CONTEMPORARY ESTHETIC PERIODONTICS
Figure 5 . Keratinized graft was allowed to heal 3 months ( now 7 months since extraction and bone graft )
Figure 6 . # 21 Implant placed with healing abutment in one-stage procedure and allowed to heal 4 months
Figure 7 . Final torque test and tissue evaluation performed at 4 months
Figure 8 . Final restoration clinical photo ; note adequate hard and soft tissue contours present on implant site as well as opposing dentition site , which also had a clinical recession presenting . # 24 was treated with a free gingival graft as well
Sharpey fibers into the implant is not possible . Soft tissue procedures are limited in implant dentistry and guided bone regeneration is favored 6 . 2.1 . Soft tissue coverage of dental recessions and implant soft tissue regeneration Armitage 7 defined gingival recession by the apical position of the free gingival margin to the cementoenamel-junction ( CEJ ) of the tooth or teeth . The indications for periodontal root coverage procedures include : tooth sensitivity , progression of recession , poor oral hygiene maintenance and patient dissatisfaction with appearance 8 . The objective of the corrective surgical procedure is to achieve a color match with the adjacent tissues and symmetrical margins while thickening the tissue to avoid relapse in the absence of inflammation with clinical presentation of probing depth . Gingiva is a specialized and keratinized mucosa . It consists of the free marginal gingiva around the tooth and the attached gingiva , extending from the free gingival margin to the muco-gingival junction . Not all keratinized gingiva is attached , as the free margin and any gingival and periodontal pocketing is unattached by definition . Coincidently , non-keratinized gingiva may be attached , as keratinization is lost at the onset of inflammation , while pocketing has not yet occurred and the gingiva is attached to the tooth . From this biology stems the notion that the lack of keratinized gingiva is compatible with periodontal health , while still attached , in the absence of inflammation 26 . In the presence of inflammation when patients have difficulty to keep the sites clean or when sensitivity and progressive attachment loss prevail at the recession site , surgical intervention is indicated . Pedicle and coronally positioned flap , with the base of the flap attached and the coronal part of the flap covering the denuded root surface , with and without autogenous connective tissue graft have demonstrated healing by repair with
214 STOMA . EDUJ ( 2016 ) 3 ( 2 )