Esthetic soft tissue ridge augmentation using an acellular dermal connective tissue allograft

Residual ridge defects present significant limitations to the esthetic restoration of edentulous tooth sites. Augmentation techniques can aid in the re-establishment of natural ridge contours. This article describes a technique in which an acellular dermal connective tissue allograft is used to augment a buccolingual residual ridge defect. A single vertical incision enables the allograft to be placed laterally into a buccal pouch. Augmentation of this edentulous site permitted a three-unit bridge to be placed with a highly esthetic pontic.

CLINICAL SIGNIFICANCE

This article presents a simplified method of esthetic ridge augmentation that reduces patient discomfort.

Use of Double Layer of Acellular Dermal Matrix and Modified Tunnel Technique to Treat Multiple Adjacent Gingival Recession Defects

The goal of connective tissue grafting is to cover exposed root surfaces with gingival tissues that are stable and have a natural appearance. The use of an acellular dermal matrix (ADM) has been shown to be a successful alternative to the palatal connective tissue graft. Use of a double layer of an ADM has been shown to have stable results for 1 year. Tunnel grafting techniques can yield root coverage with a natural appearing soft-tissue architecture. The purpose of this case report is to demonstrate the use of a modified tunnel technique and a double layer of ADM in the treatment of multiple adjacent gingival recession defects. Treated teeth were found to have root coverage and natural soft-tissue contours that were stable at 20 months.

Minimizing shrinkage of interdental papilla height when treating multiple Miller Class III gingival recession defects

Miller Class III and IV gingival recession defects have interdental bone and soft-tissue loss that limit root coverage. Given the importance of the interdental papilla, protecting the integrity of this structure would seem prudent. Tunnel techniques have been successfully used to protect the interdental papilla. This article discusses the results of two cases in which multiple Miller Class III gingival recession defects were treated using tunnel-grafting techniques and an acellular dermal matrix. In both cases, root coverage was achieved while protecting the interdental papilla height.

The aesthetic replacement of mandibular incisors using an implant-supported fixed partial denture with gingival-colored ceramics

Restoration of the anterior dentition using dental implants can be technically demanding. Loss of the supporting hard and soft tissue structures diminishes the clinician's ability to obtain optimal results. The use of gingival-colored ceramics offers on effective method of developing aesthetics when reconstructive surgery is not an option. This article describes the use of gingival-colored porcelain in creating a natural-looking, implant-supported fixed partial denture to replace compromised mandibular incisors.

Preservation of Natural Gingival Pigmentation When Treating Multiple Gingival Recession Defects

Proper surgical techniques can permit treatment of multiple gingival recession defects without altering the visible gingival pigmentation. In this case report, a patient presented with multiple adjacent sites displaying gingival recession. Natural pigmentation was present in the interdental papillae and in the zone of keratinized gingiva. This patient wanted his natural pigmentation to be preserved. A modified tunnel technique was used to avoid traumatizing the pigmented tissues and allow placement of a large graft. A double layer of an acellular dermal matrix (ADM) was implanted and the gingival complex was relocated coronally. Root coverage and preservation of the natural gingival pigmentation were achieved. The use of the modified tunnel technique with a double layer of ADM can preserve natural gingival pigmentation when treating adjacent gingival recession defects.

Implant Abutment and Restoration Design and Risk Factors for Peri-Implant Disease

With dental implants continuing to gain in popularity and their usage steadily rising, clinicians must be wary of peri-implant disease in patients with implants. Poorly constructed and inadequately delivered implant restorations can lead to peri-implant bone loss and disease. Implant abutment design plays an important role in minimizing the risk of the development of peri-implant disease. Abutment design elements that may affect the risk for developing peri-implantitis include topography, materials, height, implant-abutment connection, and emergence profile. This article discusses these implant abutment design elements for bone-level implants and the risks they may present for the development of peri-implant disease.

Modified Tunnel Technique and Double-Layer Acellular Dermal Matrix to Treat Multiple Teeth and Implant: 3.5-Year Results

Recession defects can affect both tooth and implant sites. The objective of connective tissue grafting is to correct recession defects and develop a soft-tissue architecture that is both stable and natural in appearance. By protecting the integrity of the interdental papillae, tunnel techniques are intended to maximize esthetic results. The use of an acellular dermal matrix (ADM) allows treatment of multiple adjacent recession defects without the need for a palatal donor site. The dental literature is scarce on the use of ADMs to treat recession affecting implant sites. The purpose of this article is to discuss and demonstrate the use of a modified tunnel technique and a double layer of an ADM in the treatment of recession defects affecting multiple teeth and an implant.

Lateral Access Pouch Technique to Treat Implants With Gingival Recession

Connective tissue grafting is a means of developing stable and natural-looking soft-tissue architecture. The use of a subepithelial connective tissue graft (SCTG) has been successful in achieving root coverage and augmenting tissue thickness. Tunnel techniques enable root coverage with results that appear natural. These techniques can be applied to the treatment of dental implants with gingival recession. The purpose of this article is to demonstrate the use of a SCTG and a lateral access pouch in the treatment of multiple gingival recession defects affecting adjacent implants.

Double-layer technique using an ADM and CAF to treat a mandibular incisor with a Cairo RT2 defect: 8.5 year results

INTRODUCTION

The purpose of this case report is to document the 8.5 years result of treatment of a mandibular incisor having a buccal Cairo Recession Type 2 (RT2) gingival recession defect (GRD) using a double-layer technique using an acellular dermal matrix (ADM) with a coronally advanced flap (CAF). To the author's knowledge, no long-term results of this treatment modality in the mandibular incisor area have been reported.

CASE PRESENTATION

A 65-year-old non-smoking female presented with an RT2 GRD on the buccal aspect of tooth #25 (International Standards Organization, ISO #41). Her overall periodontal status was healthy. This GRD was treated using a double-layer of an ADM with a CAF. Tension-free flap advancement was permitted by eliminating a frenum pull. Improved root coverage and stable gingival margins were found after 8.5 years.

CONCLUSION

This report provides evidence to support the use of a double-layer technique using an ADM with a CAF to treat a mandibular incisor with an RT2 GRD.

Treatment of gingival recession with a modified "tunnel" technique and an acellular dermal connective tissue allograft

The treatment of gingival recession through the creation of a "tunnel" beneath the buccal mucosa allows coronal repositioning the soft tissue with predictable root coverage and aesthetics. Vertical incisions on either side of this tunnel preparation enable placement of a connective tissue graft within the tunnel. The use of an acellular dermal connective tissue allograft permits grafting of multiple sites without the need for a donor tissue surgical site or additional visits. This article demonstrates a modified tunnel technique and a case presentation that incorporates this procedure.

Full-mouth rehabilitation using a multidisciplinary approach: material and periodontal considerations

The complete aesthetic rehabilitation of dentition can be a complicated task. A multidisciplinary approach is often necessary to achieve ideal results. Clinical crown lengthening surgery can develop an aesthetic soft tissue profile and sufficient tooth structure for preparation and restoration. In addition, the development of novel all-ceramic zirconia materials has resulted in the delivery of improved aesthetics, function, and longevity. This article discusses the use of zirconia crowns in multidisciplinary full-mouth rehabilitation and provides recommendations to enhance the performance of these restorations.

Use of the tunnel technique and an acellular dermal matrix in the treatment of multiple adjacent teeth with gingival recession in the esthetic zone

The proper management of gingival recession is critical to the establishment of a natural-appearing soft tissue architecture. Subepithelial connective tissue grafts have been considered the "gold standard" but are limited by the availability of palatal donor tissue. Tunnel techniques have improved the esthetic results of connective tissue grafting. Acellular dermal matrices have been successful in the treatment of gingival recession and are not limited by the palatal anatomy. The aim of this report is to describe the application of the tunnel technique, with use of an acellular dermal matrix, in the correction of gingival recession affecting multiple adjacent teeth in the esthetic zone.

Esthetic correction of gingival recession using a modified tunnel technique and an acellular dermal connective tissue allograft

Esthetic correction of gingival recession is an important goal of periodontal therapy. This article describes a surgical technique that combines a modified tunnel technique and an acellular dermal connective tissue allograft. With the aid of vertical incisions, a tunnel is created under the buccal mucosa of the affected tooth. These incisions enable easy access for graft placement and create mobility for gingival coronal positioning. The use of an acellular dermal connective tissue allograft eliminates the need for a surgical palatal donor site. This minimizes postsurgical complications.

CLINICAL SIGNIFICANCE

The combination of a modified tunnel technique and an acellular dermal connective tissue allograft permits esthetic root coverage in a manner that reduces postsurgical complications.

Development of natural soft tissue architecture and interdental papillae between adjacent implants in the aesthetic zone

A classification of predicted vertical height of the interdental papillae has been developed based on whether a papilla has a tooth, a pontic, or an implant on either side of it. Based on this classification, it may be prudent to avoid the placement of adjacent implants in multiple-unit restorations. To further enhance the aesthetics of multiple-unit restorations, endodontically retained roots may be submerged between implant sites. Some patients, however, require adjacent implants due to limited bone support. Others request them for personal reasons. In these cases, additional efforts must be made to create naturally appearing soft tissue architecture with full and symmetrical papillae.