Gingival creep on implants

Gingival creep is a well-known and highly desirable effect of gingival augmentation procedures. Matter and Bell as early as the late seventies demonstrated this concept in what could be described as case series. At present, we do not definitely know what the predictive variables for this phenomenon are. It is strongly associated with: Tooth position in the […]

Apicectomy for GBR using Symbios

Rushing to label a tooth hopeless and proceeding to extract it can be a very costly affair for patients.  Teeth with large apical pathosis should have the apical pathology managed and preferably bone regenerated prior to proceeding on to bridgework or implant based replacement. Teeth can have a regenerative potential from the PDL stem cells […]

Regenerative treatments for peri-implantitis

The holy grail for the management for peri-implantitis is bone regeneration and re-osteointegration. These are difficult to achieve reliably and in fact most histological studies indicate that true reintegration is unpredictable and difficult to achieve. From a practical clinical perspective, we aim to achieve a pocket depth reduction to manageable levels (ie less than or […]

To link or not to link??

There are numerous clinical, logistic and financial advantages from linking teeth to implant restorations.  Tarnow et al 2009  presented a literature review to on the subject of linking teeth and they sited a high risk of intrusion of abutment teeth in cases of parafunction or when semi-rigid (ie fixed movable) connectors were used. Palmer et al 2005 demonstrated high […]

Worsening recession!!

Gum recession so what and who cares?? Relax and keep cleaning it and it will be fine! NOT TRUE ANY MORE!!!!These statements will soon be a thing of the past. Chambrone et al 2016 demonstrated with systematic review and a meta-analysis that about 80% of untreated recession defects worsened over 24 months moreover the number of recession defects […]

Free gingival graft

​Free gingival grafts have high success rates in achieving:1-increase in keratinised tissue2-deepening of vestibule3-increasing biotype4- eliminating frenal attachmentsThey have limited efficacy when it comes to improving cosmetics or root coverage. If these two aims are the holygrail for mucogingival surgery, why do we still utilise free gingival grafts??The answer is in the nature of the […]

High risk recession defects

From experience, I can assure most patients that recession is likely to progress but is unlikely to lead to tooth loss. The exception is when a horizontal (not vertical) probing depth of 3mm or more is noted in association with the recession defect. This horizontal attachment loss is indicative of bone loss compromising the width […]

Importance of maintenance

Maintenance is the corner stone of every dental treatment plan particularly a periodontal one. Periodontal patients with strict maintenance programmes have better outcomes in terms of tooth retention and dental implant survival. Is this the stuff of legend? Is this really necessary given the effectiveness of modern dentifrices and brushing aids?The answer is a resounding […]

Papillae Regeneration

The dental papilla is the 3 dimensional soft tissue feature that is influenced by the following: 1-underlying alveolar morphology in relation to the contact point (Tarnow, Chu and Palmer propose that a distance of 5-6mm is highly predictive of papilla presence)2-inter-radicular proximity3-root circumference4-tissue biotype ​As a periodontist, I can strongly affirm that restorative dentistry procedures […]

Peri-implantitis treatment with clinical photographs

Peri-implantitis is report to affect approximately 7-10% of all implants after 10 years of service. We currently don’t know what the prevalence of peri-implantitis is after 10 years of service.Mrs JN presented complaining of recurrent gum infection around two implants placed about 18 years ago. JN was diagnosed with per-implantitis and went on to have […]