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)