Esthetic Crown Lengthening

This is a post-orthodontic treatment case that required esthetic crown lengthening due to inappropriate gingival position and contours.  The appropriate steps prior to this procedure in cases where the teeth will not be restored, are the following:

1. evaluate radiographically and clinically the interproximal bone position
2. evaluate, with bone sounding, the position of the bone in relation to the CEJ of the teeth
3. evaluate the presence and extension of frenums in the area
4. evaluate the crown and root position in relation to the bony envelope
5. evaluate the root shape and color

All of the above are factors that can influence your results.

Always tell the patient in advance that a second small procedure (touch up) such as gingivectomy with either blade or laser, might be necessary in order to achieve an optimal result.

Best,
Ioannis

Protocol: Teeth in 24 hours with implants

This patient presented with a failed anterior bridge and huge aesthetic concern. We proceeded with extractions of the remaining teeth and immediate implant placement. A temporary titanium re-inforced acrylic prosthesis was placed within 24 hours. Utilizing the described protocol in the video, this type of treatment option can be very easy and predictable for the doctor and very satisfactory for the patient.

Best,

Ioannis

Dr.Vergoullis: Free Gingival Graft case

In this case we describe the indications of doing a Free Gingival Graft in order to cover a recession, increase the thickness of the tissue and create a zone of attached gingival in the lower central incisors.

It is very important to identify the cause of the problem:

1. Thin tissue biotype
2. Absence of attached gingiva
3. High Frenum insertion
4. Root position post orthodontic treatment
The free gingival graft in combination with plasty of the root during the procedure will eliminate the above causes and will offer a good and stable long term result.

Disadvantage of the technique:

1. Morbidity of the donor site ( use a stent and/or mouthwash NSAID)
2. No good color match of the graft with the adjacent tissue (even though is not really an aesthetic area but you have to inform the patient in advance)

Bottom-line:
Very predictable technique for this area of the mouth to treat muccogigival defects.

Best,
Ioannis

ERE with socket grafting

In this case we showed how important is to evaluate the edentulous space and to perform bone reconstruction of the whole area and not only of the extraction sockets. At the end, the quality of regenerated bone was very good, the initial stability of the implants was very high, therefore we decided to place only 2 and not 3 dental implants as original planned,  to be restored with a 3-unit bridge.
It is my belief that bone manipulation techniques like ERE can give more long-term stable results than regular GBR techniques. No evidence is available in the literature, however we could start a debate on this matter.

Best,
Ioannis