Dental Tribune U.S. Edition

Dental Tribune U.S. Edition | November 2013A4 CLINICAL Ad periosteal elevator by Hu-Friedy, re- vealed the extent of the recession of both the cuspid and the bicus- pid buccally. Most important is the preservation of the interproximal tissue. Keeping the interproximal gingiva is paramount for the blood supply of the interproximal tissue. This avoids loss of interproximal tissue, which would result in dark- appearing interproximal voids, re- ferred to as “black diamonds.” Placement of the Guidor mem- brane covering the recessed labial root of #11 is done next (Fig. 4). The labial recession of #12 was left with- out a membrane. No scaling was done nor chemicals applied to ei- ther root. Next, the coronal repositioned flap technique was performed. This coronally repositions the gingival tissue, especially the preserved ke- ratinized gingiva. The tissue was then sutured in the desired posi- tion. The tissue now will cover all the recession as well as the mem- brane (Fig. 5). Figure 6 shows how the color of the newly attached keratinized gingiva achieved on the previous recessed root of #11 blends in with the symmetrical background tis- sue, giving the esthetic appearance desired while restoring health. Note also that #12, without using the bar- rier GTR, does not regenerate gin- gival coverage and returns to the original recession level. The patient was thrilled with the results and continued to maintain his oral hygiene with our profes- sional help. The results remained consistent for more than 11 years be- fore the patient changed locations. Conclusion Root recession coverage using the GTR technique (with a polylactic barrier by Guidor in this case study), resulted in regeneration of the gin- gival coverage of the recessed root. In the same patient on an adjacent tooth, using the same technique but without the barrier utilized on the first tooth, the technique resulted in the recession returning to its origi- nal level. It should be noted that, before do- ing any root coverage technique, the cause of the recession, such as toothbrush abrasion or other oral- hygiene habits (especially occlusal trauma), or any local causes that might have led to the recession, should first be addressed. In this case, with cosmetic periodontal sur- gery, the patient was thrilled with the results. DAvID L. HoExtEr, DMD, FICD, FACD, is director of the International Acad- emy for Dental Facial Esthetics, and a clinical professor in periodontics at Temple University, Philadelphia. He is a diplomate of implantology in the International Congress of Oral Implantologists as well as the American Society of Osseointegration, and a diplomate of the American Board of Aesthetic Dentistry. He lectures throughout the world and has published nationally and internationally. He has been awarded 11 fellowships, includ- ing FACD, FICD and Pierre Fauchard. He maintains a practice at 654 Madison Ave., New York City, limited to periodontics, implantology and esthetic sur- gery. He can be reached at (212) 355-0004 or drdavidlh@gmail.com. Fig. 4: The polylactic membrane is placed on #11, and, as discussed with the patient, no barrier is placed on #12. Fig. 5: The coronally repositioned flap, sutured in the desired position to cover the previously recessed area on both #11 and #12. Fig. 3: Reflected buccal tissue of the surgical site. The sulcular incision is performed from the gingiva to the osseous crest. Notice the equal amount of exposed root on both #11 and #12. Fig. 6: Gingival coverage is achieved on the previous recessed root of #11. The color of the newly attached keratinized gingiva blends in with the symmetrical background tissue, giving the esthetic appearance desired — while restoring health. Note also that #12 without using the barrier GTR does not predictably regenerate gingival coverage and results in a recession once again. “ BARRIERS, page A3 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Editorial Note: Part 1 in this series appeared in the Dental Tribune U.S. Edition, Vol. 4, No. 13/14; Part 2 in Vol. 6, No. 17; and Part 3 in Vol. 7, No. 11.