CONTEMPORARY ESTHETIC PERIODONTICS
Table 1. The clinical parameters associated with teeth # 16 & # 14
Clinical Parameters Baseline 5 months
# 16 # 14 # 16 # 16
Buccal PD( mm) 3,2,3 2,3,3 2,1,2 2,2,3
KT width( mm) 1 0 4 1-4
Vitality- +- + Mobility----
A
B
Figures 11a and 11b. An Intraoral periapical and bitewing radiograph of the maxillary right posterior region
completed treatment included: Extraction of tooth # 21( Fig. 3) with concurrent ridge augmentation using a freeze dried bone allograft and nonabsorbable membrane( removed at 1 month). The site was allowed to heal while the patient was provisionalized with an essix retainer for 4 months. A keratinized autogenous free gingival graft was performed to augment the buccal gingiva of the # 21 site lacking sufficient keratinized tissue( Fig. 4). After 3 months of healing( Fig. 5) a dental implant was placed( 4.3x11.5 Nobel Replace Select Tapered Groovy RP) with healing abutment via use of a surgical prosthetic guide( Fig. 6). The implant was allowed to heal for 4 months before restoration( Fig. 7). A new radiograph and torque test were performed at 4 months and the implant was restored with a cement-retained crown( Figs. 8-9).
3.2. Case 2 Background A 77-year-old female non-smoker with controlled hypertension presented to the Post Graduate Periodontology Clinic, Nova Southeastern
University, Fort Lauderdale, Florida, in February 2016 with a chief complaint of“ sensitive gums and discomfort when brushing” associated with an FPD in the maxillary right posterior region(# 16- X-14). Intraoral examination revealed good oral hygiene, thin gingival biotype with generalized lack of keratinized gingiva, and generalized mild to moderate gingival recession. In the maxillary right posterior, there was decreased vestibular depth and lack of keratinized gingiva associated with an FPD with teeth # 16 & # 14 as abutments and tooth # 15 as a pontic( Fig. 10). The FPD( fixed partial denture) was fabricated by her previous dentist 2 years ago and she recently had RCT( root canal treatment) on tooth # 16 before presenting to the Periodontics Department. The clinical parameters associated with teeth # 16 & # 14 are described in Table 1. An intraoral periapical and bitewing radiograph of the region are shown in Fig. 11. The patient was informed of the bulky overhanging margins of the FPD, however, refused to proceed with any prosthetic treatment at this time. It was decided to use a Free Gingival Graft harvested from the
216 STOMA. EDUJ( 2016) 3( 2)