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Interdental osteotomy presents a small risk for the tooth adjacent to the line of the osteotomy. Five out of 41 teeth adjacent to the site of an osteotomy showed loosening degree 1. The PM index rose from 1.0 to 1.4. The depth of the periodontal pockets did not change. The roots of two out of 41 teeth were damaged during osteotomy, but not devitalized.
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This article presents the rationale for the use of a preprosthetic surgical crown-lengthening procedure, particularly in the anterior region where esthetics is of great concern. Clinical cases illustrate the procedure and demonstrate how it can be used to provide enough sound tooth structure to restore teeth without impingement on the biologic width, at the same time reducing a "gingival smile" and creating new papillae.
Modern esthetic dentistry involves not only the restoration of lost teeth and their associated hard tissues, but increasingly the management and reconstruction of the encasing gingiva with adequate surgical techniques. The loss of interproximal dental papillae may cause functional, phonetic, and devastating esthetic problems. Complete and predictable restoration of lost interdental papillae remains one of the biggest challenges in periodontal reconstructive surgery. On reviewing the literature, publications involving surgical and nonsurgical techniques for papilla reconstruction are basically case presentations. Very little scientific data concerning long-term success and predictability of specific techniques has been published so far. Starting with facts about the anatomy and morphology of the interdental tissues, this article gives an overview of surgical and nonsurgical techniques to restore lost interproximal dental papillae.
During embryogenesis the clefting event unleashes a series of processes that act in concert to deform the soft tissue envelope into a "dysfunctional matrix" within which bone and cartilage subsequently form. Much of secondary cleft deformity results from failure to solve this pathologic soft tissue-bone equation at the primary repair. The sliding sulcus procedure uses the subperiosteal plane to create a centralization of the soft tissue matrix, alleviate tension, and redistribute the forces of growth in a more normal pattern. By incising at the level of the alveolus, this approach preserves the blood supply to the osteogenic cells of the buccolabial periosteum. This approach has interesting theoretical implications for the preservation of alveolar growth potential. Arch stabilization and elimination of fistula may be of long-term benefit to the orthodontist.
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The stabilization of inflammatory periodontal diseases (gingivitis and periodontitis) and result periodontal maintenance is achieved most effectively by first establishing health within the dento-gingival complex (connective tissue, junctional epithelium, and sulcus). Two forms of surgical periodontal therapy commonly employed to reach this endpoint are resective in nature:, the gingivectomy/gingivoplasty technique for soft tissue resection and the ostectomy (osteoectomy)/ osteoplasty approach for hard tissue resection. These two forms of therapy are presented here from a historical perspective through to today's accepted methodology. The are agumented by literature references and presentations of clinical cases.
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