North Texas Dentistry Volume 9 Issue 4 2019 ISSUE 4 DE | Page 7

porate the new technology into his practice. “I have been excited about the videoscope for use in minimally invasive surgery since I first read about the impressive clinical improvements it deliv- ered in a study published by Dallas periodontist Dr. Stephen Harrel and colleagues in the International Journal of Periodon- tics and Restorative Dentistry (IJPRD, 2016),” he notes. “Dr. Harrel’s study showed not only an outstanding reduction in probing depths and increase in clinical attachment, but also a striking lack of gingival recession in the surgical sites. This maintenance of soft tissue height results in less postoperative root sensitivity and food impaction along with improved esthet- ics. This can be a game changer in the esthetic zone, particularly if exposure of restorative margins can be avoided.” Innovative Approaches for Soft Tissue Regeneration Gingival recession can cause root sensitivity and compromised esthetics, as well as undermine the stability of the dentition. Effective treatment for this dental pathology began with the Free Gingival Graft (FGG) technique, first described in the 1960s. FGG involves the harvesting of surface epithelial and connective tissue from the hard palate and grafting it to a pre- pared mucoperiosteal bed. This resulted in excellent gains in keratinized tissue, but was associated with minimal root cover- age and significant postoperative pain, especially in the area of tissue harvest from the palate. In addition, FGG produces sig- nificant thermal sensitivity and esthetic concerns. Dr. Stewart never recommends FGG, as he finds it to be an outdated and inferior procedure. Autogenous gingival grafting techniques have been improved over the years. Most notably, in 1985, Langer and Langer first described the Subepithelial Connective Tissue Graft, in which connective tissue is harvested from the palate after reflecting the surface epithelial layer. This graft, which can acquire blood supply from both surfaces, can be placed under the patient’s In addition to the described minimal gingival reflection with sharp instruments, the VMIS technique involves debridement of the bony defect and root surfaces with hand and ultrasonic instrumentation, application of EDTA (PrefGel ® ) to condition the root surface and enamel matrix protein (Emdogain ® ) to enhance osseous regeneration along with a grafting with freeze- dried bone allograft. The mini flap is closed with a single vertical mattress suture to gain primary closure. Dr. Stewart notes, “The videoscope allows me to visualize tooth roots and implants in a high-definition monitor with excellent clarity, magnification, and lighting. I am amazed that I can now find and remove small contaminants that were never visible before. I use the MicroSight on all regenerative osseous surgical procedures, even if the minimally invasive approach is not possible due to circumferential defects. I expect this to produce superior long- term results for my patients. In addition, I am thrilled with the lack of postoperative pain, swelling, bleeding and sensitivity with the minimally invasive approach.” Dr. Stewart addresses the patient’s concerns and expectations and provides a thorough explanation of the various treatment options. | NORTH TEXAS DENTISTRY 7