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never recommends FGG, as he finds it to be an outdated and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.
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