Help with Treatment Planning?
So I took the Soft Tissue Augmentation course with Dr. Maurice Salama a couple weekends ago (loved it BTW) and have gotten my Salvin microsurgery kit in, and I have a patient who is very interested in proceeding. He has teeth with recession in all 4 quadrants of varying degrees of severity, so I'm thinking of using a couple different techniques and would like feedback on my tentative treatment plans. Also, I want to make sure that I use the correct ADA codes.
Overall periodontal health is excellent, with PDs of 1-3mm on the facials of all teeth. Little to no inflammation, pt. is pretty obsessive about oral health.
BWX do show some posterior horizontal bone loss, and he's obviously a bruxer and does not current wear a nightguard. He's probably apneic but has not been diagnosed.
The patient is in excellent health, no meds, no allergies, he's good to go on that front.
RIGHT SIDE, BOTH ARCHES: Semi-lunar incisions and coronal repositioning.
Because he already has significant AG, 2-3mm of recession, and minimal cervical abfractions, I am thinking of doing some slight buccal contouring to reduce the abfractions further (a la Danny Melker and Biologic Shaping), then doing Semi-lunar incisions to pull that great AG over the recession without adding additional tissue. Why add more when he already has so much?
LEFT SIDE, BOTH ARCHES: Alloderm/tunneling technique
Again, first do some recontouring of the buccals to reduce the height of contour. Geristore in the #14 and #20 abfractions as they're closer to 1.5mm deep. Because the amount of AG present on #13 and on the mandibular teeth are noticeably less, I am thinking a tunneling technique with Alloderm (the patient would prefer to avoid a palatal donor site if possible)
Thoughts, critique of the plan and my rationale for each, alternate suggestions?
I believe the correct ADA code for the Alloderm is D4275, but I do not know what the ADA code for a semilunar flap and coronal repositioning is.
Lastly, any suggestions for insurance narratives?