Papilla regeneration/ FM

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Posted on By Jason Witons In Soft Tissue Enhancement

This patient came in recently saying its time to fix his smile. From south america.

sorry for photo quality. CT scan has been taken.

My first thought was to have patient initiate orthodontic therapy after initial debridgement to force erupt #6-8.

Following forced eruption, implant/ implants could be done.

Perhaps #1,2 should be extracted or distalized for spacing in #3.

What Connective tissue sequencing is recommended and thoughts?

Thank you, merci,


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This is a case where Digital Smile Design and Computer generated plan would be of great assistance to you and the patient. Your plan may in fact involve ortho but also can be crown length opposite for balance and symmetry as well as artificial gingiva in defect area....lot's of options but need to have patient involved in decision process. For me, this is a full arch decision in maxilla....Dr. Salama


Hi! I would start with perio first. Your patient might suffering from breathing problem, check him for sleep apnea please. The treatment will depends what patient wants and finance. Ortho would be great after perio is stable. Gregory


Greg; What makes you think Breathing/Sleep Apnea issues here? Airway space typically requires a Lateral Ceph or CBCT? Thnx Dr. S


Good afternoon,

Hopefully it was a good conference.

Thank you for the thoughts on the case.

Sounds like there is a tongue thrust that is contributing.

I am going to start with acute infections and inflammation.

I hope to make the papilla the best it can on 7 which is think will be after ortho.

Will 6 and 8need to extracted



You are right! But if you look at his bite, it is Cl II Div1. His lower jaw is retruded, arch like S shape, his tongue size is larger than arch of the teeth which causing him to keep his tongue back, you can see clearly on the picture, his upper arch like V shape and anterior teeth proclined, it means when he asleep his pushing his tongue forward and stretch to keep airway open. Since the tongue stretches it pushing his anterior teeth forward. All of it usually give a sign of breathing problem. I hope it helps. Gregory


For may I will start with orthodontic extrusion of central and lateral to get soft tissue occlusally and get more bone height there ....
Then i will discuss with patient about treatment options. And if it will involve whole maxilla
It’s appear to be type 2defect between central &lateral so may I need bone augmented in this area and soft tissue graft then place implant in lateraled site and keep central as apontic


When I said type 2 I mean it will shifted from type 3to type 2defect by ortho extrusion


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