Dentaltown January 2022 - 52

interproximal attachment loss on the adjacent
teeth and there is adequate blood supply for the
graft to heal at the level of the cementoenamel
junction (CEJ). Partial root coverage may
be the goal and expected outcome in cases
where interproximal attachment loss is
present. These cases are still successful and
increase the health of a particular site, but
the expected outcomes need to be clearly
communicated with the patient beforehand.
Increasing the amount of tissue can
take on various forms, including increasing
tissue thickness, increasing the amount
of attached gingiva or adding keratinized
tissue. These can be particularly helpful
in patients with thin gingival phenotypes,
implants lacking keratinized gingiva and in
patients undergoing orthodontic treatment
who have minimal attached gingiva.
More than likely, you're seeing some
form of soft tissue defect in your practice on
a daily basis. This could be some recession,
thin tissue resulting in crown margins or
implant abutments being visible through
the tissue, a lack of keratinized gingiva,
or an aberrant frenum attachment. All
of these situations can often be improved
by treatment with a soft tissue graft, but
deciding which type of grafting procedure
to employ is critical to a successful outcome.
Connective tissue graft case
A common clinical scenario we see
is a tooth presenting with recession and
some sort of Class V buccal restoration.
The cementoenamel junction is no longer
visible and the restoration may extend both
coronal and apical to the CEJ.
Soft tissue grafts do not adhere to
most restorative materials, including the
most commonly used composite resins and
amalgam. If these materials are present,
they need to be removed before surgery,
at least to the level of the CEJ or line of
expected root coverage.
In the instance on the next page
(Figs. 3-11), we need to visualize where the
CEJ of the tooth was originally located by
using landmarks such as adjacent teeth and
the interproximal CEJ of the same tooth.4
It is important to note that the soft
tissue cannot be grafted to cover coronal
to the location of the original height of the
CEJ. The only restorative materials that
have shown the ability to have connective
tissue or epithelial adhesion are glass
ionomers.5
Figs 1a-c: Epithelialized free gingival grafts.
Figs 2a-c: Subepithelial connective tissue grafts.
52 JANUARY 2022 // dentaltown.com

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Dentaltown January 2022

Table of Contents for the Digital Edition of Dentaltown January 2022

Howard Speaks: Coach Your Team To Success
Professional Courtesy: Losing It Is Just The Beginning
Continuing Education Update
Industry News
Poll: Sleep Dentistry
Message Board: Crown Lengthening or Not
Message Board: Fixing a Natural Open Contact
Message Board: Golden Handcuffs/How to Retain an Associate Long Term
Message Board: Upper All-on-4 - Fast Track Workflow
Office Visit: Dr. Eric Steinbach
Autogenous Soft Tissue Grafting — Dr. David Paulson
Taking It In-House — Dr. Joe Westbury
Ad Index
Turning On the Dental Overhead Light — Dr. Claudia Le
Earn Trust, Then Compliance — Jay Geier
A Team Wins Playing 1-On-1 — Dr. Tim Goodheart
Dentally Incorrect
Dentaltown January 2022 - 1
Dentaltown January 2022 - Cover1
Dentaltown January 2022 - Cover2
Dentaltown January 2022 - 1
Dentaltown January 2022 - 2
Dentaltown January 2022 - 3
Dentaltown January 2022 - 4
Dentaltown January 2022 - 5
Dentaltown January 2022 - 6
Dentaltown January 2022 - 7
Dentaltown January 2022 - 8
Dentaltown January 2022 - 9
Dentaltown January 2022 - 10
Dentaltown January 2022 - 11
Dentaltown January 2022 - Howard Speaks: Coach Your Team To Success
Dentaltown January 2022 - 13
Dentaltown January 2022 - Professional Courtesy: Losing It Is Just The Beginning
Dentaltown January 2022 - 15
Dentaltown January 2022 - Continuing Education Update
Dentaltown January 2022 - 17
Dentaltown January 2022 - Industry News
Dentaltown January 2022 - 19
Dentaltown January 2022 - Poll: Sleep Dentistry
Dentaltown January 2022 - 21
Dentaltown January 2022 - Message Board: Crown Lengthening or Not
Dentaltown January 2022 - 23
Dentaltown January 2022 - 24
Dentaltown January 2022 - 25
Dentaltown January 2022 - Message Board: Fixing a Natural Open Contact
Dentaltown January 2022 - 27
Dentaltown January 2022 - Message Board: Golden Handcuffs/How to Retain an Associate Long Term
Dentaltown January 2022 - 29
Dentaltown January 2022 - 30
Dentaltown January 2022 - 31
Dentaltown January 2022 - Message Board: Upper All-on-4 - Fast Track Workflow
Dentaltown January 2022 - 33
Dentaltown January 2022 - 34
Dentaltown January 2022 - 35
Dentaltown January 2022 - 36
Dentaltown January 2022 - 37
Dentaltown January 2022 - 38
Dentaltown January 2022 - 39
Dentaltown January 2022 - Office Visit: Dr. Eric Steinbach
Dentaltown January 2022 - 41
Dentaltown January 2022 - 42
Dentaltown January 2022 - 43
Dentaltown January 2022 - 44
Dentaltown January 2022 - 45
Dentaltown January 2022 - 46
Dentaltown January 2022 - 47
Dentaltown January 2022 - 48
Dentaltown January 2022 - 49
Dentaltown January 2022 - Autogenous Soft Tissue Grafting — Dr. David Paulson
Dentaltown January 2022 - 51
Dentaltown January 2022 - 52
Dentaltown January 2022 - 53
Dentaltown January 2022 - 54
Dentaltown January 2022 - 55
Dentaltown January 2022 - Taking It In-House — Dr. Joe Westbury
Dentaltown January 2022 - 57
Dentaltown January 2022 - 58
Dentaltown January 2022 - 59
Dentaltown January 2022 - 60
Dentaltown January 2022 - 61
Dentaltown January 2022 - 62
Dentaltown January 2022 - 63
Dentaltown January 2022 - 64
Dentaltown January 2022 - Ad Index
Dentaltown January 2022 - Turning On the Dental Overhead Light — Dr. Claudia Le
Dentaltown January 2022 - 67
Dentaltown January 2022 - 68
Dentaltown January 2022 - 69
Dentaltown January 2022 - Earn Trust, Then Compliance — Jay Geier
Dentaltown January 2022 - 71
Dentaltown January 2022 - 72
Dentaltown January 2022 - 73
Dentaltown January 2022 - A Team Wins Playing 1-On-1 — Dr. Tim Goodheart
Dentaltown January 2022 - 75
Dentaltown January 2022 - 76
Dentaltown January 2022 - 77
Dentaltown January 2022 - 78
Dentaltown January 2022 - 79
Dentaltown January 2022 - Dentally Incorrect
Dentaltown January 2022 - Cover3
Dentaltown January 2022 - Cover4
Dentaltown January 2022 - 86
Dentaltown January 2022 - 87
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