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The Perio Perspective

THE PERIO PERSPECTIVE Winter 2019 The Basics We don’t save many lives. This is a blessing, since it also means that we don’t have to live with the possibility of patients dying under our care. But nothing is more gratifying than knowing that someone is alive today because of you. In previous newsletters we have …

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Molar Furcation Root Coverage Using a Connective Tissue Gum Graft

Covering the roots of a molar is very difficult when the notch between them (furcation) is exposed. But in this case, we were able to restore the lost gum tissue, completely cover the roots, and protect the furcation with a minimally invasive connective tissue graft.

Correction of Recession and Exposed Roots With Tunneling Connective Tissue Gum Grafting

Suppose that the patient shown in the first photo presents with a chief complaint “I don’t like how long my teeth are getting and their dark staining.” What treatment would you recommend?  In our opinion, there is a best approach: subepithelial connective tissue grafting (SECTG). This is the only approach that can restore the teeth …

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Bilateral Tunneling Gingival Grafts

Our patient had no attached gum tissue and recession threatening both of her lower first molars. Our microsurgical tunneling graft technique is so much less invasive than previous approaches that most patients return for another procedure without hesitation. 

Root Coverage via Tunneling Connective Tissue Grafting

Our patient had substantial recession along with staining and early decay of the roots of all his upper anterior teeth. We removed the staining and decay and covered the roots with a connective tissue graft using the tunneling technique. He plans to brighten and perfect his smile with veneers for the New Year. Happy 2019 …

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Pocket Depth and Surgical Indications

The Perio Perspective The Magic Number No one wants surgery. Since our patients, like us, naturally resist surgery, it is important to know when it makes sense, and what the risks are if it is not done. An accumulating body of clinical research offers guidance when we discuss periodontal surgery with our patients. Obviously, the …

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Root Coverage of a Canine Despite Lack of Papilla

Achieving 100% coverage of a root is difficult when the gum tissue (papilla) between teeth is missing, leaving a black triangle. Using a tunneling connective tissue graft maximizes the odds. In this case we achieved an ideal result around the canine tooth despite the lack of tissue between it and its neighboring lateral incisor. Happy …

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The Burden Of Care

The Perio Perspective Summer 2018 The Burden of Care       One of the concepts that seem underappreciated by doctors is the burden of care. Some treatment modalities require more time, pain, expense, risk, and long-term care than others. When we discuss treatment options with our patients, the burden of care is an important factor …

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Root Coverage With a Lateral Pedicle Flap and Connective Tissue Graft

In this case we “borrowed” some gum tissue from the area next to the exposed root of the lateral incisor. By sliding it laterally we could cover the connective tissue graft that we placed over the root to achieve a natural-looking, stable result.

Smile Makeover With Tunneling Connective Tissue Grafting

Our young patient was unhappy about looking prematurely “long in the tooth” and had sensitivity of the exposed root of her left central incisor. We performed a tunneling connective tissue graft to cover the exposed roots and recreate a youthful smile. We also smoothed the edges of her incisors. She was thrilled with her appearance …

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Root Coverage over the Mesiobuccal Root of a Maxillary First Molar

The mesial (forward) half of upper six-year molars often bulges outward. This makes it especially prone to recession due to toothbrushing and chewing. Using a tunneling connective tissue graft, we can reverse the recession and fortify the tissue to prevent further recession. 

Long-term Follow-up of Root Coverage Grafting

There are several techniques available for gingival grafting to cover exposed roots and to prevent future recession. Of these, the subepithelial connective tissue graft has abundant research showing its superiority to other approaches for root coverage and long-term stability. This is why we use it for the great majority of cases, despite its technically demanding …

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Internal Frenectomy and Tunneling Connective Tissue Graft For Complete Root Coverage

A common cause of gingival recession is a muscle (frenum) attachment too close to the edge of the tissue. We repositioned this stringlike attachment for our patient along with placing a tunneling connective tissue graft. The result was complete coverage of her root and prevention of future recession due to the pull of the frenum.

Restoring Lost Gingiva and Cementum With a Gingival Connective Tissue Graft

Our patient brushed away her attached gum tissue and the surfaces of her molar and bicuspid roots. Following tunneling connective tissue grafting we restored her lost tissue and covered her roots. If she can control her toothbrushing with a pressure-sensing electric toothbrush, this area should be healthy and stable for life. 

Connective Tissue Gingival Graft to Cover a Molar Furcation

This patient waited too long to have his gum graft. Once the furcation (notch) between a molar’s two roots becomes exposed, our ability to cover it with a graft is markedly reduced. Fortunately, using a microsurgical tunnel, we were able to beat the odds and achieve an ideal result.