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Aesthetic Periodontal Surgery

It was Miller (1988) who established the concept of aesthetic periodontal surgery. He saw opportunities for expanding classic mucogingival surgery that dealt with broadening the vestibule and removing troublesome frenula. Aesthetic periodontal surgery does not primarily treat functional disturbances, but rather aesthetic problems, such as gingival recessions, defects, excesses, and proliferations as well as defects of the alveolar ridge and incompletely or unerupted teeth.

Many new surgical techniques are available for these conditions. The miscellaneous techniques use sliding flaps, gingival and connective tissue grafts, guided tissue regeneration with resorbable or nonresorbable membranes, reconstruction of bone with bone substituting materials (e.g., tricalciumphosphate or decalcified freeze-dried bone), and growth factors to stimulate growth of new tissue and attachment.

79 Aesthetic periodontal surgery

Aesthetic periodontal surgery corrects excessive tissue and tissue recessions.

Left: Excess tissue in the maxilla is removed and is used to supplement tissue in the mandibule.

Right: Situation after completed treatment and placement of new restoration.

Gingival Recessions

While a multiplicity of gingival problems can be improved with aesthetic periodontal surgery, the most frequent task is that of covering gingival recessions. A variety of treatments is available:

—laterally sliding flap (Grupe and Warren 1956)

—free mucous graft (Björn 1963)

—coronally repositioned flap (Bernimoulin et al. 1975)

—connective tissue graft (Kaldahl 1982; Langer and Calagna 1982)

—free gingival grafts on conditioned root surfaces (Miller 1982)

—supraperiostal envelope flap (Raetzke 1985)

—semilunar flap (Tarnow 1986)

—guided tissue regeneration (GTR) with resorbable and nonresorbable membranes (Roccuzzo et al. 1996)

—a combination of methods with or without membranes, grafts, or growth factors

80 Gingival recessions before aesthetic periodontal surgical treatment