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 | 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.