Hi Janet,

Good to have met you as well.

The tension is certainly reduced on the gingival area on those teeth by you. Nice work.

Cheers.

Andrew

Hi everyone,

I must say that I strongly disagree with this treatment.

Those teeth should have been grafted. It was the perfect indication. No attached keratinized gingiva, 3-4mm of recession, root sensitivity. Minimal interproximal bone loss?

Now the patient has premolars that are too long and restorations where there was no decay. Not to mention a high likelyhood of recurrent decay or the need to replace the restoration over time.

Even though the tissue is sitting nicer after the frenectomies, there will likely be an increase in the recession over time.

If you presented that case on Dental Towne they would chew you up and spit you out!!

Please folks, I am not trying to be difficult. Periodontists are your friends. We want to help you provide excellent treatment for your patients.

Owning a laser does not mean you can’t refer your patients out for proper treatment.

Bye all,

Andy

Glenn,

I would do the graft and the frenectomy together in this case. It is also very easy to do the graft after a frenectomy.

The problem is that now the roots have been covered with composite. It would have to be removed in order to cover the roots with a connective tissue graft. Depending on the extent of the root preparation it may not be possible.

Also, frenum attachments are not considered etiology for gingival recession. They are recognized by many as a contributing factor. Big difference.

As you know Glenn, I don’t try to put anyone down. Covering recession with composites is something I see often and I think it is improper treatment. sort of a pet peev.

See ya,

Andy

I agree with you Andy and your professionalism always comes across. I think that the composites were done well Janet. If I was going to do this form of treatment , it has to be a small amount of recession, and I would adjust the occlusion afterwards.

WIth more than a mm or 2 , and particularly in the anterior where the resin and length of the teeth in high smile cases doesnt look nice I think the connective tissue graft is a great idea.

I think that frenums are part of the problem not all, and if the occlusion was adjusted here, the frenum removed and the patient given the opportunity to do either a graft or a frenectomy with occlusal adjustment , I think both are plausible.

In conclusion , I want to thank Janet for posting pictures, its a little harrowing to show your work for others and many people are reluctant to do so. I have learned so much from the constructive criticism that I have received in the past, and Andy your posts are always professional and offer solid advice.

Thanks for posting Janet, and nice input Andy.

Glenn

This thread isa perfect example of why the Laser Dentistry Forum is so great. Truely a professional group and not the brawling pub of some forms. You can post a case and not get blasted. If there are helpful hints they are given in a friendly professional matter. Better yet they are recieved by the poster as helpful hints and not destructive criticism!
Pretty cool sight you have here Ron.

David

Andy, I just wanted you to know that I will never — NEVER — post any cases on DT because of your self-righteous assessment of this case.

There are ways to present your pet peeves diplomatically and professionally, but that takes knowledge, patience, self-control and respect.

Fortunately, for every colleague like you there are several knowledgeable, respectful and mature doctors who will praise someone who has the cajones (sorry, Janet) to post a case and will offer constructive criticism or alternative paths to successful treatment of the case.  Just proclaiming that this case was mistreated on the basis of the information given is rude, boorish and immature.

There are a handful of posters who seem to revel in such diatribe, and their rants only reveal their lack of integrity.  Please don’t become one of them, Andy.

Glenn, I always learn a lot from your posts.  Please continue to offer praise and criticism in the manner to which we’ve all become accustomed.  Your attitude toward fellow colleagues, despite their individual experience levels, reveals your depth of character.  Many thanks!

— Don

(Edited by N8RV at 4:07 pm on May 25, 2004)