In Part I of this series I showed the lower anterior bridge removed and provisionalized in preparation for root coverage procedures and grafting in the lower arch. There are multiple teeth to be treated.

This patient presents with two challenges for grafting. The first is the large number of teeth to be treated. In order to cover the exposed root surface many surgeons would prefer to use an autogenous (from the patient) graft. Those grafts are usually harvested from the palate just below the gingival margins of the posterior teeth or the tuberosity.

 

The connective tissue is harvested from under an incision and used in the process. Since the grafting will extend from first premolar to first premolar, that will require a large amount of tissue.



The second challenge is that this patient already has implants in the upper arch that required soft tissue grafting and the sites on the palate have already been harvested.

That means that graft tissue will need to be augmented from another source, in this case Alloderm a derivative of human cadaver tissue that is acellular.



Her treatment plan consists of harvesting tissue from the tuberosities and using it to graft the lateral incisors and then using Alloderm to graft the remaining areas. The end result will be a normal band of keratinized tissue and coverage of most of the exposed cementum.


The concept of Facially Generated Treatment Planning can greatly simplify treatment planning for patients. You can find more information about treatment planning, esthetics and occlusion within the Spear Digital Suite. Download the free resource:
The 8 Steps Checklist-Facially Generated Treatment Planning.

 

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