CONTEMPORARY ESTHETIC PERIODONTICS
Figure 1 . 29 year-old white , male patient presents with fractured , hopelessly involved tooth # 21 ( Mucogingival defects of recession and inadequate keratinized gingiva are also present )
Figure 2 . Periapical film showing failing tooth # 21
Figure 3 . Tooth was extracted and ridge augmented with freeze-dried bone allograft and membrane ; 4 months healing . Note keratinized gingiva was still lacking in buccal aspect of # 21 site
the denuded tooth surface . In the apical region of the flap , histological slides have shown repair by connective tissue attachment of the flap to the tooth surface 5 . The approximation of the flap to the tooth is the prerequisite for proper wound healing . In tandem with the patient ’ s compliance , the holding quality of the sutures determined by the skill level of the surgeon will prevent wound healing failure . The down growth of epithelium at the interface along the root surface is a barrier to connective tissue attachment . If a space is allowed between the flap and the tooth during the healing phase the epithelium will occupy that space first . Epithelium proliferates more rapidly than connective or osseous tissue . When the flap is allowed to remain tightly adapted by an undisrupted fibrin clot and adequate sutures during the ten days of initial healing , contact inhibition will stop the epithelium on the outside
Figure 4 . Autogenous free gingival graft completed at # 21 ridge prior to implant placement to augment keratinized gingiva
of the flap from progressing and lining the inside of the flap that is facing the root surface 5 . Healing by regeneration requires new formation of cementum , bone , periodontal ligament and gingiva with a short epithelial attachment to the tooth . This healing does not occur spontaneously or by resective procedures . Usually biomaterials and modifiers are added to the surgical site to induce or promote regeneration of lost tissues by new technologies . Guided tissue regeneration techniques and soft tissue coverage procedures are used today around teeth and implants . Soft tissue healing surrounding implants differs from periodontal healing around a tooth . The peri-implant mucosa is isolated from the implant surface by the long junctional epithelium coronally . The supracrestal connective tissue fibers are dense and oriented parallel to the long axis of the implant above the crest of the bone , since insertion of
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