Cosmetic dentistry beauty & science

I technique _ periodontal regenerative therapy Figs. 3a–b_The mesial and distal papilla coronal to the relaxing incisions are de-epithelized and a periosteal relising incision at the base of the flap allows to move the flap coronally without tension. Figs. 4a–b_The biomaterials are placed into the defect to promote regeneration and to stabilize the clot. In this case, Emdogain (Straumann, CH) was mixed with BioOss (Geistlich CH) graft and protected with a collagen resorbable membrane (BioGide, Geistlich, CH). Figs. 5a–b_With a 5-0 Gore-Text suture, a sling suture suspended to tooth #22 and one suspended to tooth #23 will stabilize the flap coronally, firm on the teeth, creating a stable buccal Soft Tissue Wall. Now, an internal mattress suture with a 7-0 Gore-Tex will close the papilla, extrofletting the wound margins and allowing perfect adaptation of the flaps. 26 I cosmeticdentistry 3_2013 when the marginal portion of the flap is able to passively reach a level more coronal to the CEJ and to cover the de-epithelialised anatomic papillae. Two sling sutures are used to stabilise the coro- nal displacement of the buccal flap. The root sur- face may be conditioned to remove the smear layer and to obtain a surface free of organic debris. Bio- logical elements as enamel matrix derivative gel (Emdogain®,Straumann,CH)orfillingbiomaterials incombinationsornotwithgrowthfactorsdelivery may now be applied to the defect. A tension-free primary closure of the interdental papilla upon the bony defect is achieved with an internal horizontal mattress suture and the vertical releasing incisions are closed with interrupted sutures. Usually, patients receive systemic antibiotic therapy and analgesic therapy to prevent post- operativepainandoedemaandsuturesarechecked and removed eight days after surgery. Local plaque control is maintained by a 0.2 % chlorhexidine digluconate rinse (three times daily) for eight weeks. During this period, patients are recalled weekly for professional prophylaxis. At-home me- chanicalcleaningofthetreatedareaisallowedfour weeks after completion of the surgical procedure, using an ultra-soft tooth-brush and a roll tech- nique in apico-coronal direction. Interproximal mechanical cleaning with dental floss is allowed two months after the regenerative procedure. After the initial eight weeks, recall appointments for professional supragingival tooth cleaning are scheduled at one-month intervals for one year post-treatment. No attempt to probe or for sub- gingival scaling is made before the twelve-month follow-up examination. Two main hypotheses have been described to explain the mechanisms involved in the regenera- tion of new periodontal structures including new cementum, new boundle bone and a functionally oriented periodontal ligament. The first suggested mechanism is the cell occlu- sionmechanismoriginallypostulatedbyMelcherin 19761 and then revised and integrated by different authors. According to this concept, five cellular Fig. 5bFig. 5a Fig. 4bFig. 4a Fig. 3bFig. 3a