North Texas Dentistry Volume 9 Issue 4 2019 ISSUE 4 DE | Page 8

MicroSight view of mesial
of first premolar showing
subgingival calculus
After scaling/root planing
and debridement of the 2-3
wall periodontal defect
Emdogain applied
following root conditioning
with EDTA
Placement of freeze-dried
bone allograft
Primary closure using
vertical mattress suture
8 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
existing tissue prepared with a flap or tunnel. The graft can then
be coronally positioned with sutures to gain root coverage.
Postoperative pain and bleeding are reduced due to the smaller
wound on the palate. Esthetics are also greatly improved due
to the ability to cover the root and achieve a superior color and
texture blend with the adjacent tissue. Dr. Stewart notes, “The
connective tissue graft is still considered by many to be the gold
standard in soft tissue regeneration. I continue to perform it,
especially when a small area needs to be grafted or when the
patient prefers to use their own tissue.”
In the 1990s, a similar technique using Acellular Dermal Matrix
(ADM) derived from donated human skin (AlloDerm ™ , Perio-
derm ® and others) as the donor tissue was developed. Because
ADM is supplied in various sizes, an unlimited number of teeth
can be grafted in one appointment. There is no palatal wound
and postoperative pain and bleeding is further reduced. “This
technique can also produce excellent results and has obvious
postoperative benefits for the patient,” Dr. Stewart notes. “It is
very technique-sensitive, because any ADM that becomes
exposed will not survive.”
A Minimally Invasive Option for
Gingival Recession
Dr. Stewart has incorporated a new option for the treatment of
gingival recession: Pinhole Gum Rejuvenation ® using the Chao
Pinhole ® Surgical Technique (PST). He became a Pinhole Sur-
gical Technique Certified Clinician in 2017. This patented pro-
cedure was developed by Dr. John Chao, who published a
clinical study (IJPRD, 2012) showing excellent results in root
coverage and tissue stability. Like ADM grafting, PST does not
require the use of autogenous graft material and is incision-free
and usually suture-free. Patients generally report very little dis-
Dr. Stewart is able to visualize
fine detail on the MicroSight’s
high definition monitor.