Lip Repositioning for Reduction of Excessive Gingival Display: A Clinical Report
This case report demonstrates the successful management of excessive gingival display with a lip-repositioning procedure.

Healing of Gingival Recessions Using a Collagen Membrane with a Demineralized Xenograft
A Randomized Controlled Clinical Trial

Use of PRGF to Accelerate Bone and Soft Tissue Regeneration in Postextraction Sites
Evealuation of regenerated bone density.

Use of the Natural Tooth for Soft Tissue Development: A Case Series
The achievement of optimal esthetics around anterior dental implants has been a major challenge for many clinicians. The key to an esthetically pleasing appearance lies in the clinician’s ability to properly manage the soft tissue profile around dental implants. Hence, the purpose of this case report is to describe a new technique that uses the patient’s own natural tooth for the provisional implant restoration to develop soft tissue architecture that is almost identical to the patient’s original immediately…

The Tunnel Technique in the Periodontal Plastic Treatment of Multiple Adjacent Gingival Recession Defects
“Originally published in Inside Dentistry, 2008. Copyright 2008. AEGIS Communications. Reprinted with permission.”

Bipolar Electrosurgery: Gingival Modification in Passive Eruption
Excessive gingival display can affect the total aesthetics of a smile, becoming its focus instead of its frame. This can be the result of passive eruption of the gingival complex as the teeth erupt. The condition of delayed or altered passive eruption exists when the gingival complex remains coronal to the cementoenamel junction (CEJ), with the attachment on the enamel instead of the cementum of the root, giving the appearance of short clinical crowns. Crown lengthening is critical to the success…

Connective Tissue & Bone Graft for Anterior Immediate Implant Placement
Immediate implant placement in a one-stage approach, with or without provisionalization, has proven to be advantageous in preserving gingival anatomy around dental implants. But placing implants immediately in the changing alveolar bone of an extraction socket can result in progressive recession of the gingival labial margin over the implant restoration. Thicker biotypes and bone of the labial periimplant tissue have been shown to promote long-term stable gingival margins. A surgically simple technique…

Bipolar Soft Tissue Management & Functional Mock-Ups
Patients desiring a cosmetic smile improvement can present challenges to the dentist when treatment planning. An excessive display of gingiva due to a high lip line often complicates treatment planning and can compromise the final esthetic result when proper planning is not considered prior to finalizing the case. We often have to ask ourselves as we evaluate the patient, do we “lower the river” (increase tooth length incisally), “raise the bridge” (increase tooth length gingivally) or a combination…

Soft Tissue Management and Functional Mock-Ups
Patients desiring a cosmetic smile improvement can present treatment planning challenges. An excessive display of gingiva resulting from a high lip line often complicates treatment planning and can compromise the final esthetic result. As we evaluate the patient, we often have to ask ourselves, do we “lower the river” (increase tooth length incisally), “raise the bridge” (increase tooth length gingivally) or use a combination of both approaches? This article addresses this issue using a methodological…

Predictable Gingival Correction of Passive Eruption
While the need to maintain a dry operative field has traditionally caused complications during various soft tissue surgical procedures, the use of bipolar electrosurgical techniques can eliminate the need to maintain a dry field, thus increasing the clinician’s ability to deliver predictable, long-term results. This case presentation describes how to determine the presence of passive eruption, treatment plan its correction, and surgically alter the gingiva to provide a more aesthetic smile. This…

Laser Assisted Crown Lengthening
Clinical scenarios where crown lengthening procedures are indicated within the esthetic zone require special consideration to achieve predictable restorative results. Whether they are performed for the purposes of exposing sound tooth structure, or to enhance the appearance of the definitive restorations, these procedures must be planned to satisfy biologic requirements, while simultaneously avoiding deleterious esthetic effects. The implementation of diagnostic criteria, along with evidence-based…

Achieving Predictable Connective Tissue Root Coverage
Gingival recession creates esthetic issues. These issues may be corrected from a restorative perspective by the placement of composite resin or ceramic over the exposed root. But this approach often results in a gingival-incisal length that does not blend esthetically with the adjacent teeth. Often accompanying the gingival recession is a decrease in the band of attached gingiva. The wider the band of attached gingiva, the more stable the long-term result. Therefore, surgical correction of the recession…

Achieving Predictable Connective Tissue Root Coverage
Gingival recession creates esthetic issues. These issues may be corrected from a restomtive perspective by the placement of composite resin or ceramic over the exposed root. But this approach often results in a gingival-incisal length that does not blend esthetically with tire adjacent teeth. Often accompanying the gingival recession is a decrease in the band of attached gingiva. The wider the band of attached gingiva, the more stabIe the long-term result Therefore, surgical correction of the recession…

Achieving Predictable Connective Tissue Root Coverage
Gingival recession creates esthetic issues. These issues may be corrected from a restorative perspective by the placement of composite resin or ceramic over the exposed root. But this approach often results in a gingival-incisal length that does not blend esthetically with the adjacent teeth. Often accompanying the gingival recession is a decrease in the band of attached gingiva. The wider the band of attached gingiva, the more stable the long-term result. Therefore, surgical correction of the recession…

Current Trends in Gingival Recession Coverage
The recession of the gingiva is increasingly becoming a more prominent condition in the oral health of many patients and should be treated at its earliest detection. The multifactorial etiology, decision modality, and current trends followed in the treatment of gingival recession are discussed in this presentation. The correction of Class I and II gingival recessions are presented as a means of minimizing surgical trauma and achieving predictable aesthetic results. Part II of this discussion will present alternative techniques in treating gingival recession.

Current Trends in Gingival Recession Coverage 2
The recession of the gingiva is increasingly becoming a prominent condition in the oral health of many patients and should be treated at its earliest detection. Part I of this discussion reviewed the multifactorial etiology and decision modality; a treatment option was demonstrated for gingival recession using the tunneling technique. This concluding part of the discussion highlights two clinical cases using alternative approaches. The correction of Class I and II gingival recessions are presented as a means of minimizing surgical trauma and achieving predictable aesthetic results.

A Review of Dental Suturing for Optimal Soft-Tissue Management
Establishing nontension primary wound closure of various softtissue flaps is paramount for optimal postsurgical wound healing. Surgical procedures that require clinical flap manipulation such as those used with traditional periodontal therapy, periodontal plastic cosmetic surgery, hard- and soft-tissue regeneration, and the excision of pathologic tissue also require excellence in execution and thorough understanding of the various techniques of surgery, suturing, and the materials currently available to…

Aesthetic Crown Lengthening
The rationale for crown lengthening procedures has progressively become more aesthetic-driven due to the increasing popularity of smile enhancement therapy. Although the biologic requirements are similar to the functionally oriented exposure of sound tooth structure, aesthetic expectations require an increased emphasis on the appropriate diagnosis of the hard and soft tissue relationships, as well as the definitive restorative parameters to be achieved. The development of a clinically relevant aesthetic blueprint and attendant surgical guide is of paramount importance for the achievement of successful outcomes.

Soft Tissue Procedures Related to Dental Implant Surgery
Clinicians often encounter an insufficient amount of keratinized soft tissue in the proposed implant site. When this occurs, the question arises: Should the necessary softtissue manipulation be performed before, during, or after placement of the implant? There are three answers or scenarios for this question, according to Lee Silverstein, DDS, associate professor at the Medical College of Georgia in Augusta.

Using an Acellular Dermal Matrix for Increasing Keratinized Tissue Around Dental Implants
In previously published articles, investigators concluded that gingival recession may affect up to 90% of the population. Gingival recession ranges from one to three millimeters and is predominantly noted on the buccal surfaces of molar, premolar, and lower incisor teeth. Although surgical grafting techniques have traditionally been used to restore these recession sites, an acellular allograft material has recently been developed for increasing the zone of keratinized tissue surrounding teeth and…

Similarities Between an Acellular Dermal Allograft and a Palatal Graft for Tissue Augmentation
Predictable tissue regeneration presents a considerable challenge in the surgical treatment of gingival tissue defects. Soft-tissue augmentation procedures to increase the existing or create a new zone of attached keratinized gingival tissue have classically been performed using the patient's own masticatory mucosa and, more recently, using an acellular dermal allograft as the donor material. This article presents a clinical case whereby an acellular dermal allograft was placed on the buccal surface…

Similarities Between an Acellular Alloderm and a Palatal Graft for Tissue Augmentation
Predictable tissue regeneration presents a considerable challenge in the surgical treatment of gingival tissue defects. Soft-tissue augmentation procedures to increase the existing or create a new zone of attached keratinized gingival tissue have classically been performed using the patient's own masticatory mucosa and, more recently, using an acellular dermal allograft as the donor material. This article presents a clinical case whereby an acellular dermal allograft was placed on the buccal surface…

Fundamentally Changing Soft Tissue Grafting
Soft tissue augmentation procedures to increase the existing zone or create a new zone of keratinized tissue have been classically, and are routinely, performed using the patient's palate as the donor material. This article describes the simplistic use of a periodontal material that can be used for soft tissue augmentation procedures without using the patient's own palate to procure the donor tissue. This periodontal material is an acellular dermal allograft that has been used extensively in medicine.…

The Aesthetic Smile: Diagnosis and Treatment
Until recently, dentists' and the public's concept of dental aesthetics was necessarily limited to alterations of the teeth themselves. Dentists concerned themselves with changing the position, the shape and the color of the teeth -basically restoring missing units or enhancing those already present. For the most part the dentist was forced to accept the pre-existing relationship between the three components of the smile; the teeth, the gingival scaffold and the lips.

Developing Optimal Peri-Implant Papillae within the Esthetic Zone: Guided Soft Tissue Augmentation
Osseointegrated dental implants have enjoyed longterm success in the rehabilitation of totally edentulous patients. Every aspect of traditional treatment planning protocols continues to be re-evaluated and updated to better incorporate the benefits of osseointegration into clinical practice. This is particularly evident as dentistry has committed to fully integrating this approach into the more varied and demanding environment of the partially edentulous patient.

Use of the Subepithelial Connective Tissue Graft to Improve Esthetics
The subepithelial connective tissue graft is a gingival grafting plastic surgery procedure that can be used to enhance the aesthetic and gingival contour of the periodontium around dental implants. This technique is described and illustrated to create a soft-tissue root prominence and mask the grey color penetrating the thin labial attached gingival tissues over dental implants.

A Modified Surgical/Prosthetic Approach for Optimal Single Implant Supported Crown
Optimal implant placement can be achieved only if the ridge maintains its dimensions and the qllality of bone. To prevent the resorption of the ridge and to enhance the quality of regenerated bone, two main approaches have been suggested. Palt I of this article presents a modified regenerative technique - the "socket seal surgery"' (SSS). Part II will present a modified prosthetic technique - the "cervical contouring concept" (CCC) - and it will be published in the May, 1994, issue of PP&A. The…

Bone Regeneration and Tissue Acceptance of Human Fascia Lata Grafts Adjacent to Dental Implants
The biologic principle of guided tissue regeneration (GTR) has been studied extensively in hopes of regenerating alveolar bone. Various materials have been utilized as regenerative membranes; however, all materials have disadvantages, and the ideal membrane material is yet to be identified. In this case report, human freeze-dried fascia lata strips were used as a regenerative barrier membrane in conjunction with the placement of endosseous root implants and demineralized, freeze-dried bone allograft.…

The Endentulous Ridge in Fixed Prosthodontics
In those clinical situations in which missing teeth are replaced with fixed prosthodontics, the clinician is faced with the task of fabricating the pontics to fulfill the requirements of esthetics, form and function, and oral physiotherapy. The relationship of the "dummy tooth", or pontic to the underlying ridge is inordinately complex, since the esthetic requirements invariably conflict with those of function and hygiene. Although pontic designs have been discussed in some depth in the literature,…

Connective Tissue Graft Using Alloderm
Gingival recession is a clinical condition encountered in many dental practices during routine patient care. Fortunately, there are a variety of surgical procedures that the clinician can use to address gingival recession and return the patient to optimal health and aesthetics. As dental professionals gain a higher awareness of the available surgical materials and restorative techniques, the success and predictability of treatment for gingival recession on single and multiple adjacent teeth has…

Laser Assisted Gingival Tissue Procedures
Soft tissue lasers are increasing in popularity among clinicians in part due to their potential value in preprosthetic gingival procedures. The ability of soft tissue lasers to control moisture and facilitate hemostasis appears particularly promising for clinicians excising gingival tissues, performing esthetic crown lengthening, and using resective techniques for gingival troughing—and these applications will grow as practitioners become more familiar with such technologies. This presentation highlights…