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The Examiner

Online Edition
January, 2010
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Case Study
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Wade A. Diab, DDS, MS
3900 Frey Road, # 102
Kennesaw, GA 30144
I hope you had great holidays and are charged up for the new year.  I would like to present you with the third edition of the Examiner Online. Knowing what your periodontist can offer your practice could greatly help you in making treatment decisions that would give your patients the comfortable, functional and esthetic dentition they always deserve. I hope you find this publication helpful and please do not hesitate to contact me with any question.  Your input is greatly appreciated.
Thank you,
Wade A. Diab, DDS, MS

Reclaiming a Hopeless Smile with Gingival Grafting

Gingival recession is a common problem with a prevalence of 58% in individuals between the ages of 30-90 years old(1). Gingival recession also increases with age (2). One of the common complications of gingival recession is unsightly exposed root surfaces in addition to root sensitivity and root abrasion.  The esthetic problems associated with gingival recession are compounded when the recession is on the maxillary anterior teeth.
Case Study
A 58 year old  female patient was referred to my office for the treatment of severe gingival recession.  Her primary concern was the unaesthetic appearance of her upper teeth when she smiles. The patient suffered from gingival recession for many years and she admitted to aggressive brushing.  
The initial evaluation revealed gingival recession ranging from 5 - 8 mm on teeth # 4 - 12.  Some of the exposed roots were treated with large composite restorations adding additional complexity to the  esthetic challenge of this patient. 
Treatment Plan:  The treatment was divided into three phases:
Phase I- Surgical Phase:  Connective Tissue Grafts on teeth # 4 - 12
Phase II- Restorative Phase: Provisional restorations and bleaching of the mandibular teeth. 
Phase III- Restorative Phase: Final restorations
Phase I- Surgical Treatment:  The goal of the surgical treatment was to provide the patient with functional and esthetic periodontium which was achieved by performing a connective tissue graft procedure on teeth # 4-12.  Palatal tissues were used for the grafting.  The bonded restorations were removed at the time of surgery after flap reflection.  All root surfaces had to be free of composite residues in order to achieve epithelial and possibly connective tissue attachment of the newly grafted tissues.  Flat root surfaces were also achieved after the removal of the restorations.
Phase II- Restorative Treatment:  After six weeks of healing the teeth were prepared and provisionalized by the restorative dentist.  The patient was also allowed to bleach her mandibular teeth.  Surgical recontouring of some of the grafted areas was performed during this phase in order to achieve maximum esthetic outcome from the initial periodontal surgery.
Phase III- Restorative Treatment:  The final restorations were placed after twelve weeks of healing.
Treatment Phtographs


Above and below: Initial Presentation. Advanced gingival recession is noted on teeth # 4-12 with large bonded composite restorations.




 Above:  Six weeks after the connective tissue graft procedure. 
Note the significant root coverage and the thickness of the gingival tissues.


     Above: Twelve weeks post-operative.
Provisional restorations were placed and gingival re-contouring was completed.


  Above and below: Final restorations after eighteen weeks of healing. 


1.  Kemppainen P, Eskola S. Ylipaavalniemi A: Comparative prospective clinical study of two single tooth implants: a preliminary report of 102 implants, J Prosthet Dent 77:382-387, 1997.
2.  Groisman M, Frossard WM, Ferreira H et al: Single tooth implants in the maxillary incisor region with immediate provisionalization: 2 year prospective study, Pract Proced Aesth Dent 15:115-112, 2003.
Restorative work performed by Dr. Dennis L. Radcliffe from Towne Lake Family Dentistry.
© 2009. Wade A. Diab, DDS, MS
Wade A. Diab, DDS, MS
Diplomate, The American Board of Periodontology 
Implants & Periodontal Artistry
3900 Frey Road, Suite 102
Kennesaw, GA 30144
P 770-426-1062
F 770-426-6789