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Recession : 2 x CT grafting - Courtesy ROOTS

From: "Tommie Van de Velde"
To: "ankylos@rxdentistry.com"
Sent: Thursday, June 03, 2010 7:51 AM
Subject: recession

What would you do? Patient referred with obvious complaints, surgeon tried 2 x CT grafting without success.
Treated the case today, show the pics after some comments.

Tommie Van de Velde

Hi All, I have attached an image of the recession area in question. The basic rule of thumb is that you cannot get gingiva higher than the tangent to the transitional line angles of the adjacent teeth. As you can see from the image and the white line I have drawn, the buccal gingival of the implant is already at the tangent of the transitional line angles. Thus no graft, nor occlusally positioned sliding flap will add more gingiva than is present. There is nothing to do except use pink porcelain expertly done. The other alternative would be to extrude the canine and central to bring the entire gingival complex more occlusally. This will work everywhere around the teeth except on the implant. Once the transitional line angles have changed, then a graft is possible, but may not do the trick. You are left with doing piezo surgery and moving the implant en block occlusally (very tough) or putting the implant to sleep and doing a 3 unit bridge. Since once the canine and central have been moved they will require a crown anyway, this is not too far fetched. Of course the patient management of having to deal with an implant placed that cannot be used is a large problem, the recession on the central and the canine are not a result of the implant ( I hope) and would have to be addressed anyway. - Sheldon Lerner

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