Dentaltown January 2017 - 71

Fig. 13

Before-and-after:
Free-gingival grafts
Notice the predictable band of keratinized gingiva that was created in Figs. 12
and 13.
Fig. 14, meanwhile, shows another
example of a case that healed after a free
gingival graft. Notice the poor color match
and how the areas of recession weren't
improved or addressed. (This case was not
treated by the author).

Before-and-after: Subepithelial
connective tissue grafts
Notice the nice color match and improvement in root coverage (Figs. 15 and 16).

Using donor tissue
The second broad category to treat
mucogingival defects is using donor tissue.
Many practitioners use these products
with great success. Generally, the products
available are sourced from a human cadaver,
with cells removed from the dermal layer
of tissue and processed so the practitioner
can use the tissue in much the same way
they would for a subepithelial connective
graft, without the need for incisions on the
palate to harvest any grafts.
The main advantages of using donor tissue

is the lack of a palatal incison, which means
less pain for the patient during recovery,
and the ability to treat larger areas because
there's not a limited amount of available
autogenous tissue, like there would be for a
free gingival graft or subepithelial connective
tissue graft. The main disadvantages are the
additional cost to purchase the tissue, and
greater amount of unpredictability in the
long-term success of the graft.
There are also options for using biologics
(Emdogain and Gem21, for example) to
add to the graft materials or as stand-alone
substitutes. The intent of this article is not
to go into too much detail on this.

Conclusion
It's essential to understand how to
identify mucogingival defects and either
treat or make the appropriate referral to
halt future tissue and bone loss. The many
different options for treatment are based
on the outcome goals, the patient's desires,
and the stage of Miller Defect the tooth is
currently in.
It's less important in understanding the
technique du jour that is so heavily marketed
in today's climate, and more important to
understand how to identify it, diagnosing
the defect so it's not left untreated. ■

Fig. 14

Fig. 15

Fig. 16

Discover when to refer cases
to a perio specialist
In which situations should clinicians refer cases to a periodontist? Dr. Brian S. Gurinsky's
article on Dentaltown.com discusses some of the factors and flags where it makes
sense to refer out. To read the piece, go to dentaltown.com/gurinsky-on-perio.

dentaltown.com \\ JANUARY 2017

71



http://www.dentaltown.com/gurinsky-on-perio http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown January 2017

CE Update
On Dentaltown.com
Study Abroad: Live CE Events
Industry News
New Products
Poll
Product Profile: Glidewell Laboratories
Ad Index
Product Profile: OCO Biomedical
The Curious History of Occlusion in Dentistry
Making a Good First Impression
Townie Meeting 2017 Preview
Howard Speaks: Suck It Up Buttercup
Professional Courtesy: Package Deal
Show Your Work: Crowning a Winner
Product Profile: Aspen Dental
Dentally Incorrect
Message Boards: Best Way to Text Patients
Message Boards: Teach An Old Guy About Perio
Message Boards: Powerprox 6-Month Braces (Trouble Getting Started)
Office Visit
Does My Patient Need A Gum Graft
Earn Your Keepers
CE Requirements by State
CE: Honing Our Edge
Dentaltown January 2017 - Intro
Dentaltown January 2017 - Cover1
Dentaltown January 2017 - Cover2
Dentaltown January 2017 - 1
Dentaltown January 2017 - 2
Dentaltown January 2017 - 3
Dentaltown January 2017 - 4
Dentaltown January 2017 - 5
Dentaltown January 2017 - 6
Dentaltown January 2017 - 7
Dentaltown January 2017 - 8
Dentaltown January 2017 - 9
Dentaltown January 2017 - On Dentaltown.com
Dentaltown January 2017 - 11
Dentaltown January 2017 - Howard Speaks: Suck It Up Buttercup
Dentaltown January 2017 - 13
Dentaltown January 2017 - 14
Dentaltown January 2017 - 15
Dentaltown January 2017 - Professional Courtesy: Package Deal
Dentaltown January 2017 - 17
Dentaltown January 2017 - CE Update
Dentaltown January 2017 - 19
Dentaltown January 2017 - 20
Dentaltown January 2017 - 21
Dentaltown January 2017 - Study Abroad: Live CE Events
Dentaltown January 2017 - 23
Dentaltown January 2017 - Industry News
Dentaltown January 2017 - New Products
Dentaltown January 2017 - Poll
Dentaltown January 2017 - 27
Dentaltown January 2017 - Show Your Work: Crowning a Winner
Dentaltown January 2017 - 29
Dentaltown January 2017 - 30
Dentaltown January 2017 - 31
Dentaltown January 2017 - Message Boards: Best Way to Text Patients
Dentaltown January 2017 - 33
Dentaltown January 2017 - 34
Dentaltown January 2017 - 35
Dentaltown January 2017 - 36
Dentaltown January 2017 - 37
Dentaltown January 2017 - Message Boards: Teach An Old Guy About Perio
Dentaltown January 2017 - 39
Dentaltown January 2017 - 40
Dentaltown January 2017 - 41
Dentaltown January 2017 - 42
Dentaltown January 2017 - Message Boards: Powerprox 6-Month Braces (Trouble Getting Started)
Dentaltown January 2017 - 44
Dentaltown January 2017 - 45
Dentaltown January 2017 - 46
Dentaltown January 2017 - 47
Dentaltown January 2017 - Office Visit
Dentaltown January 2017 - 49
Dentaltown January 2017 - 50
Dentaltown January 2017 - 51
Dentaltown January 2017 - 52
Dentaltown January 2017 - 53
Dentaltown January 2017 - The Curious History of Occlusion in Dentistry
Dentaltown January 2017 - 55
Dentaltown January 2017 - 56
Dentaltown January 2017 - 57
Dentaltown January 2017 - 58
Dentaltown January 2017 - 59
Dentaltown January 2017 - 60
Dentaltown January 2017 - 61
Dentaltown January 2017 - 62
Dentaltown January 2017 - Making a Good First Impression
Dentaltown January 2017 - 64
Dentaltown January 2017 - 65
Dentaltown January 2017 - Does My Patient Need A Gum Graft
Dentaltown January 2017 - 67
Dentaltown January 2017 - 68
Dentaltown January 2017 - 69
Dentaltown January 2017 - 70
Dentaltown January 2017 - 71
Dentaltown January 2017 - Earn Your Keepers
Dentaltown January 2017 - 73
Dentaltown January 2017 - 74
Dentaltown January 2017 - 75
Dentaltown January 2017 - Townie Meeting 2017 Preview
Dentaltown January 2017 - 77
Dentaltown January 2017 - 78
Dentaltown January 2017 - 79
Dentaltown January 2017 - 80
Dentaltown January 2017 - 81
Dentaltown January 2017 - 82
Dentaltown January 2017 - 83
Dentaltown January 2017 - 84
Dentaltown January 2017 - 85
Dentaltown January 2017 - 86
Dentaltown January 2017 - 87
Dentaltown January 2017 - Product Profile: Glidewell Laboratories
Dentaltown January 2017 - Ad Index
Dentaltown January 2017 - Product Profile: OCO Biomedical
Dentaltown January 2017 - 91
Dentaltown January 2017 - Product Profile: Aspen Dental
Dentaltown January 2017 - 93
Dentaltown January 2017 - CE Requirements by State
Dentaltown January 2017 - 95
Dentaltown January 2017 - CE: Honing Our Edge
Dentaltown January 2017 - 97
Dentaltown January 2017 - 98
Dentaltown January 2017 - 99
Dentaltown January 2017 - 100
Dentaltown January 2017 - 101
Dentaltown January 2017 - 102
Dentaltown January 2017 - Dentally Incorrect
Dentaltown January 2017 - 104
Dentaltown January 2017 - Cover3
Dentaltown January 2017 - Cover4
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