Aesthetic Considerations in Periodontal Therapy PDF

Aesthe&c considera&ons in periodontal therapy GDC Learning Outcomes 1.5.2 Obtain valid consent from the pa8ent before star8ng treatment, explaining all the relevant op8ons and possible costs 1.7.7 Refer to other members of the dental team or other health professionals 1.7.8 Recognise the need for...

Aesthe&c considera&ons in periodontal therapy GDC Learning Outcomes 1.5.2 Obtain valid consent from the pa8ent before star8ng treatment, explaining all the relevant op8ons and possible costs 1.7.7 Refer to other members of the dental team or other health professionals 1.7.8 Recognise the need for and make arrangements for appropriate follow-up care 1.10.5 Assess the results of treatment and provide appropriate aEercare and ongoing preven8ve advice 1.11.6 Recognise and appropriately manage the complica8ons associated with periodontal therapy 2 Learning Outcomes At the end of the session you will be able to:  Describe the common aesthe8c complica8ons of periodontal treatment  Explain the complica8ons of recession  Describe tunnel graEing  Explain black triangle disease and the possible treatments available 3 Aesthe&c considera&ons in periodontal treatment  Recession  Black triangles  “Gummy smile” 4  Occurs when there is apical migration of gingival margin Can be a result of periodontal disease, treatment, tooth brushing trauma, orthodontics (if tooth moves outside of buccal housing) More likely if thin gingival bio type present Recession  All types of periodontal treatment will poten8ally cause generalised recession which will be much more widespread than that determined by the local anatomy of the gingiva.  Partly dictated by the gingival biotype.  Mainly dictated by the extent of the underlying bone loss from the disease process.  Surgical periodontal treatment will usually Image credit Beach Denture Clinic cause most recession.  Include in consent 5 Complica&ons of recession  Sensi8vity  Caries  Appearance, especially in the “aesthe8c zone” Image credit Dr Ian Dunn 6 Appearance Connective tissue graft- usually comes from palate. Localised recession  Gingival graEing can give good results – aesthe8cally - sensi8vity  Manipula8on of the pa8ent’s 8ssues to augment the gingivae and cover the exposed root. Image credits www.periomaine.com 7  tunnel grafting Generalised recession Image credits Dr Ian Dunn 8  Clean exposed root surfaces Doxycycline treatment used to further detoxify the root surface Non incisional technique Tunnel under gum tissue to create space for graft Interdental papilla always remains attached Usually patient own tissue (palate) or donor tissue Tunnel Gra=ing Secured by single suture Image credits www.periodontalimplantok.com 9 Image credits Dr Ian Dunn 10 Black Triangle Disease  Common aEer periodontal therapy  Needs to be covered in pre treatment consent  Recession in the interdental area  May be treatable restora8vely  Not amenable to regenera8ve surgery  A gingival veneer can give excellent cosme8c results 11 Black triangles – composite closure Image credits Dr Ian Dunn 12 Gingival Veneer  Can be made of acrylic or silicone  Needs a special impression  Worn buccally  Lock into the ID spaces for reten8on  Needs an experienced lab 13 Gingival Veneer Image credit Dr Ian Dunn 14 Gingival Veneer Image credit Dr Paul Stevenson 15 Gingival Veneer with Implants Image credits Dr Paul Baker, PerioLondon 16 Combina&on case – uneven smile Image credits Dr Ian Dunn 17  Gingivectomy - gives patient a new gingival margin Bone removal may also be required to gain results Changes shape of tooth Aesthetic procedure Patients may been crown lengthening for crown placement - aesthetics or restorative needs May also be used for sub gingival caries Gummy Smile – crown lengthening Image credits Dr Ian Dunn 18 Addi&onal Resources  (73) EFP Perio Sessions 1 - Anton Sculean's webinar on treatment of gingival recessions – YouTube  (73) Tunnel Technique – YouTube  www.bsperio.org members area case studies  On Moodle Dr Paul Baker video of a tunnel graE case he has kindly shared for you.  Oral status and aesthe8cs aEer nonsurgical periodontaltreatment Do pa8ent's percep8on and den8st's evalua8onagree.pdf on Moodle  prosthe8c-management-of-pink-aesthe8cs.pdf on Moodle 19 Thank you. 20