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February 9, 2009
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Beyond soft-tissue appearance

By Renee Knight

In the February issue of Dental Products Report, Dr. Peter Cabrera discusses the importance of looking beyond soft-tissue appearance when it comes to periodontal diagnosis. He offered two clinical cases—one involving a patient who is diligent about recare visits and home care, while the other looks at a smoker and how that lifestyle choice can contribute to soft-tissue appearance. This third case illustrates the importance of a comprehensive periodontal exam before orthodontic treatment.

CASE IN PICTURES: SLIDESHOW
(refer to slideshow for figures)

The teenager

A 17-year-old female wanted to have her maxillary anterior diastemas closed and was referred by her orthodontist for periodontal clearance before the start of orthodontic treatment. The patient had a history of scaling and root planing along with subgingival antimicrobials. The medical history was non-contributory.

As in cases presented in the February issue of Dental Products Report, the marginal tissue appeared pink and healthy (Fig. 1). Probing revealed deep pockets along with significant bleeding on probing (Fig. 2). This was confirmed radiographically (Fig. 3).

Access to the roots was obtained via a flap that preserved the interproximal papillae by positioning the incision on the palate (Fig. 4) and carefully reflecting the tissue while maintaining the papillae intact (Fig. 5). Final closure was obtained with 4-0 gut sutures. By using individual vertical mattress intrapapillary sutures (Fig. 6) the buccal and palatal tissues were approximated without vertical compression that would have led to poor esthetics.

Click here to read Dr. Cabrera’s full article, “Soft tissue and periodontal diagnosis,” or check out the February issue of DPR.