This patient is concerned about the dark line at the cervical of #11 (above). I am usually very kind to tissue when I use retraction cord and she also had healthy tissue at the time of the impression. The provisional (below) had its cervical margin just tucked under the tissue.

Notice the bluish tinge to the tissue; the discoloration is partly due to root discoloration from an older endodontic treatment. However, even though the tissue was healthy the sulcus depth was 3mm and the tissue was very thin. A deep sulcus with healthy bone and tissue is the most predictable for a gingivectomy. Unfortunately, it is also the most susceptible to recession. I thought I was gentle, yet it appears I wasn't gentle enough. I was saved only by a low lip line.


Post a Comment

Comments

Commenter's Profile Image Mary Valentine
August 26th, 2013
It looks as though the emergence profile is fuller on temp maybe supporting tissue and hiding the grey better. Also is it a bridge with a pontic on 12?. 12 looks slightly longer in final, maybe lateral interferences? Really beautiful work in a difficult situation.
Commenter's Profile Image Larry Gottesman
August 27th, 2013
Steve: If the patient's lips were this blue would the construct of your thoughts and your question be the same? Larry
Commenter's Profile Image Rex Baumgartner
August 27th, 2013
Morning Steve. Might there be a post in the endodonticly treated tooth that is preventing light from being reflected being back through the tissue, creating the dark discoloration Rex
Commenter's Profile Image Larry Gottesman
August 27th, 2013
It is not a post issue. The tissue is blue from 11 to 13 in the picture with the provisionals. I don't see a thin tissue biotype in these pictures. Look at the marginal tissue around number 8 which is also slightly discolored. The tissue is ischemic! So, why? Steve, I think this might be a good time to reveal the complete medical and family history. There is something in this patient's history which will explain the story. Larry
Commenter's Profile Image John Merrill DDS
September 26th, 2013
The tissue looks hyperemic with the provisionals even though sulcus wise it would probe and behave within normal parameters. Tissue apically looks a bit swollen. I propose that the swelling resolved with the final restorations and tightened up and receeded a bit. Low lip line? It looks perfect otherwise. Georgious case--John
Commenter's Profile Image Gayle Wood
November 14th, 2013
It appears to me in both photos as if there is a deficit of tissue in both photos but it is somewhat difficult to see. Remember that recession and thinning of tissue not only occurs coronally-apically in direction, but bucco-lingually. The canine prominence appears to be missing in both and appears to be due to a lack of underlying facial bone. Many patients have this situation but it does not become an issue until restorative therapy. Perhaps a connective tissue graft #11F which is fairly wide (approaching #10 and 12) could restore both color and architecture? Gayle