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Gingival grafting/augmentation prior to Prosthodontic care
Posted on 08.24.2012 09:53 AM
By William Cohen
In Periodontics
This is a 30 year old female who had tooth #4 removed 10 years ago and has been wearing a unilateral temporary that has been ill-fitting and eroding the facial gingival tissue from the mesial buccal root #3. Also, #4 edentulous ridge is reduced and has esthetic concerns. There is not enough bone support or soft tissue for implant consideration. My suggestion is for a large Connective Tissue Graft #3-5 then a 3 unit bridge. If any of you have suggestions feel free to comment.
William Cohen DMD, MS
Periodontics & Implantology
St. Louis, Missouri
Clinical of #3-5
X-ray of 3-5
Direct buccal view #3-5
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6 Comments
omid moghaddas says on 08.24.2012 10:33 AM
Dear Dr Cohen
i think the idea for gingival augmentation is great,but there is a little space available for pontic and also i think putting that molar under crown may compromise the situation of molar.what about crowning tooth number 5 and build a small contact free cantilever instead of crowning tooth number 3.
tnx for sharing this challenging case.
William Cohen says on 08.24.2012 11:05 AM
Omid, thanks for the reply and great thought, but I feel #5 is compromised due the root canal and feel with augmentation of #3 we can certainly gain gingival height and a more favorable prognosis. Maybe placing a crown on #3 with a mesial cantilever.
William Cohen DMD, MS
Perio
omid moghaddas says on 08.24.2012 04:44 PM
thats a good alternative but i think maybe because tooth number 3 is intact,and also because of that recession and bone loss,it would be better not to compromise the situation with crown,tnx again Dr Cohen
anoosh afifi says on 08.24.2012 01:36 PM
MB root amputation due to furcal involvement followed by GT graft would make the prosthesis more predictable long term. It will also afford reshaping of the molar abutment mesio-distally creating space for a proper sized bicuspid esthetically. Good luck with the case.
Maurice Salama says on 08.24.2012 06:26 PM
Bill; I am going to throw something out for discussion.
Why not perform intentional endo on #3 and do a MB root amputation (see Daniel Melker's videos on this site).
Then bone and CTG followed by single crown on #3 and implant #4. Without the root which will limit the vertical extent of any bone graft i think you can get the Verticla you need for a decent result.
Just another thought from my days at U of Penn.
regards Maurice
Robert Burstein says on 08.28.2012 04:13 PM
What a great case! To me its about patient selection. A 30 yo woman is a different animal than a 70 yo man. If she has a revealing smile I doubt she will ever be happy with that molar. Root amps I have done with great success (meaning the patient died before the tooth was lost). Grafting this area seems like it will make the molar fail quicker. Part of me wants to just bite the bullit and exo the molar followed by a bone graft and perhaps a soft tissue graft and restore with implants. I think this will be the best for esthetics and long term function. Thanks for presenting such an interesting case. Good luck.