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2 thoughts on “Is this a good case for Alloderm grafting?

  1. bassel says:

    It would be nice to see an X-ray. If bone levels are normal then coverage up to the CEJ is possible (BUT WHERE IS THE CEJ?). Here is one confounding issue: this patient may have lost some enamel too so even after grafting he will show some yellow dentin that was under the enamel (actually most this cervical lesion is in the enamel). You will need to plan for composite restoration as well. In this case with no cosmetic issues simply restoring with composite without grafting is a feasible option since mostly your are restoring an enamel defect.

  2. bassel says:

    Looking at the big picture: There are different cause for recession and bone loss. For example, orthodontic movement can cause erosion of the buccal plate and bone loss and recession. This can be successfully treated with soft tissue grafting in most cases.

    Chronic periodontal disease causes circumferential recession around the teeth, and it is a progressive condition. I don’t recommend soft tissue grafting for most of these cases because it won’t work (can’t achieve any root coverage due to the underlying bone loss, and also since it is a progressive condition, the graft will do very little to stop further deterioration and this grafting intervention may be viewed as a failed intervention by you patient in the future.

    Of course, nothing is every that clear cut, and sometimes you can have overlapping conditions such as chronic periodontitis and also a thin tissue biotype or recession caused by ortho or trauma or localized inflammation, in that case soft tissue grafting may be helpful. (These cases are not so common)

    Most common is a middle aged patient with mild but progressive chronic periodontiits that is starting to show some roots and is distressed by this. They desire to cover the roots to perhaps feel more youthful. This won’t be possible at all due to the underlying bone loss.

    Another question to ask: What is the purpose of the soft tissue graft in each scenario? Esthetic improvment? Reduction of dentin sensitivity? Prevention of further recession? Treatment of a mucogingival defect? Ask yourself if you can achieve this purpose.

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