Cosmetic dentistry beauty & science

Figs.1a–b_Pocketdepthof13mm misiallytotooth#23.Thetoothis stableandtheperiapicalradiography showsangularbonelosswiththe formationofaninfrabonydefect. Figs.2a-b_Thepresenceofthepapilla withnopocketdepthbetweenthe lateralandthecentralincisorand betweenthecanineandthefirst premolarsuggesttoplacevertical relisingincisionatthebaseofthose papillaandprerervethepapillaover theinfrabonydefectwithabuccal incision.Theflapisthenelevated full-thicknessandthedefect debridedandmisured. I technique _ periodontal regenerative therapy _Introduction Periodontal regeneration (PR) has provided the practitioner with a more conservative therapeutic strategy for the treatment of infrabony periodon- tal defects. In fact, PR not only helps reducing peri- odontal pocket depth (PPD), but it also allows to gain clinical attachment level (CAL) with minimal negative effects on gingival recession (REC), which is particularly important when treating aesthetic areas. In this paper, we will evaluate different ap- proaches for periodontal regenerative therapy in the aesthetic area and we will suggest how regen- erative treatment of infrabony defects may be tai- lored to even have a positive effect on REC. These approaches are different when compared to tradi- tional guided tissue regeneration (GTR) techniques used for root coverage purposes; instead they help reducing REC by reestablishing a positive periodontal architecture via regeneration and im- proving the support for soft tissues during wound healing. _Indication Traditionally, periodontal therapy is aimed at reducing PPD and improving CAL by eliminating bacterial deposits and factors predisposing to bac- terial accumulations. Osseous resection is often required or suggested when a negative osseous architecture is present. Apically positioned flaps or repositioned flaps with removal of the secondary flaps are often used. This therapeutic approach is very predictable and allows maintaining the pa- tients’ dentition in the long term even in complex cases. Unfortunately, however, it can only worsen gingival recession and patients treated with tradi- tional periodontal therapy often complain of un- aesthetic outcomes of the surgery and root hyper- sensitivity. Moreover, when deep infrabony defects are present, the practitioner is put on the hotspot of having to choose the lesser of two evils: either sacrifice a large amount of the supporting bone of the neighboring dentition or sacrifice the tooth with the deep bony lesion. PR is particularly indi- cated in such cases. _Techniques With most PR treatments, including the use of Enamel Matrix Derivative (EMD), bone grafts, Guided Tissue Regeneration (GTR) or combinations of the above, regeneration of bone, cementum and afunctionallyorientedperiodontalligamentcanbe Periodontal tissue repair in the aesthetic zone Authors_Prof. Giulio Rasperini & Dr Giorgio Pagni, Italy 24 I cosmeticdentistry 3_2013 Fig. 2bFig. 2a Fig. 1a Fig. 1b