Creative Soft Tissue Augmentation of a Large Papilla defect.

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Posted on By Paul Kozy DDS In Soft Tissue Enhancement

A large esthetic area periodontal defect is partially filled with opposing pedicle flaps. Final outcome and review of the clinical techniques up for discussion. Paul Kozy

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17 Comments

Paul; This is an extremely thorough review of the treatment of one interproximal defect. Many thanks for the significant efforts to document, video, photo and edit this for all of the members of DentalXP. Outstanding.
Maurice


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Well done Paul! That's a lucky patient.


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Fabulous results for a very difficult esthetic situation!


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Excellent service to the patient Dr.Kozy. Since you shifted the palatal raphe and rugae off midline, would this have any effect on phonetics? Thanks.


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Thank you Bassam .
She has had no complaints about speech. But I have not asked either.
Paul.


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Well done. That is a tough one! Great idea to use the unique properties of the incisive papillae. To answer your question, prior to the palatal pedicle, I would have used CTG to get buccal root coverage and thicken buccal tissue. Perhaps even a buccal pedicle 11-10-9. Never the less, not sure a better result is possible. I'm sure you have a very happy patient. Great post!
Chuck


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Chuck
I think I could have been more aggressive with the facial flap dissection (Pat Allen technique) mobilizing more tissue into MGJ and adjacent pappillae all by tunneling. Also I could then have overfilled the defect expecting contraction.
PK


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Wow ,this is very impressive,,I have one question..What do you think about long term stabiltiy of this result. I just am wondering if new pappilla will survive without support from hard tissue..Thank you so much for sharing,,DS


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Dong,
Thank you. I will post 2+ year follow-up. I think it can survive because it may be different than typical papilla. More like a tuberosity with dense tissue.
PKDDS


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Thank you, Dr Kozy.


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Really nice treatment, Paul. The combination of surgery and restorative achieved the best result. However, I am afraid most dentists would have tried to solve the problem solely through restorative means which would have significantly changed the shape of the teeth to the detriment of the smile.


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Excellent case and great approach. Ricardo Gapski


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Wow Paul super result and thanks for sharing that with me. A question. The palatal flap is full thickness? na do you de-epithelialise the papilla on the palatal portion in order to tuck it underneath the buccal papilla? The whole treatment was a huge success. well done


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great job


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Not sure you could have done anything better but I would have used Tuberosity tissue over CTG and autologous over ACDM....Can you show a FINAL PA radiograph? GREAT case. Thanks Mo


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3D Scan.


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Recent photo of Palatal Area.
6+ yrs.
Note Stable Interproximal Tissue.

Recent Palatal View


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360 Imaging
3Shape