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Use of mucogingival surgical procedures to enhance esthetics.

The procedures outlined herein deal primarily with improving esthetics. The importance of esthetics in periodontics is most apparent in patients with a high lip line. Current mucogingival procedures provide the surgeon with the capability to have a major role in the total treatment of complex restorative cases. Periodontal considerations must be included as an integral part of esthetic dentistry. A complete examination of the patient must include a thorough periodontal evaluation. In addition to the usual detection of periodontal pockets and inflammation indicative of periodontal disease, the examination should include a thorough mucogingival evaluation for detection of the following: (1) inadequate keratinized gingiva; (2) gingival recession; (3) excessive gingival display; (4) insufficient clinical crown length; (5) asymmetric gingival margins; (6) flat marginal contour; (7) improper gingival margin relationships; (8) lack of harmony of gingival margins with the lip line; and (9) alveolar ridge deficiencies. Mucogingival surgical procedures should be performed after control of all etiologic factors and in concert with the restorative therapy so that the surgery can produce the most desirable esthetic result. It must be understood that the location and contour of the gingival margin and its relationship to adjacent margins are as important to the final esthetic result as the location, form, and relationship of the incisal margins of the anterior teeth. Attention to the total dental display as framed by the smile, with appropriate mucogingival analysis and treatment, is necessary to achieve the most satisfying esthetic results.

Alveoloplasty↗

A modified flap design in exposing the palatally impacted canine.

A modified flap design for exposing a palatally impacted canine before orthodontic intervention is described, which utilizes an incision 4-5 mm apical to the free gingival margin. The reflected flap provides good surgical access without violating the integrity of the periodontium.

Adolescent↗

[Incisions in oral surgery].

Oral mucosa incision can allow several interventions: cellulitis or periodontal abscess opening, gingival tissue excision or repositioning or at least exposure of alveolar bone for tooth extraction or infrabony pockets' treatment. The different incisions are described with special considerations: --on the anatomic environment of the oral cavity (palatal arteries, mandibular nerve...)--on the healing patterns of the different periodontal tissues (rapid cellular turnover of the epithelial attachment for instance)--at last on the suturing for each intervention. The instrumentation needed for the different incisions is described and clinical cases are presented before, during and after oral surgery. The use of an electrical knife is noted with the contraindications of this operative procedure.

Electrosurgery↗