be the same homogeneous color. It should also be equal and symmetrical in vertical and in lateral size. This will not detract, but aid in the maintenance and appearance of our smile. Many techniques can be used There are many cosmetic periodontal surgical techniques that can be used to Fig. 1: Labial pretreatment view. Notice the uneven gingival horizontal lines, the crowns’ unpleasant color — as well as the dark, uneven gingival margins in the maxillary posteriors. Photos/Provided by Dr. David L. Hoexter Fig. 2: Provisional replacements of the previous old crowns in the upper-right posterior. Notice the uneven zone of attached gingival affording the vision of uneven, unattractive teeth. Fig. 4: A vertical line shows the more-than-adequate vertical zone — as well as desired color of attached gingival. Fig. 5: The upper-right area now healed after cosmetic crown lengthening technique. Notice the preservation of the surgically manipulated attached gingival background and the lateral symmetry appearance of the future new restorations. Fig. 7: Final treatment, labial view. Fig. 3: The line shows our goal of symmetrical, horizontal- appearing teeth. Fig. 6: Restored upper-right area. The new horizontal and vertical zone of healthy attached gingival allow the restorations to blend to a cosmetic healthy and maintain- able smile. CLINICAL